tag:theconversation.com,2011:/uk/topics/fitbit-13058/articlesFitbit – The Conversation2024-03-13T12:28:21Ztag:theconversation.com,2011:article/2254652024-03-13T12:28:21Z2024-03-13T12:28:21ZWhat we know so far about the rumoured Apple smart ring<figure><img src="https://images.theconversation.com/files/581294/original/file-20240312-18-nq5gb9.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3858%2C2583&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A generic image of a smart ring in use.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/modern-payment-new-technology-payments-using-691766359">Fotos593 / Shutterstock</a></span></figcaption></figure><p>Samsung officially announced the launch of a new smart ring-shaped wearable device, Galaxy Ring, as <a href="https://www.youtube.com/watch?v=J7x0E0hLaJ8">part of its Galaxy Unpacked event</a> earlier this year. The ring, expected to be on sale in late summer 2024, will be able to monitor the user’s health parameters and provide insights based on the health metrics observed, which is very similar to what a smartwatch can do.</p>
<p>The global smart ring <a href="https://exactitudeconsultancy.com/reports/34772/smart-ring-market/">market is expected to grow</a> from USD$314.52 billion (£246.3 billion) in 2023 to USD$2,570.30 billion (£2,012 billion) by 2030. So it is no surprise that Apple is now rumoured to be <a href="https://www.forbes.com/sites/davidphelan/2024/02/27/apple-developing-ring-to-beat-samsung-galaxy-ring-report-claims/?sh=53a35fbd4e2c">applying for its smart ring patents</a> and is expected to have the product ready in time to compete with Samsung’s release.</p>
<p>But it might be surprising to learn that neither Samsung nor Apple are pioneers in this new wearable technology. <a href="https://ouraring.com/">Oura was launched in 2015</a> with a Kickstarter campaign for the first generation ring.</p>
<p>Now on its third generation, with the fourth one expected in 2024, this smart ring can measure respiratory rate, heart rate, health rate variability (HRV), blood oxygen levels, and body temperature. The ring also has an accelerator that logs the user’s activity and movement. However, the main question is: is wearable technology worth it?</p>
<h2>What is wearable technology?</h2>
<p>Wearable devices come in many shapes and sizes, including smart watches and sports watches, fitness trackers, head-mounted displays, smart jewellery, smart clothing, and even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185336/">implantable devices</a>.</p>
<p>Technological advances have enabled manufacturers to access low-cost, low-power sensor technology and develop this variety of devices. At a minimum, wearable devices are equipped with sensors, software and connecting technology.</p>
<p>The sensors gather information from the person wearing the device, and the software gathers the data and sends it to a device with processing capacity via a wireless connection. The ecosystem on which wearable technology works is <a href="https://www.oracle.com/uk/internet-of-things/what-is-iot/">known as the Internet of Things (IoT)</a>. It is the same principle as smart technology used at home, on devices such as thermostats that can be operated from a mobile device outside the home, or smart speakers, but applied at a personal level. It is important to note that mobile devices do not process the data; it is usually sent to “the cloud” for processing, and the mobile device displays the data to the user.</p>
<p>What makes an IoT solution even more attractive is the interpretation of the data gathered by the sensors. For example, the <a href="https://ouraring.com/oura-experience">Oura Ring and the Oura Membership</a> allow users to monitor their sleep, manage stress and predict when they might get sick by monitoring body temperature and heart rate. This is all possible due to analysis of the data collected by the ring. </p>
<p>With advances in artificial intelligence (AI), it is expected that in 2024, there will be a <a href="https://www.cnet.com/tech/mobile/what-to-expect-from-smartwatches-in-2024-more-ai-new-health-features-and-more/">boost in health tracking</a>.</p>
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<img alt="Smart watch and smart phone." src="https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581298/original/file-20240312-22-xfl78v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smart rings are unlikely to replicate the functionality of smart watches and other devices.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/data-synchronization-health-book-between-smartwatch-188507768">Alexey Boldin</a></span>
</figcaption>
</figure>
<h2>Benefits and drawbacks</h2>
<p>Smart rings come with sensors similar to those of a smartwatch. However, because of their proximity to large blood vessels in the fingers, smart rings can provide more accurate readings than smartwatches, because they can use the capillaries (small blood vessels) in your finger to get their readings. Another advantage of smart rings is that they have a longer battery life than smartwatches. However, smart rings are unlikely to come with GPS or a screen.</p>
<p>In terms of price, the cheapest version of the Oura ring starts at £299 and users must pay a membership fee of £5.99 per month, with the first month free. This is required to get all the benefits of data analysis. However, the ring will still work with the Oura mobile app. The most affordable version of the AppleWatch, the SE version, starts at £219, while the Samsung Galaxy Watch6 Bluetooth starts at £239.</p>
<p>Smart rings can’t and won’t be able to replicate the functionality offered by a smartwatch. However, they represent an attractive choice for users interested in health tracking, who also want a simple device with minimalistic features. <a href="https://www.cnet.com/tech/mobile/samsungs-surprise-galaxy-ring-whos-the-wearable-actually-for/">Bryan Ma</a>, the Vice President of devices research at International Data Corporation, has said: “The idea behind such rings is not so much about being cheaper than smartwatches, but instead being a much smaller and discrete device for use in cases like sleep tracking.”</p>
<h2>The future of wearable technology?</h2>
<p>Wearable technology will continue evolving, with a strong focus on health monitoring. For example, Microsoft has been <a href="https://duoskin.media.mit.edu/">exploring smart tattoos</a> as the next generation of wearable tech since 2016. However, due to the labour intensive fabrication technique for gold leaf, which is used in the tattoos, researchers are now focusing on more robust, advanced, and inexpensive materials.</p>
<p>Researchers at the University of Washington have also <a href="https://www.washington.edu/news/2024/02/07/smart-earrings-can-monitor-temperature/">developed the thermal earring</a>. This was able to measure the user’s earlobe temperature but shows promise for other areas of monitoring, including for eating and exercise. Although not commercially available, this device demonstrates how engineers are developing new ideas for wearable devices.</p>
<p>Under Armour already sells <a href="https://www.underarmour.com/en-us/t/connected-shoes-page.html">running shoes embedded with Bluetooth and sensors</a> that track run statistics such as distance and pace. The shoes also measure running from metrics such as cadence (steps per minute), ground contact time, foot strike angle and stride length. </p>
<p>The app provides real time audio coaching, but only focuses on cadence. In future, we can expect to see advances in <a href="https://www.feelgoodcontacts.com/blog/smart-contact-lenses-of-the-future">smart contact lenses</a>, <a href="https://shop.jakcom.com/products/jakcom-n3-smart-nail-chip">smart nails</a>, <a href="https://www.nordicsemi.com/Nordic-news/2018/02/beam-smart-button">smart buttons</a>, and many more.</p>
<h2>Is wearable technology worth it?</h2>
<p>The expected increase in the market size of this technology shows users’ interest in monitoring their health and improving their lifestyle. Developments in the Internet of Things, in general, have improved our way of life and supported our wellbeing.</p>
<p>Connected devices collect, track, and store user data, which is the primary purpose of the technology. What users need to know is that many wearable devices share data with third party apps and services, and it is often unclear how this data is being used. The data can be sold to other companies or utilised for different purposes without the user’s knowledge or consent. Moreover, <a href="https://www.cnbc.com/2016/01/08/theres-a-hack-for-that-fitbit-user-accounts-attacked.html">wearable devices can be hacked</a>.</p>
<p>With this in mind, and as we have done with all new technology, users must consider the advantages of wearable technology and determine if the risks are worth taking. If security and data privacy are a concern, users are encouraged to follow all security recommendations provided by experts and manufacturers to protect their devices and research more on how their data is used and shared.</p><img src="https://counter.theconversation.com/content/225465/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erika Sanchez-Velazquez does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What are the benefits and drawbacks of putting smart technology into a ring?Erika Sanchez-Velazquez, Deputy Head of School, Computing and Information Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1940602022-11-08T19:40:21Z2022-11-08T19:40:21ZShould you really use your smartwatch or fitness wearable to monitor your heart?<figure><img src="https://images.theconversation.com/files/494006/original/file-20221108-22-8gdqj1.jpg?ixlib=rb-1.1.0&rect=4%2C22%2C2991%2C1976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Dragana Gordic / Shutterstock</span></span></figcaption></figure><p>Wearable devices that can record your pulse can be handy for tracking your fitness – but can you really use them to monitor for an irregular heartbeat?</p>
<p>The short answer is maybe, and it depends on who you are. These devices are great, but there are some things you need to know.</p>
<p>Several large studies have been carried out to examine how well wearables can check for signs of a common heart rhythm problem called “atrial fibrillation”, which can lead to strokes.</p>
<p>In a <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.058911">new Frontiers review published in Circulation</a>, we and our colleagues in the <a href="https://www.afscreen.org">AF-Screen International Collaboration</a> weighed up the current evidence, including from three very large studies: the <a href="https://doi.org/10.1161/CIRCULATIONAHA.122.060291">Fitbit Heart study</a> (funded by Fitbit); the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1901183">Apple Heart study</a> (supported by Apple) and the <a href="https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.08.019">Huawei Heart study</a> (Huawei was involved in development and optimisation of the app but did not fund the study).</p>
<h2>What is atrial fibrillation?</h2>
<p>Atrial fibrillation is the most common heart rhythm problem (arrhythmia). Up to <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">80% of patients may have no symptoms</a>.</p>
