This document discusses consumer health wearables such as activity trackers and discusses their usefulness, limitations, and challenges. Wearables can help monitor chronic conditions and activity levels but have limitations in accuracy and reliability. Many users stop using devices after 6 months and behavioral changes may not be sustained long-term. Further research is still needed to validate data and standardize monitoring methods while also addressing privacy and regulatory issues.

1. Consumer Health Wearables
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2. What are they ?
* Digital technology has been used for decades (
thermometers, glucose monitor, etc.)
* Patients will gain personal analytics to help in diagnosis
and monitoring.

3. Usefulness:
 Help patients with defined illness or comorbidity (3):
1- Monitoring severity of depression by tracking physical activity, sleep, etc.
2- Monitoring sleep quality
3- Early diagnostics ( PD)
4- At home management of chronic conditions
5- Obesity / sedentary lifestyle ( using pedometers has been associated with increase
in physical activity and decrease BMI).
 Activity trackers may offer new social experience, boost self esteem and enhance
feeling of autonomy (2).

4. Limitations & Challenges:
 People with already healthy lifestyle are more likely to buy wearable. “solution in search
of a problem.” In one survey, 30% have an income > 100,000 and about half < 35 (
making it less available for people who need it most).
 Only few RCTs were done to test the validity and reliability of the data gathered by
these devices. Errors margins between different devices tracking physical activity was
up to 25%.
 Recent surveys showed that 32% of users stop wearing these devices after six months,
and 50% after one year.
 Systematic review of 22 studies included assessments of five Fitbit and two Jawbone
trackers, focusing on validity and reliability of steps, distance, physical activity, energy
expenditure, and sleep. No single specific tracker had a complete assessment across
the five measures (1) ( UNC).

5. Limitations & Challenges:
 Benefit was seen in the setting of clinical trials setting and there is no evidence
that behavioral changes are consistent beyond the duration of the trials. Sustained
behavioral changes are what matter most especially for chronic disease.
 Excessive self monitoring can have negative consequences: uncomfortable,
unpleasant.
 The relationship between patients and wearables is complex , further research is
needed and personality factors or other extrinsic factors may play a role in how
useful it is.
 Security/Privacy: Patients do NOT own their data often. It’s owned by the
manufacturer. Easy to hack.

6. Moving forward
 Regulatory framework, similar in a way to regulating “prescribed” health apps.
 Standardize monitoring data and methods to validate trackers.
 More RTC; validation.
 Decoding individual big data by connecting medical devices together and personalize
their interpretation , providing feedback to the patient. The connection may be
physical with having one device ( e.g smar phone) (4).
 Education: the margin of error can be high when patients attempt to attribute
symptoms to a specific stream of unreliable data.
 Privacy: set rules to safeguard personal information collected by medical devices ( 5)

7. Rogers's technology diffusion trajectory.
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Source: Rogers (1983).

8. References:
(1) Evenson KR, Goto MM, Furberg RD. Systematic review of the validity and reliability of consumer-
wearable activity trackers. The International Journal of Behavioral Nutrition and Physical Activity.
2015;12:159. doi:10.1186/s12966-015-0314-1.
(2) Karapanos E, Gouveia R, Hassenzahl M, Forlizzi J. Wellbeing in the Making: Peoples’ Experiences
with Wearable Activity Trackers. Psychology of Well-Being. 2016;6:4. doi:10.1186/s13612-016-0042-6.
(3) Piwek L, Ellis DA, Andrews S, Joinson A (2016) The Rise of Consumer Health Wearables: Promises
and Barriers. PLoS Med 13(2): e1001953. doi:10.1371/journal.pmed.1001953
(4) Patel MS, Asch DA, Volpp KG. Wearable Devices as Facilitators, Not Drivers, of Health Behavior
Change. JAMA. 2015;313(5):459-460. doi:10.1001/jama.2014.14781
(5) Kostkova P, Brewer H, de Lusignan S, et al. Who Owns the Data? Open Data for Healthcare.
Frontiers in Public Health. 2016;4:7. doi:10.3389/fpubh.2016.00007.