New technology has always come with the promise of improvements to our quality of life. Some deliver what they promise, while others flounder, and still, others succeed sheerly on the dopamine-driven attraction people have to keep up with the Joneses—or maybe these days, we could say keeping up with the Jobses.
Regardless, it's rare that a new category of gadgets has had the degree of impact on our everyday physical health that wearables have delivered. They have empowered individuals with a suite of self-monitoring capabilities previously available only from medical specialists fresh off their online accelerated BSN programs; perhaps even more importantly, they have unlocked economies of scale for relevant components and technologies that have improved clinical-grade medical equipment in ways we could only have dreamed about even just a decade ago.
Fitbit: Humble Beginnings
Before wearables were cool, fancy, shiny status symbols, they were mostly just novel little widgets for nerds and health nuts. The original Fitbit, launched in 2007, was basically just a step counter. It was a little display that clipped to your shirt or a wristband. It used an accelerometer that counted "steps" in order to attempt to measure how far you'd walked, how many calories you might have burned, and even when you've fallen asleep—not bad for a first gen product.
In 2011, the first smartwatches were born. The Vyzin VESAG might be the first device that could rightly be called a smartwatch—it's not a coincidence that it was a health gadget in concept. The VESAG had cellular connectivity and a suite of features that made it an optimal device for elder care, including two-way calling, GPS tracking, fall detection, and even a geofencing feature to alert caretakers and children if their elderly charge had wandered outside their normal bounds.
In the same year, Motorola released the MOTOACTIVE, a more mass-market device targeted at everyday consumers. The MOTOACTIVE had an accelerometer to enable Fitbit-like features while adding a pulse sensor and additional Bluetooth capabilities, including audio, allowing fitness buffs to listen to their favorite tunes without lugging around a phone or MP3 player.
2014 saw the advent of high-end mobile device makers like Samsung and LG launching smartwatches of their own, designed to sync with mobile phones, and eventually, in 2015, Apple themselves took the dive into wearables with the smartwatch we are all probably most familiar with: the original Apple iWatch.
The Magic of Mass Markets
Since then, the name of the game has been cramming more and increasingly sophisticated sensors into the same-sized package. The most important of these for real, practical healthcare are probably the wearable ECG (electrocardiogram), CGMs (continuous glucose monitors), blood oxygen sensors, and optical and pulse wave analysis sensors.
An ECG is a device that allows people to record their heart rhythm, enabling rapid detection of potentially fatal conditions like atrial fibrillation, a condition that can easily lead to a stroke if left untreated. This is a huge step forward for people with heart conditions, allowing them to catch serious health episodes—hopefully before they escalate. With heart disease as the leading killer of Americans, it's difficult to overestimate the impact this early warning system can have on someone's life. Similarly, devices with advanced optics systems, compact pressure sensors, or pulse wave analysis sensors can aid people with high blood pressure in heading off signs of a serious episode.
CGMs are especially important for diabetics. They allow people who previously relied on constant pinprick tests and careful intermittent monitoring to instead rely on a wearable that allows them to track their blood sugar without painful blood draws or larger, more unwieldy measuring gear. Since most people with type 1 diabetes cannot produce sufficient insulin, and can easily lose consciousness or even die if their blood sugar drops too low, the advent of more portable, wearable CGMs has been a massive step forward towards independence and peace of mind for millions of people.
Blood oxygen sensors are similarly useful to people with a variety of chronic conditions, including anemia, asthma, long COVID, or postural orthostatic tachycardia syndrome ("POTS"), a condition that can cause unexpected and uncontrollable fainting or loss of bodily control due to reduced blood flow. For these people, understanding their blood oxygen levels can be the difference between sitting down for a quick breather and falling uncontrollably onto the pavement, which could easily cause permanent brain damage or even death.
Following in the footsteps of the original smartwatch, one of the most widespread uses of wearable sensing devices is RPM (remote patient monitoring). Inspired by devices like the VESAG, a whole host of remote monitoring devices for patients who are elderly or possess chronic conditions that require remote monitoring by doctors and nurses have sprung into the market—everything from simplified smartwatches to neural implants allowing remote electroencephalography (EEG).
The New Normal
While technologies enabled by traditional wearables are already making an enormous impact and improving—or saving—the lives of millions, even more exotic technologies lurk just above the horizon, delivering treatments we might have relegated to the land of science fiction before the last decade.
Virtual reality (VR) has shown promise in a variety of therapies, most notably in psychiatric settings. VR headsets enable more personal remote therapy sessions and can be used to provide safer, less intimidating versions of exposure therapy for people who suffer from severe anxiety or post-traumatic stress. These people can often make improvements to their experience of fearful emotions and become more functional if they can be exposed to the things that trigger their anxieties. It doesn't get much more controlled than VR.
Even more recently, brain-computer interfaces like Neuralink have enabled patients to control computers using their brains. The long-term goal of such devices is to enable a better understanding of the way our brains work, which will hopefully enable such miracles as allowing paralyzed patients to regain control of their limbs someday.
Calling a BCI "wearable" might be a bit of a stretch, but it's certainly part of the emerging trend of improving convenient devices that improve medical outcomes. The one thing we can say for sure is that portable health technology has come a long way and that the more we improve the interoperability of our digital devices with our bodies, the more potential we unlock for improving health outcomes.