<p>Atrial fibrillation becomes more common with increasing age, and it can substantially increase the risk of stroke. Patients at <a href="https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk">high risk</a> of atrial fibrillation-related stroke, due to age and/or other risk factors such as hypertension and diabetes, are generally prescribed blood-thinning medication.</p>
<p>More and more devices for recording heart rhythm are available to consumers. These include handheld electrocardiogram (ECG) and pulse-based technology in smartwatches, other wearables and portable consumer devices. These are often marketed as “health and wellness” products.</p>
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Read more:
<a href="https://theconversation.com/why-wearable-fitness-trackers-arent-as-useless-as-some-make-them-out-to-be-173419">Why wearable fitness trackers aren't as useless as some make them out to be</a>
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<p>For people aged 65 and over, <a href="https://www.heartfoundation.org.au/Bundles/Your-heart/Conditions/Atrial-Fibrillation-for-Professionals">Australian</a> and other international <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">guidelines</a> <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.026693">recommend</a> occasional screening for atrial fibrillation.</p>
<p>However, new technologies (including wearables) allow consumers to record their own heart rhythms whenever they wish, and continuously monitor the regularity of their pulse. This technology can empower consumers and provide important information, but it does have limitations.</p>
<h2>How accurate are wearables and other consumer devices?</h2>
<p>The short answer is that, for identifying atrial fibrillation, wearables are probably quite accurate (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752409/">often over 95%</a>). However, the information is often based on studies of small numbers of people.</p>
<p>Some devices include an algorithm that automatically says whether your heart rhythm is regular (a “normal sinus rhythm”) or irregular (which may indicate atrial fibrillation). These algorithms generally require regulatory approval (such as from the <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/medical-devices/manufacturer-guidance-specific-types-medical-devices/regulation-software-based-medical-devices">Therapeutic Goods Administration</a> (TGA) in Australia). </p>
<p>However, device companies often don’t publish many details about the accuracy and performance of their devices. Wearables that simply track heart rate or activity without making claims about serious conditions are not regulated by the TGA.</p>
<p>It’s important that manufacturers of health devices:</p>
<ul>
<li><p>are accurate in their health claims</p></li>
<li><p>don’t advertise unproven benefits</p></li>
<li><p>report the accuracy and performance of their devices in different populations.</p></li>
</ul>
<p>While the <a href="https://doi.org/10.1161/CIRCULATIONAHA.122.060291">Fitbit</a>, <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1901183">Apple</a> and <a href="https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.08.019">Huawei</a> studies were very large, the calculations used to determine accuracy of the device may be based on small numbers because not many people in the study had atrial fibrillation.</p>
<p>For example, the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1901183">Apple Heart study</a> had 419,000 participants overall – which is a lot of people! However, the accuracy was calculated by comparing simultaneous recordings of atrial fibrillation on the smartwatch pulse irregularity detector and an ECG patch in only 86 people.</p>
<h2>Who are they good for?</h2>
<p>If you have symptoms, or are aged over 65, wearables can be very useful for detecting atrial fibrillation.</p>
<p>Wearables are great as an “event recorder” for anyone with a symptom (such as heart palpitations) that could be an arrhythmia. Devices with ECG capability such as <a href="https://www.apple.com/au/healthcare/apple-watch/">Apple Watch</a> Series 4 or later, <a href="https://www.withings.com/au/en/scanwatch">Withings Scanwatch</a> and <a href="https://www.kardia.com/">KardiaMobile</a> are particularly good as they provide more information. Once you have an ECG recording during a symptom, you can give it to your doctor, which can help guide further follow-up.</p>
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<img alt="A photo of a smartwatch on a woman's wrist." src="https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494052/original/file-20221108-16-e5ih7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Wearable devices give us more heart rhythm data than ever before – but it’s not always clear how to interpret it.</span>
<span class="attribution"><span class="source">Unsplash</span></span>
</figcaption>
</figure>
<p>Wearables are also good for helping people to get an early diagnosis of atrial fibrillation. Ideally, this needs to be supported by integrated care, including risk factor reduction and lifestyle changes to reduce progression and complications (especially relevant for young people who may need no specific therapy).</p>
<p>We also know wearables can be used to screen enormous numbers of people: 457,000 in the Fitbit study, 419,000 in the Apple Heart study and 188,000 in the Huawei study. However, the yield of <a href="https://doi.org/10.1038/s41569-022-00803-9">new atrial fibrillation detected was low</a> (less than 1%) in these studies, mainly because the study participants were very young (the average age in all three studies was 41 years or less).</p>
<h2>What are the problems then?</h2>
<p>More data isn’t always better. If your GP checks your pulse at an appointment, finds it irregular and an ECG confirms it is atrial fibrillation, it’s likely you are experiencing atrial fibrillation quite a lot of the time (or all the time).</p>
<p>The risks of atrial fibrillation are <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1588-8867">similar</a> for people with symptoms and those without, and we know how to treat the condition.</p>
<p>However, wearables are able to monitor people’s heart rhythm far more frequently and for much longer. The more you look, the more atrial fibrillation you find, but we are not yet sure we should.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-media-is-overhyping-early-detection-tests-and-this-may-be-harming-the-healthy-158229">The media is overhyping early detection tests, and this may be harming the healthy</a>
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<p>So, while wearables increase detection of atrial fibrillation, we don’t know whether this will also prevent strokes.</p>
<p>Many people who buy wearables are younger and at lower risk. We aren’t yet sure about what it means when a young person with few or no risk factors has short episodes of atrial fibrillation.</p>
<p>More evidence is needed, ideally from good-quality, independent, randomised studies.</p>
<h2>Drawbacks and data</h2>
<p>Even highly accurate devices can and do <a href="https://twitter.com/CardiologyBlurb/status/1587302634976735232">sometimes give false positives</a>, more frequently in younger people who have a lower risk of having atrial fibrillation. Additional tests may be needed, which increase cost, and may lead to unnecessary testing that could cause problems and potentially anxiety.</p>
<p>Data privacy is also a concern. There are important legal gaps in relation to <a href="https://support.mips.com.au/home/should-you-trust-the-data-from-wearable-fitness-devices">data protection and regulation of apps</a> in many countries.</p>
<p>Consumers often lack <a href="https://canberraweekly.com.au/who-owns-the-data-fitbits-and-private-health-data-give-pause-for-thought/">ownership or control of data</a> from health apps.</p>
<h2>What should I do if my wearable tells me I have atrial fibrillation?</h2>
<p>If your device says you may have atrial fibrillation, save a copy of the reading and talk to your doctor about the result. You may need further testing or treatment. However, don’t panic!</p>
<p>We need to remember one size doesn’t fit all. Either way, wearables are here to stay. We have to make sure we understand their benefits and limitations.</p><img src="https://counter.theconversation.com/content/194060/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jessica Orchard is a Research Fellow at the Centenary Institute and Adjunct Senior Lecturer, School of Public Health, the University of Sydney. She is supported by a Heart Foundation fellowship and some of her research has been supported by Pfizer-BMS (investigator-initiated research grants) and Alivecor (provided devices for study purposes).</span></em></p><p class="fine-print"><em><span>Ben Freedman receives current competitive grant funding from the Medical Research Future Fund, the NSW Dept of Health, and from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement no. 648131, the European Union’s Horizon 2020 research and innovation programme under the grant agreement no. 847770 (AFFECT-EU). In the past 5 years, B.F. has received speaker fees and travel support for speaking at sessions or official satellites of large international or continental society meetings from Bayer, Bristol-Myers Squibb–
Pfizer Alliance, Daiichi Sankyo and Omron; and investigator-initiated research grants to the institution from Bristol-Myers Squibb–Pfizer Alliance. </span></em></p>Wearables and smartwatches can track your pulse – but if you’re using them to scan for irregular heart rhythms, there are some things you should know.Jessica Orchard, Research Fellow, Centenary Institute; and Adjunct Senior Lecturer, School of Public Health, University of SydneyBen Freedman, Director External Affairs and Group Leader Heart Rhythm & Stroke Group, Heart Research Institute, and Honorary Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779002022-05-04T12:33:36Z2022-05-04T12:33:36ZA boom in fitness trackers isn’t leading to a boom in physical activity – men, women, kids and adults in developed countries are all moving less<figure><img src="https://images.theconversation.com/files/459877/original/file-20220426-22-gzk038.jpg?ixlib=rb-1.1.0&rect=11%2C23%2C7892%2C5273&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Since the mid-1990s, people have been doing less and less walking or bicycling to work and school and spending a lot more time staring at screens. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-couple-changing-channels-while-relaxing-on-royalty-free-image/1321174010?adppopup=true">RainStar/E+ via Getty Images</a></span></figcaption></figure><p>Worldwide sales of fitness trackers increased from US$14 billion in 2017 to over <a href="https://www.fortunebusinessinsights.com/fitness-tracker-market-103358">$36 billion in 2020</a>. The skyrocketing success of these gadgets suggests that more people than ever see some value in keeping tabs on the number of steps they take, flights of stairs they climb, time they spend sitting and calories they burn. </p>
<p>The manufacturers of these devices certainly want consumers to believe that tracking fitness or health-related behaviors will spur them on to increase their activity levels and make them healthier. </p>
<p>Our analysis of research published over the past 25 years suggests otherwise.</p>
<p>We are professors of kinesiology – the science of human body movement – at <a href="https://www.boisestate.edu/humanperformance/faculty-staff/dr-scott-conger/">Boise State</a>, the <a href="https://krss.utk.edu/faculty-staff/david-r-bassett-jr-ph-d/">University of Tennessee</a> and the <a href="https://webapps.unf.edu/faculty/bio/n01443361">University of North Florida</a>. To learn whether and how physical activity has changed in the years since fitness trackers became popular, we analyzed more than two decades of research from several industrialized nations – all conducted before the COVID-19 pandemic.</p>
<p>Our systematic review of data from eight developed nations around the world shows that despite the surge in sales of fitness trackers, <a href="https://doi.org/10.1249/mss.0000000000002794">physical activity declined</a> from 1995 to 2017. What’s more, we discovered that this was not an isolated effect in one or two countries, but a widespread trend. </p>
<h2>Reviewing the research</h2>
<p>To conduct the study, we first searched for published research that tracked physical activity such as walking, household activities or playing sports throughout the day. We wanted studies that obtained two “snapshots” of daily activity from a population, with the measurements separated by at least one year.</p>
<p>We found 16 studies from eight different countries that met these criteria: Canada, the Czech Republic, Denmark, Greece, Japan, Norway, Sweden and the United States. The studies were conducted between 1995 and 2017.</p>
<p>It is important to note that these snapshots did not track specific individuals. Rather, they tracked samples of people from the same age group. For example, one Japanese study of physical activity among adults ages 20 to 90 collected data each year for 22 years from people in each age group. </p>
<p>Scientists tracked the participants’ physical activity using a variety of wearable devices, from simple pedometers – step counters – to more sophisticated activity monitors like accelerometers. </p>
<p>The study groups ranged from large, nationally representative samples numbering tens of thousands of people to small samples of several hundred students from a few local schools. </p>
<p>After identifying the research studies, we calculated an “effect size” for each study. The effect size is a method of adjusting the data to allow for an “apples-to-apples” comparison. To calculate the effect size, we used the data reported in the studies. These include the average physical activity at the beginning and end of each study, the sample size and a measure of the variability in physical activity. Using a technique called meta-analysis, this allowed us to combine the results of all studies to come up with an overall trend. </p>
<p>We discovered that overall, researchers documented fairly consistent declines in physical activity, with similar decreases in each geographical region and in both sexes. Overall the decrease in physical activity per person was over 1,100 steps per day between 1995 and 2017.</p>
<p>Our most striking finding was how sharply physical activity declined among adolescents ages 11 to 19 years – by roughly 30% – in the span of a single generation. For instance, when we compared the studies reporting physical activity in steps per day, we found the total steps per day per decade declined by an average of 608 steps per day in adults, 823 steps per day in children and 1,497 steps per day in adolescents.</p>
<p>Our study doesn’t address why physical activity has declined over the past 25 years. However, the studies we reviewed mentioned some contributing factors. </p>
<h2>More staring at screens, less walking or bicycling</h2>
<p>Among adolescents, declines in physical activity were associated with increases in ownership and use of smartphones, tablets, video games and social media. </p>
<p>In the U.S., for example, screen time increased dramatically in adolescents, from <a href="https://eric.ed.gov/?id=ED527859">five hours per day in 1999</a> to <a href="https://doi.org/10.1097/dbp.0000000000000272">8.8 hours per day in 2017</a>. </p>
<p>At school, most of the physical activity that adolescents perform has traditionally come from physical education classes. However, the changes in the frequency of physical education classes during the study period are <a href="https://doi.org/10.1016/j.jsams.2014.06.002">inconsistent and vary from country to country</a>. </p>
<p>All of these factors may help to explain the decline in physical activity that we observed in our study.</p>
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<figcaption><span class="caption">Lisa Cadmus-Bertram, an assistant professor of kinesiology at University of Wisconsin – Madison, explains which fitness trackers are best at tracking.</span></figcaption>
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<p>In addition, fewer adults and children are walking or bicycling to school or work than 25 years ago. For instance, in the late 1960s, most U.S. children ages 5 to 14 <a href="https://doi.org/10.1016/j.amepre.2007.02.022">rode a bicycle or walked to school</a>. Since then, this “active transportation” has largely <a href="https://doi.org/10.1016/j.amepre.2011.04.006">been replaced by automobile trips</a>. Rates of travel by school bus or public transportation have seen little change. </p>
<h2>So why use a fitness tracker?</h2>
<p>So if levels of physical activity have dropped at the same time that the popularity of fitness tracking has grown, what makes these gadgets useful?</p>
<p>Fitness trackers can help to increase people’s awareness of their daily physical activity. However, these devices are only part of the solution to addressing the problem of sedentary lifestyles. They are <a href="https://doi.org/10.1001/jama.2014.14781">facilitators, rather than drivers, of behavior change</a>. </p>
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<p>When a person’s physical activity goes down, it opens the door to overall reduced fitness levels and other health problems such as obesity or diabetes. On the other hand, physical activity has a dramatic positive impact <a href="https://doi.org/10.1097/hco.0b013e32833ce972">on health</a> and <a href="https://doi.org/10.1176/appi.ajp.2017.16111223">well-being</a>. The first step to increasing active movement is to measure it, which these devices can do. But successfully increasing one’s overall physical activity requires several additional factors such as goal setting, self-monitoring, positive feedback and social support.</p><img src="https://counter.theconversation.com/content/177900/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research is revealing that fitness trackers alone can be helpful facilitators toward changing a sedentary lifestyle but don’t motivate people to increase their physical activity.Scott A. Conger, Associate Professor of Exercise Physiology, Boise State UniversityDavid Bassett, Professor and Department Head of Kinesiology, Recreation and Sport Studies, University of TennesseeLindsay Toth, Assistant Professor of Kinesiology, University of North FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1734192021-12-12T19:09:02Z2021-12-12T19:09:02ZWhy wearable fitness trackers aren’t as useless as some make them out to be<figure><img src="https://images.theconversation.com/files/436841/original/file-20211210-172173-80w7n7.jpeg?ixlib=rb-1.1.0&rect=77%2C44%2C7238%2C4858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Wearable fitness trackers will be on many Christmas shopping lists this year, with a vast range of devices (and an ever-increasing number of features) hitting the market just in time for the festive season. </p>
<p>But what does the latest research say about how effective they are? </p>
<h2>Fitness trackers are trendy</h2>
<p>Currently, <a href="https://www2.deloitte.com/au/en/pages/technology-media-and-telecommunications/articles/digitalconsumertrends.html">about one in five</a> Australians own one of these wearables, and about a quarter use a mobile app or website to monitor their activity levels and health. And sales are <a href="https://www.mordorintelligence.com/industry-reports/australia-wearables-market">predicted to grow</a> over the next five years. </p>
<p>The landscape of the market is fast changing. For years, Fitbit and Garmin were the market leaders. But Australians now <a href="https://www.statista.com/forecasts/1187946/ehealth-tracker-smart-watch-usage-by-brand-in-australia">favour</a> Apple watches (used by 43% of people owning a wearable tracker) over Fitbit (35%) and Samsung watches (16%) over Garmin (13%).</p>
<p>So far fitness trackers have mostly been taken up by younger people: about one in four Australians aged 20–40 report using one, compared to just one in ten people aged <a href="https://www.statista.com/statistics/662856/australia-tracking-health-via-apps-bands-or-smartwatches-by-gender/">60 or older</a>.</p>
<p>However, manufacturers are on a mission to change this, by adding features that allow users to monitor not just their fitness activity, but several other aspect of their health.</p>
<p>For instance, recent wearable models from all the leading manufacturers claim to measure a host of medical metrics, such as blood pressure, body fat levels, the amount of oxygen in your blood, your heart activity, and even identify when you’ve taken a fall (with a feature that lets you call for help). </p>
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<strong>
Read more:
<a href="https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765">Do we really need to walk 10,000 steps a day?</a>
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<h2>Wearables get the basics right</h2>
<p>Firstly, a multitude of <a href="https://mhealth.jmir.org/2020/9/e18694/">studies</a> have looked at the accuracy of wearable fitness trackers for measurements related to physical activity, including step counts, heart rate and number of calories burned. They show step counts are generally highly accurate, while heart rate and calories burned are reasonably accurate. </p>
<p>When study participants wear two different activity trackers at the same time, the numbers of steps, minutes of activity and calories burned aren’t exactly the same, but they are <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-015-0314-1">correlated</a>. That is, when one goes up so does the other, and vice versa. This suggests they are generally capturing the same information, albeit with slightly different sensitivity.</p>
<p>Evidence for sleep tracking is a little patchier. Wearables are pretty good at detecting bed time, wake time and overall sleep duration. But estimates for more technical metrics such as the “phases” of sleep – such as REM sleep – don’t marry with medical-grade measurements taken by <a href="https://www.jmir.org/2019/11/e16273/?utm_source=dlvr.it&utm_medium=facebook">polysomnography</a>.</p>
<h2>Sometimes wearables go beyond the basics</h2>
<p>In a 2019 Apple-sponsored study <a href="https://pubmed.ncbi.nlm.nih.gov/31722151/">reported in the</a> New England Medical Journal, 419,297 participants without known atrial fibrillation wore an Apple Watch. During the study, 2,161 of them received an irregular pulse notification, of which 84% were subsequently confirmed to have atrial fibrillation (an irregular and rapid heart beat). </p>
<p>This is a serious medical condition that requires treatment to prevent stroke.
The ability to alert users of a potential undiagnosed cardiac condition seems highly beneficial. Although, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1901183#article_letters">others</a> have cautioned the Apple Watch can also miss cases of undiagnosed atrial fibrillation – which emphasises the importance of <em>never</em> relying on wearable metrics for medical purposes.</p>
<p><a href="https://www.ahajournals.org/doi/full/10.1161/CIRCEP.121.010063">Another study</a> published in September reaffirmed the Apple watch’s electrocardiogram feature can detect serious cardiac irregularities. A similar <a href="https://pubmed.ncbi.nlm.nih.gov/33865810/">study</a> is currently underway to evaluate Fitbit’s electrocardiogram feature, but results aren’t out yet.</p>
<h2>Building a more advanced tracker</h2>
<p>In terms of detecting falls (which would be very useful for older individuals), scientists are developing wrist-worn devices that can accurately do this using <a href="https://ieeexplore.ieee.org/document/7723508">accelerometer technology</a>, which is the same underlying technology already used by wearables. So the technology is there, but at this point it’s unclear whether the promising lab results will translate to accuracy in commercial wearables.</p>
<p>Meanwhile, the newest Samsung watch claims to measure <a href="https://www.samsung.com/au/support/mobile-devices/measure-bp-on-samsung-watch/">blood pressure</a> and <a href="https://www.samsung.com/levant/support/mobile-devices/measure-your-body-composition-with-the-galaxy-watch4-series/">body composition</a> (such as fat mass, muscle mass and bone mass). Body composition is measured using a method called bioelectric impedance analysis. </p>
<p>When the user touches the watch with their opposite hand, it passes a weak electrical signal through the body and back to the watch. The body composition is then calculated using algorithms and the manually entered body weight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Calipers" src="https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Calipers can be used to try to measure body fat percentage.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>At this stage, there’s no data in the scientific literature to support the accuracy of these measurements, so we’d recommend taking them with a pinch of salt. Then again, only a few years ago the same criticism was made of electrocardiogram measurements from wearables – and these have subsequently shown to have merit. </p>
<h2>Evidence says your effort will pay off</h2>
<p>So that’s the run down on accuracy, but do fitness trackers make a difference in people’s lives?</p>
<p>Hundreds of studies have used wearable activity trackers to try to increase physical activity in various general and patient populations. Meta-analyses (which involve combining results of multiple studies) suggest the devices are effective in helping people become more <a href="https://pubmed.ncbi.nlm.nih.gov/30977740/">physically active</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597870/">lose weight</a>. </p>
<p>A <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00955-2">meta-analysis</a> of 35 studies in various chronic disease populations suggested users added around 2,100 additional steps per day after they started using a wearable activity tracker. Other meta-analyses have suggested weight loss in the order of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589007/">1 to 1.5 kilograms</a>, on average, over the duration of the studies (with the duration varying between studies). </p>
<p>And <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-01020-8">studies</a> that look specifically at step-tracking over long periods suggest the benefits gained are still present (although smaller) up to four years after the device was first worn.</p>
<p>Accuracy and effectiveness aside, wearable users typically report being <a href="https://pubmed.ncbi.nlm.nih.gov/29141607/">satisfied with their devices</a>. So if you happen to get one in your Christmas stocking this year, keep in mind it could help with those New Year’s fitness resolutions. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-apps-track-vital-health-stats-for-millions-of-people-but-doctors-arent-using-the-data-heres-how-it-could-reduce-costs-and-patient-outcomes-162575">Health apps track vital health stats for millions of people, but doctors aren't using the data – here's how it could reduce costs and patient outcomes</a>
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<img src="https://counter.theconversation.com/content/173419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Maher receives funding from the National Health and Medical Research Council, the Medical Research Future Fund, the National Heart Foundation, the South Australian Department for Innovation and Skills, the South Australian Department for Education, Healthway and Hunter New England Local Health District.</span></em></p><p class="fine-print"><em><span>Ben Singh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>About one in five Aussies currently own a wearable fitness tracker of some kind. Yet many people doubt their effectiveness. Let’s see what the research suggests.Ben Singh, Research fellow, University of South AustraliaCarol Maher, Professor, Medical Research Future Fund Emerging Leader, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1625752021-07-28T12:24:42Z2021-07-28T12:24:42ZHealth apps track vital health stats for millions of people, but doctors aren’t using the data – here’s how it could reduce costs and patient outcomes<figure><img src="https://images.theconversation.com/files/408984/original/file-20210629-20-z39aiu.jpg?ixlib=rb-1.1.0&rect=101%2C50%2C8385%2C5509&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mobile health apps and gadgets could help doctors and patients treat chronic illnesses in real time.</span> <span class="attribution"><a class="source" href="http://www.gettyimages.com/detail/1267542302">Moment via Getty</a></span></figcaption></figure><p>Health-tracking devices and apps are becoming part of everyday life. More <a href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-growing-value-of-digital-health">than 300,000 mobile phone applications</a> claim to help with managing diverse personal health issues, from monitoring blood glucose levels to conceiving a child.</p>
<p>But so far the potential for health-tracking apps to improve health care has barely been tapped. While they allow a user to collect and record personal health data, and sometimes even share it with friends and family, these apps typically don’t connect that information to a patient’s digital medical chart or make it easier for health care providers to monitor or share feedback with their patients.</p>
<p>As a <a href="https://scholar.google.com/citations?hl=en&user=2SFosXQAAAAJ">professor and a researcher</a> in the field of operations management, my current research focuses on improving the efficiency and effectiveness of health care delivery. My colleagues and I recently published <a href="https://doi.org/10.1097/HJH.0000000000002909">a multiyear study</a> showing that integrating a mobile health app with ongoing medical care can significantly improve the health of patients with hypertension – a widespread, serious and potentially deadly chronic medical condition.</p>
<p>But it’s not easy to use health apps this way as a regular part of medical care in the U.S.</p>
<h2>Case study: Hypertension</h2>
<p>Hypertension, better known as high blood pressure, is one of America’s leading chronic health problems. <a href="https://www.cdc.gov/bloodpressure/facts.htm">According the U.S. Centers for Disease Control and Prevention</a>, hypertension was a primary or contributing cause to nearly half a million deaths in 2018 and affected nearly half of U.S. adults – nearly 110 million people. Left uncontrolled, <a href="https://www.nhlbi.nih.gov/health-topics/high-blood-pressure">high blood pressure </a> can also permanently damage the heart and other parts of the body.</p>
<p>Simple changes in <a href="https://doi.org/10.1016/j.amjmed.2014.10.047">diet, exercise, smoking and drinking</a> can help prevent or postpone the onset of hypertension. Once a person has high blood pressure, the focus of medical care is treatment and management. But patients typically see their doctors only three to four times a year, making it difficult for physicians <a href="https://doi.org/10.1016/j.amjmed.2014.10.047">to track, assess and address the root causes</a> of their hypertension. <a href="https://www.emerald.com/insight/content/doi/10.1108/MD-10-2017-1010/full/html">These visits also tend to be brief,</a> because the fee-for-service insurance payment model motivates doctors to see more patients in a given day. </p>
<p>Prior studies on the <a href="https://doi.org/10.2196/10723">effectiveness of mobile health apps for self-management of hypertension</a> were done in controlled settings in which all the participants agreed to use the app, rather than in clinical settings where patients had a choice of whether to engage with care providers using the app. We wanted to see how a hypertension patient’s use of an app played out in a real-world setting. So one of my study co-authors, a <a href="https://diabeticcareassociates.com/">practicing endocrinologist</a>, developed a proprietary web-based smartphone app to help monitor and treat hypertension between office visits. </p>
<p>Patients who received this app free of charge measured and entered their blood pressure and pulse readings. The physician reviewed these readings once a day and, if needed, recommended interventions such as new medications or changing doses of existing medications, or advised on diet and exercise. My co-author and his medical assistants weren’t paid to monitor these patients. </p>
<p>Patients and staff could also talk directly with one another through the app. This enabled regular <a href="https://doi.org/10.1108/MD-10-2017-1010">communication and joint decision-making</a> between providers and patients on how to best treat their hypertension, which in turn encouraged patients not to abandon the app after only a few uses. </p>
<p>In tracking the condition of 1,600 hypertension patients over the course of four years, we found that a typical app user reduced her <a href="https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings">systolic blood pressure</a> – the upper value in a blood pressure reading, indicating the pressure while the heart muscle contracts – by 2 “millimeters of mercury,” or mmHG, compared with someone not using the app. For patients with systolic blood pressure greater than 150 mmHG, the reduction was more than 6 mmHG. These were significant decreases. A reduction of 10 mmHG in systolic blood pressure lowers overall mortality risk by 13%.</p>
<p>Our study bears out the findings of other <a href="https://doi.org/10.1007/s10729-018-9458-2">researchers who have found</a> that using mobile health apps is beneficial for managing chronic conditions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A gray-haired woman snaps on a bike helmet. She is wearing an Apple watch." src="https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You may be collecting health data on your phone, but does your doctor ever see it?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-putting-on-cycling-helmet-royalty-free-image/1255380001">Tara Moore via Getty</a></span>
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<h2>Barriers to connection</h2>
<p>These finding were promising, but there’s a catch: Many patients can’t afford to buy a mobile device and pay for its service.</p>
<p>Further, medical practices need to make a profit to survive, and there is currently no clear way for a provider to charge for <a href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-growing-value-of-digital-health">time spent</a> providing medical care via an app. However, the massive switch during the COVID-19 pandemic from in-person care to telehealth has driven many insurers <a href="https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/">to figure out how to bill for services delivered remotely</a>. These solutions might eventually apply to medical health apps as well.</p>
<p>Developers also have few financial incentives to create apps that integrate with professional health care. Apps commonly earn revenues by converting users into paying customers or ongoing subscribers, or by selling advertising space within the app. The most profitable apps tend to be <a href="https://doi.org/10.1016/j.chb.2019.07.017">mobile phone games, which use psychological techniques to increase sales</a>. </p>
<p>But these would be inappropriate in the medical setting. Selling to a patient – or selling the patient’s attention to advertisers – raises questions like: Is my data safe? Is this a medically necessary sale? Does my doctor earn money from this? These concerns could reduce the trust between physician and patient <a href="https://dx.doi.org/10.1177%2F2333393616664823">that is essential to</a> treating chronic health conditions.</p>
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<p>And the tech has to work. Patients care about how easy it is to use an app, and whether it has the tools that they are looking for. <a href="https://mobius.md/2019/03/20/11-mobile-health-statistics/">Providers are unhappy</a> when their patients have bad experiences with technology. Further, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/#b11-ptj3905356">there are no established standards ensuring</a> that mobile health apps are collecting or delivering accurate information, as there are with most professional medical monitoring equipment.</p>
<p>But as the recognition grows that properly designed health care apps can play a big role in enabling more effective medical care, we could see a major stakeholder step in and provide a monetary incentive for app development and use: the insurance carriers who benefit from lower costs of care. </p>
<p>Ultimately, the key part of treating hypertension and other chronic health problems is the interplay between patient and doctor. <a href="https://doi.org/10.1097/HJH.0000000000002909">Our research shows</a> that a well-designed health app that talks not just to the user but also to the user’s care providers increases the likelihood of that engagement and leads to better treatment and better health.</p><img src="https://counter.theconversation.com/content/162575/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Saligrama Agnihothri does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Connecting health apps to health care can enable better care for patients with chronic diseases, and it has the potential to lower skyrocketing US health spending.Saligrama Agnihothri, Professor of Supply Chain and Business Analytics, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1537652021-01-28T16:27:02Z2021-01-28T16:27:02ZDo we really need to walk 10,000 steps a day?<figure><img src="https://images.theconversation.com/files/381115/original/file-20210128-19-wr5avc.jpg?ixlib=rb-1.1.0&rect=44%2C7%2C4950%2C3282&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The 10,000 step target has more to do with marketing than scientific fact. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-attractive-women-their-30s-talking-562075621">Brocreative/ Shutterstock</a></span></figcaption></figure><p>When it comes to being fit and healthy, we’re often reminded to aim to walk 10,000 steps per day. This can be a frustrating target to achieve, especially when we’re busy with work and other commitments. Most of us know by now that 10,000 steps is recommended everywhere as a target to achieve – and yet where did this number actually come from?</p>
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<p>The 10,000 steps a day target seems to have come about from a trade name pedometer sold in 1965 by Yamasa Clock in Japan. The device was called <a href="http://www.yamax-yamasa.com/aboutus/">“Manpo-kei”</a>, which translates to “10,000 steps meter”. This was a marketing tool for the device and has seemed to have stuck across the world as the daily step target. It’s even included in daily activity targets by popular smartwatches, such as Fitbit.</p>
<p>Research has since investigated the 10,000 steps a day target. The fact that <a href="https://pubmed.ncbi.nlm.nih.gov/29361921/">some studies</a> have shown this step target improves heart health, mental health, and even lowers diabetes risk, may, to some extent, explain why we have stuck with this arbitrary number. </p>
<p>In ancient Rome, distances were actually <a href="https://journals.lww.com/acsm-msse/Fulltext/2008/07002/Walking_and_Measurement.4.aspx">measured by counting steps</a>. In fact, the word “mile” was derived from the Latin phrase <em>mila passum</em>, which means <a href="https://www.britannica.com/science/mile">1,000 paces</a> – about 2,000 steps. It’s suggested the average person walks <a href="https://www.tandfonline.com/doi/abs/10.1080/02701367.2001.10608977">about 100 steps per minute</a> – which would mean it would take a little under 30 minutes for the average person to walk a mile. So in order for someone to reach the 10,000 step goal, they would need to walk between four and five miles a day (around two hours of activity). </p>
<p>But while some research has shown health benefits at 10,000 steps, <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709?guestAccessKey=afffe229-3940-4dd1-94e6-56cdd109c457&utm_source=jps&utm_medium=email&utm_campaign=author_alert-jamanetwork&utm_content=author-author_engagement&utm_term=1m">recent research</a> from Harvard Medical School has shown that, on average, approximately 4,400 steps a day is enough to significantly lower the risk of death in women. This was when compared to only walking around 2,700 steps daily. The more steps people walked, the lower their risk of dying was, before levelling off at around 7,500 steps a day. No additional benefits were seen with more steps. Although it’s uncertain whether similar results would be seen in men, it’s one example of how moving a little bit more daily can improve health and lower risk of death. </p>
<figure class="align-center ">
<img alt="Person wearing a smartwatch tying their shoe." src="https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Benefits were seen even before 10,000 steps.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/count-your-steps-smartwatch-application-can-578757676">dolphfyn/ Shutterstock</a></span>
</figcaption>
</figure>
<p>While the <a href="https://www.who.int/publications/i/item/9789240015128">World Health Organization recommends</a> adults get at least 150 minutes of moderate intensity physical activity per week (or 75 minutes of vigorous physical activity), research also shows that <a href="https://www.sciencedirect.com/science/article/pii/S0828282X16000647?via%3Dihub">even low-intensity exercise</a> can improve your health – though moderate-intensity exercise improves it to a greater extent. This means your steps throughout the day can contribute to your 150 minutes of target activity. </p>
<p>Activity can also help mitigate the <a href="https://www.nhs.uk/live-well/exercise/why-sitting-too-much-is-bad-for-us/">harms of sitting down</a> for long periods of time. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30370-1/fulltext#%20">Research has shown</a> that people who sat for eight or more hours every day had a 59% increased risk of death compared to those sitting less than four hours per day. However, they also found that if people did 60-75 minutes per day of moderate intensity physical activity, this seemed to eliminate this increased risk of death. Therefore, potentially undertaking brisk walking could help mitigate the negative effects of sitting for too long.</p>
<p><a href="https://journals.lww.com/acsm-msse/Fulltext/2021/02000/Daily_Step_Count_and_Postprandial_Fat_Metabolism.10.aspx">Recent research at the University of Texas</a> has also demonstrated that if you’re walking fewer than 5,000 steps a day, your body is less able to metabolise fat the following day. A buildup of fat in the body can also increase a person’s likelihood of developing cardiovascular disease and diabetes. This is further supported by <a href="https://journals.lww.com/acsm-msse/Fulltext/2014/10000/Effects_of_Moderate__and_Intermittent.2.aspx">previous research</a> which shows people who walked less than 4,000 steps a day could not reverse this decreased fat metabolism. </p>
<p>Increasing physical activity such as your step count reduces your risk of death by improving your health, including by reducing risk of developing chronic illnesses such as <a href="https://pubmed.ncbi.nlm.nih.gov/28049634/">dementia</a>, and certain <a href="https://pubmed.ncbi.nlm.nih.gov/23720265/">cancers</a>. In some cases it helps improve health conditions such as <a href="https://pubmed.ncbi.nlm.nih.gov/28708479/">type 2 diabetes</a>. Exercise can also help us improve and maintain our <a href="https://pubmed.ncbi.nlm.nih.gov/17303714/">immune system</a>. However, based on the current research out there, it appears that getting 10,000 steps a day isn’t essential for health benefits – half that target appears to be beneficial.</p>
<p>If you want to increase how many steps you get daily, or simply want to move more, one easy way to do that is to increase your current step count by about 2,000 steps a day. Other easy ways to move more daily include walking to work if possible, or taking part of an online exercise programme if you’re working from home. Meeting with friends for a walk – rather than in a cafe or pub – can also be useful. And given that even small amounts of physical activity positively impact your health, taking regular breaks to move around if you’re working at a desk all day will help to easily get more physical activity.</p><img src="https://counter.theconversation.com/content/153765/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsay Bottoms does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even half the amount of steps shows health benefits.Lindsay Bottoms, Reader in Exercise and Health Physiology, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1498862021-01-07T18:02:08Z2021-01-07T18:02:08ZConnected workouts can help you get fit alongside virtual buddies during the pandemic<figure><img src="https://images.theconversation.com/files/377043/original/file-20210104-17-1cfjt5n.jpg?ixlib=rb-1.1.0&rect=135%2C692%2C7180%2C4795&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Riding together from afar can help you build the exercise habit.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-cycling-indoor-with-exercise-bike-trainer-royalty-free-image/1222113631">ArtistGNDphotography/E+ via Getty Images</a></span></figcaption></figure><p>Sales of exercise gear and technology-based fitness tools have <a href="https://nymag.com/intelligencer/2020/09/how-the-pandemic-has-changed-the-fitness-industry.html">exploded in the U.S.</a> as people try to maintain their workout regimens without going to the gym.</p>
<p>Purchases range from simple dumbbells and outdoor bicycles to internet-connected devices such as the Peloton stationary bike or the Tonal digital weight machine. There are exercise video games like Nintendo’s Wii Fit and PS-2’s Eye Toy: Kinetic; wearable technology like Fitbits or Apple Watches; and mobile apps like Strava. People are even using platforms like Zoom or Skype to connect with a personal trainer.</p>
<p>These <a href="https://www.techaheadcorp.com/blog/connected-fitness/">connected fitness tools</a> bring together your exercise workouts and your digital life. <a href="https://orcid.org/0000-0003-1191-4863">As researchers in</a> <a href="http://education.msu.edu/search/Formview.aspx?email=kap@msu.edu">the field of kinesiology</a>, we’ve studied the effects of connected fitness on motivation and fitness outcomes. If you’re looking for ways to beef up your fitness during pandemic-related downtime or to replace a pre-COVID-19 exercise routine, one of these tech-enabled items may work for you.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young woman uses a Wii Fit video game" src="https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Games like the Wii Fit make users move their bodies to play.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/skylar-grey-gets-her-hands-on-wii-fit-u-while-at-the-news-photo/463355359">Neilson Barnard/Getty Images for Nintendo</a></span>
</figcaption>
</figure>
<h2>Tapping into the tech</h2>
<p>Connected fitness is not new. The <a href="http://doi.org/10.1111/j.1750-8606.2011.00162.x">first such technology</a> was developed in the 1980s: stationary bikes connected to game consoles that required pedaling and steering on a handlebar-mounted gamepad. Exercise video games (exergames) were first created around the same time, really taking off in the late 1990s with games like Dance Dance Revolution and Nintendo Wii Fit <a href="https://doi.org/10.1089/g4h.2014.0077">that require limb or trunk movement</a> as the primary interface with the technology.</p>
<p>New and creative technologies, however, continue to make exercise more convenient, trackable and customized. <a href="http://doi.org/10.1080/15213269.2012.673850">Some exergames have become more gamified</a>, including rewards, challenge levels, leader boards and immersive story lines to <a href="https://us.humankinetics.com/products/advances-in-sport-and-exercise-psychology-4th-edition">create elements of competition and enhance engagement</a>.</p>
<p>Even before the pandemic, connected fitness devices and exergames were appealing because they eliminate some of common barriers to exercise or physical therapy. Users don’t need to worry about the scheduling problems, costs of joining exercise programs or <a href="https://doi.org/10.1016/j.psychsport.2008.11.002">social physique anxiety</a> that can be associated with working out in public. These tools also shift the focus away from what can be unpleasant parts of exercising – like exertion, fatigue and boredom – to novel and engaging aspects of the activity.</p>
<p>One hitch, though, is that so far there are no independent “Consumer Reports”-type evaluations of how much these technologies affect performance outcomes or influence behavior. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman on exercise bike" src="https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inspiring gameified content doesn’t help your fitness if you don’t make it a habit.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-on-exercise-bike-royalty-free-image/1182742824">MoMo Productions/DigitalVision via Getty Images</a></span>
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<h2>Connected in more than one way</h2>
<p>Purchasing fitness equipment and technology-based devices is a great first step toward adding more physical activity to your life. But just like with a gym membership that’s paid for but never used, a high-tech piece of gear can gather dust.</p>
<p>Luckily, exercise psychology researchers have figured out frameworks that are more likely to help folks keep up the intensity of their exercise regimens and turn them into habits. Setting exercise goals, having individual choices in the type of workout, seeing improvements in your performance and exercising with others all make you more likely to stick with it. <a href="https://doi.org/10.4018/978-1-4666-9522-1.ch011">Working out in a group</a>, in particular, enhances the experience. The added social elements – including cooperation, coordination, obligation to the group, social comparison and even competition – all contribute.</p>
<p>Of course, finding the right exercise partner or group in these pandemic times can be difficult. Gyms are closed and social distancing guidelines are in effect. Can a virtual buddy do the job?</p>
<p>Our research team, which began investigating partnered exergames long before the pandemic, was the first to examine the use of virtual as well as nonhuman, software-generated exercise partners.</p>
<p>Based on principles of social comparison and what it takes to be a valued teammate, we customized our partners to be somewhat faster than the exerciser to provide a challenge to keep up. We also electronically “tethered” the partner to the exerciser in such a way that if the exerciser slowed down below their target pace, the partner had to slow down too. So if you start slacking, you slow down the team. This tool builds in some obligation to your partner.</p>
<p>We found that motivation and performance improve when the partner is slightly better than the exerciser. This finding held whether the partner is real, but virtually presented, <a href="https://doi.org/10.1519/JSC.0000000000003732">or unreal and software-generated</a>, and with a stationary bike <a href="https://doi.org/10.1016/j.chb.2018.07.004">or a walking app</a>.</p>
<p>Even if you don’t have a software-generated exercise buddy, you can team up with someone on FaceTime or Zoom while you are on a stationary bike, treadmill or even doing dance aerobics. That way you can challenge and encourage each other to keep up the pace. Teaming up with someone who will also hold you accountable to keep showing up is also helpful. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CJJu4z1h4E6","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Even if you can’t find someone who can work out virtually with you at the same time, you can still share your workout results, compare notes and set future team challenges. A number of running apps, like Strava and RunKeeper, for instance, allow you to keep in touch with running buddies. Pricey indoor cycling classes like Peloton offer many options for how much or how little you want to compare with others, and let you share workouts with friends.</p>
<p>But you can apply the same motivational principles without spending money on such programs. Choose your activity, set your workout goals and search out an exercise buddy where you both challenge and encourage each other. If finding a workout pal is difficult, <a href="https://www.getmotivatedbuddies.com">GetMotivedBuddies</a> provides a low-cost membership.</p>
<h2>Just having fun or really working up a sweat</h2>
<p>Certainly, any movement is superior to a sedentary lifestyle in terms of health benefits. But to meet U.S. Department of Health and Human Services <a href="http://health.gov/paguidelines/">recommendations</a>, adults should attain at least 150 minutes per week of physical activity that is of at least the intensity of a brisk walk.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<p><a href="https://us.humankinetics.com/products/advances-in-sport-and-exercise-psychology-4th-edition">Few of the companies that sell technology-based tools</a> to increase physical activity have provided evidence of objective changes in long-term physical activity. Exergames may or may not help you meet recommended levels of physical activity.</p>
<p>In one systematic review of 28 studies, researchers found that when playing the game outside of structured settings, <a href="https://doi.org/10.1177/1090198112444956">exergamers rarely hit moderate to vigorous physical activity levels</a>. The most common exergames reviewed were DDR, Wii Fit, Playstation2 and GameBike.</p>
<p>An important consideration is how tools are used. For example, people can cheat to avoid exercise with a Wii controller by simply flicking the wrist instead of performing full-body movements. People still must commit to using tools for their intended purpose. </p>
<p>Physical activity is good for you in so many ways – including lowering the risk of developing multiple forms of cancer, diabetes and cardiovascular disease. Importantly, physical activity is also positively linked to <a href="https://doi.org/10.1007/s10238-020-00650-3">immune system function</a> and <a href="https://doi.org/10.1080/17437199.2015.1022901">mental health</a>, which are paramount concerns during a pandemic like COVID-19.</p>
<p>So figure out your personal preferences and what motivates you. See what resources you can access. Fortunately, there are creative options available for those wishing to be physically active, and many of them involve technology-based tools. Now is a great time to get connected to fitness.</p><img src="https://counter.theconversation.com/content/149886/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah L. Feltz has received funding from the Robert Wood Johnson Foundation, the National Space Biomedical Research Institute, and National Institutes of Health. She currently does not receive funding from any company or organization that would benefit from this article. </span></em></p><p class="fine-print"><em><span>Karin Pfeiffer has previously received funding from the Robert Wood Johnson Foundation. She has previously received and currently receives funding from the National Institutes of Health. </span></em></p>From step counters and active video games to apps for exercisers and tech-enabled gear, there are a lot of ways to combine your workouts with your digital life.Deborah Feltz, Distinguished Professor Emerita of Kinesiology, Michigan State UniversityKarin Pfeiffer, Professor of Kinesiology, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1478052020-10-15T12:38:23Z2020-10-15T12:38:23ZWhat is HIPAA? 5 questions answered about the medical privacy law that protects Trump’s test results and yours<figure><img src="https://images.theconversation.com/files/363533/original/file-20201014-21-q2f1h4.jpg?ixlib=rb-1.1.0&rect=473%2C0%2C6875%2C4912&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors can share your medical information, with your permission.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bad-news-royalty-free-image/486418295">sturti/E+ via Getty Images</a></span></figcaption></figure><p><em>When President Trump was hospitalized with COVID-19, his doctor pointed to “<a href="https://www.cnn.com/2020/10/07/politics/hipaa-trump-conley/index.html">HIPAA rules and regulations</a>” as the reason he couldn’t speak more freely about Trump’s condition. HIPAA is a medical privacy law, but people often misunderstand what it does and doesn’t do.</em></p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1313205926309093378"}"></div></p>
<p><em>Margaret Riley is a <a href="https://www.law.virginia.edu/faculty/profile/mf9c/1202931">law professor at the University of Virginia</a> who specializes in health law. She spends a lot of time teaching future lawyers and medical professionals how medical privacy laws work. Here are the basics.</em></p>
<h2>1. What is HIPAA and why did Congress pass it?</h2>
<p>The <a href="https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html">Health Insurance Portability and Accountability Act’s</a> Privacy Rule is a federal law that <a href="https://www.hipaajournal.com/when-was-hipaa-enacted/">went into force in 2003</a>. The need for such a law had been underscored when tennis star <a href="https://www.nytimes.com/1992/04/09/sports/an-emotional-ashe-says-that-he-has-aids.html">Arthur Ashe’s HIV status was revealed publicly</a> and country music star <a href="http://www.cmt.com/news/1475729/medical-worker-sentenced-over-wynette-medical-records/">Tammy Wynette’s health records were sold</a> to tabloids for a few thousand dollars. People were also starting to worry about genetic privacy. And Congress recognized that the internet would make it easier for health care privacy breaches to occur.</p>
<p>The law prohibits health care providers and businesses and people working with them – including administrative staff, laboratories, pharmacies, health insurers and so on – from disclosing your health information without your permission. That includes information about your COVID-19 symptoms and test results – though there are some exceptions.</p>
<h2>2. Is all my medical info protected by HIPAA?</h2>
<p>No, HIPAA protects only health care information that is held by specific kinds of health care providers. For example, health care data that may be on your Apple Watch or Fitbit are usually not covered by HIPAA. Similarly, genetic data you enter on websites like Ancestry.com are not covered by HIPAA.</p>
<p>Even some apps that do things like help you maintain your blood sugar may not be covered by HIPAA if you aren’t using them at the direction of your health care provider. Other laws or agreements like the privacy disclosures required on many apps (although <a href="https://theconversation.com/nobody-reads-privacy-policies-heres-how-to-fix-that-81932">many people don’t read them</a>) may protect that information, but HIPAA does not.</p>
<p>Employers are generally not covered health providers, so HIPAA does not apply to them. If necessary to protect others, your work could share that you have an illness. That said, other laws like the Americans with Disabilities Act may prevent your employer from disclosing identifiable health information about you that you may have shared with them.</p>
<h2>3. Who can disclose what under HIPAA?</h2>
<p>HIPAA gives you the right to control your health information disclosures so you can tell your health care provider what to share. </p>
<p>For example, you may be willing to have your health care provider share some of your health information with family members, but you might not want to share all of it; you can tell your health care provider not to share any stigmatizing information or procedures that your family might not know about. You need to be very clear with your health care provider if you want to exclude some information. Some information, like psychotherapy notes or giving your data to marketing companies, requires written authorization. </p>
<p>Sometimes people try to use HIPAA as an excuse for actions that it doesn’t in fact cover. In 2020, for instance, some people confronted with rules about wearing masks in stores assert that they don’t need to wear one and <a href="https://www.usatoday.com/story/news/factcheck/2020/07/19/fact-check-asking-face-masks-wont-violate-hipaa-4th-amendment/5430339002/">don’t need to explain why because of HIPAA</a>. That’s not actually how this privacy law works.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="exterior of a medical center with mask sign" src="https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363537/original/file-20201014-21-1mxfqp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Even during the pandemic, your personal medical information is largely protected.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bad-news-royalty-free-image/486418295">Spencer Plat/Getty Images News via Getty Images</a></span>
</figcaption>
</figure>
<h2>4. Could my health care provider be required to disclose any of my info without my permission?</h2>
<p><a href="https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html">There are exceptions</a> to HIPAA’s nondisclosure requirements. For example, HIPAA regulations allow covered health care providers to disclose patient information to help treat another person, to protect public health and for certain law enforcement purposes.</p>
<p>There are additional exceptions that apply during a pandemic. For instance, while health departments may have access to information about people in their district who’ve tested positive for COVID-19, HIPAA and other privacy laws require them not to release any more information than is needed to keep people safe. So, health departments will provide information about how many people have tested positive and how many people are hospitalized, but they won’t release any names to the general public. Health department contact tracers may reveal identities of individuals if it’s really necessary to alert specific people that they may have been exposed.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>HIPAA covers President Trump just as it does you and me. There may be good reasons that people want to know more about the president’s health, but his health providers can provide the public only with information about his health that he has allowed them to share. They shouldn’t say anything that isn’t true, but they can certainly omit information.</p>
<h2>5. What if someone violates my rights under HIPAA?</h2>
<p>Only the government can bring a claim if an individual’s protected health information is breached. So to bring a federal claim, you would need to work with the Office of Civil Rights at the U.S. Department of Health and Human Services. You may be able to sue under state law and use the breach of your HIPAA rights as evidence.</p>
<p>Some people who are particularly worried about their privacy may ask health care providers to sign a nondisclosure agreement that gives them additional claims and the right to sue directly if there is a breach.</p><img src="https://counter.theconversation.com/content/147805/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Riley does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A health law expert explains what the regulation does and doesn’t protect.Margaret Riley, Professor of Law, Public Health Sciences, and Public Policy, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1433882020-08-07T12:35:59Z2020-08-07T12:35:59ZWearable fitness devices deliver early warning of possible COVID-19 infection<figure><img src="https://images.theconversation.com/files/350944/original/file-20200803-24-1x9uoce.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5615%2C3715&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fitness information from wearable devices can reveal when the body is fighting an infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/runner-in-the-park-using-smart-watch-royalty-free-image/636251614?adppopup=true">Nico De Pasquale Photography/Stone via Getty Images</a></span></figcaption></figure><p>The difficulty many people have getting tested for SARS-CoV-2 and delays in receiving test results make early warning of possible COVID-19 infections all the more important, and <a href="https://advances.sciencemag.org/content/early/2020/06/30/sciadv.abd4794.full">data from wearable health and fitness devices shows promise</a> for identifying who might have COVID-19. </p>
<p>Today’s wearable device gather data about physical activity, heart rate, body temperature and quality of sleep. This data is typically used to help people track general well-being. Smartwatches are the most common type of wearable. There are also smart wrist bands, finger rings and earbuds. Smart clothing, shoes and eyeglasses can also be considered “wearables.” Popular brands include Fitbits, Apple Watches and Garmin watches.</p>
<p>Several studies are <a href="https://med.stanford.edu/snyderlab/news/20202-covid-19-research.html">testing algorithms</a> that <a href="https://wvumedicine.org/news/article/wvu-rockefeller-neuroscience-institute-announces-capability-to-predict-covid-19-related-symptoms-up-/">assess data</a> from wearable devices to detect COVID-19. Results to date show that the concept is sound. However, wearables can be expensive and sometimes challenging to use. Addressing these issues is important to allow as many people as possible to benefit from them.</p>
<h2>Detecting flu-like illness</h2>
<p>Because wearables are excellent tools for monitoring general health conditions, researchers began studying ways of using them to detect illness before the COVID-19 pandemic. For example, researchers used Fitbit data <a href="https://doi.org/10.1016/S2589-7500(19)30222-5">to identify people who could have an influenza-like illness</a> from their resting heart rate and daily activity patterns. An elevated resting heart rate can be related to an infection. </p>
<figure class="align-right ">
<img alt="Fitbit fitness tracker" src="https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=775&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=775&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=775&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=974&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=974&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=974&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fitness trackers like this Fitbit monitor heart rate, activity and quality of sleep. Elevated resting heart rate is a sign of infection.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/185603127@N05/49111707501/">Krystal Peterson/Flickr</a></span>
</figcaption>
</figure>
<p>Most Fitbit models measure and record heart rate, so the devices can be used to spot periods of increased resting heart rate. They also measure and record activity, so they can identify reduced levels of daily activity. Combining these two measures allowed the researchers to better predict who had an influenza-like illness. </p>
<p>It’s not possible to determine if a smart device wearer has a particular illness from just these data measures. But seeing a sudden change in these conditions can prompt people to isolate themselves and get diagnostic tests, which can reduce the spread of communicable diseases like COVID-19.</p>
<h2>Body temperature</h2>
<p>Fever and persistent cough are the <a href="https://doi.org/10.1371/journal.pone.0234765">most common symptoms of COVID-19</a>. This has sparked widespread screening using thermometers, most commonly contactless infrared thermometers. </p>
<p>Despite the ubiquity of thermometers, temperature sensors in wearables are uncommon. This is due in part to <a href="https://dx.doi.org/10.3390%2Fs18061714">how complicated it is</a> to obtain true body temperature from skin-based measurements. Skin temperature varies depending on environmental conditions and stress levels, sweat evaporation can lower skin temperature, and temperature sensors sometimes have less-than-ideal contact with the skin.</p>
<p>There are wearable temperature patches that communicate with smart devices and record temperature continuously. But body temperature isn’t 100% predictive of illness, and it’s impossible to diagnose a particular infection, such as COVID-19, using body temperature alone. Nonetheless, a fever alert could lead to earlier intervention.</p>
<h2>Sweat and tears</h2>
<p>Research into sensing technology continues to expand the possibilities for wearables as health monitoring and diagnosis devices. The COVID-19 outbreak is likely to influence the direction of this research as well as accelerate it. </p>
<figure class="align-right ">
<img alt="backside of Garmin smartwatch" src="https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The backside of this Garmin smartwatch shows the sensors that use light to illuminate blood vessels in order to measure heart rate.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/185627742@N03/49108710981/">Tina Arnold/Flickr</a></span>
</figcaption>
</figure>
<p>One approach is to create sensors that <a href="https://doi.org/10.1002/elan.201800677">detect compounds in sweat</a> from the skin. These compounds can provide a lot of information about a person’s health. pH, sodium ions, glucose and alcohol content are just some of the things that emerging sweat sensors can detect. Tears also contain compounds from the body, so researchers are investigating <a href="https://doi.org/10.1039/C9LC01039D">chemical sensing using contact lenses and smart lenses</a>. </p>
<p>Sweat rate can also be measured, which can be used as an indicator of temperature, so these sensors are being examined for use in <a href="https://spectrum.ieee.org/view-from-the-valley/the-institute/ieee-member-news/sweat-sensing-patch-aimed-athletes-takes-covid19">helping detect COVID-19</a>. </p>
<h2>Toward detecting viruses</h2>
<p>The drawback of many existing wearable sensors is that they can’t actually detect the presence of a virus such at SARS-CoV-2. To do this, they would have to detect virus-specific RNA. </p>
<p>RNA detection typically involves several steps, including extracting RNA from a sample, making many copies of the RNA and identifying the RNA. Although there has been a lot of progress in miniaturizing RNA detection equipment for use in rapid, point-of-care testing, there’s still a ways to go before it can fit in wearable devices.</p>
<p>Much of the ongoing research on developing rapid, point-of-care pathogen detection uses “lab-on-a-chip” technology. Lab-on-a-chip refers to the goal of shrinking laboratory tests that once required many large pieces of equipment to the size of a computer chip or microscope slide. </p>
<p>An example is a <a href="https://www.engineering.com/DesignerEdge/DesignerEdgeArticles/ArticleID/20451/Lab-on-a-Chip-LoC-COVID-19-Test-Advances-to-Clinical-Trials.aspx">COVID-19 diagnostic test</a> undergoing clinical trials. The test’s sensor is a specialized <a href="https://ieeexplore.ieee.org/document/6189704">ion-sensitive field-effect transistor</a> (ISFET) that is designed to respond to the presence of the virus RNA. The device can perform a test in less than one hour, but requires a sample collected by nasal swab. </p>
<p>While this technology is not wearable, it could become the launching point for future virus-detecting wearables because these can be made small and use little power. A wearable device that continuously monitors a person and indicates that they’ve contracted or been exposed to the virus would allow the person to seek treatment and isolate themselves to prevent further spread.</p>
<h2>Sonic screwdrivers and tricorders</h2>
<p>Fans of Dr. Who know the <a href="https://en.wikipedia.org/wiki/Sonic_screwdriver">sonic screwdriver</a>, and Star Trek followers know the <a href="https://en.wikipedia.org/wiki/Tricorder">tricorder</a>. The ideal wearable of the future would be similar to these wondrous fictional devices. It would be able to detect the presence of the virus in the environment around the wearer, providing the opportunity to leave before becoming exposed. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>But airborne virus detection requires significant equipment to <a href="https://dx.doi.org/10.1371%2Fjournal.pone.0174314">collect air samples and analyze them</a>. Other methods, such as the <a href="https://doi.org/10.1021/acsnano.0c02439">plasmonic photothermal biosensor</a>, provide promising results, but still require the user to perform the analysis. It will be some time before a smartwatch will be able to alert its wearer to the presence of a dangerous virus.</p>
<h2>Wearable and accessible</h2>
<p>For all the promise of wearables as tools to tackle the COVID-19 pandemic, and future pandemics, there are barriers to widespread use of the devices. Most wearables are expensive, can be difficult to learn to use by non-native English speakers, or are developed without data from a broad population base. There’s a risk that <a href="https://doi.org/10.2196/mhealth.6494">many people won’t accept the technology</a>. </p>
<p>Continued development of broadly accepted health-based wearables should include community input, as outlined in a <a href="https://doi.org/10.17226/23439">National Academies Workshop Summary</a>. By ensuring that everyone has access to wearables, and accepts them, the devices can help keep people healthy in the midst of a global pandemic. Ongoing research should result in improved technology that, with care, will benefit all of society.</p><img src="https://counter.theconversation.com/content/143388/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Albert H. Titus has received research funding from the National Science Foundation, the National Institutes of Health, and the Department of Defense. He has also received funding for research in this area from Garwood Medical Devices.
He is a Senior Member of the IEEE, a member of BMES, ASEE, and is a member of the BME Council of Chairs.</span></em></p>Fitness information like resting heart rate collected by wearable devices can’t diagnose diseases, but it can signal when something is wrong. That can be enough to prompt a COVID-19 test.Albert H. Titus, Professor of Biomedical Engineering, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1410522020-06-23T03:42:35Z2020-06-23T03:42:35ZEvery step you take: why Google’s plan to buy Fitbit has the ACCC’s pulse racing<figure><img src="https://images.theconversation.com/files/343130/original/file-20200622-75522-5r1j5p.jpg?ixlib=rb-1.1.0&rect=89%2C107%2C5901%2C3880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bangkok-thailand-october-06-2018-view-1381312625">Shutterstock</a></span></figcaption></figure><p>The Australian Competition and Consumer Commission (ACCC) has <a href="https://www.accc.gov.au/media-release/google%E2%80%99s-purchase-of-fitbit-raises-preliminary-competition-concerns">expressed concern</a> about Google’s <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">proposed acquisition</a> of fitness tracker company Fitbit. </p>
<p>The acquisition will let Google add years’ worth of Fitbit users’ data to its already unequalled consumer data collection. This could reduce competition in certain health services and other markets in Australia.</p>
<p>Google revealed its plans to acquire Fitbit Inc. for US$2.1 billion last November. But the deal will only go ahead if it gets clearance from competition regulators around the world. </p>
<p>While the ACCC is the first regulator globally to announce its concerns, the <a href="https://www.usnews.com/news/technology/articles/2020-06-16/eu-antitrust-regulators-set-july-20-deadline-for-google-fitbit-deal">European Commission</a> and <a href="https://nypost.com/2020/04/03/feds-ramp-up-probe-of-2-1b-google-fitbit-deal-amid-privacy-worries/">US Department of Justice</a> are also evaluating the deal. Both will likely take an interest in the ACCC’s views, for which <a href="https://www.accc.gov.au/public-registers/mergers-registers/public-informal-merger-reviews/google-llc-proposed-acquisition-of-fitbit-inc">submissions are being accepted</a>.</p>
<h2>Collective concern is called for</h2>
<p>With more than <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">28 million people</a> using Fitbit wearable devices, many have <a href="https://www.theguardian.com/technology/2019/nov/05/fitbit-google-acquisition-health-data">raised concerns</a> about Google adding Fitbit’s sensitive data to its <a href="https://www.wired.com/story/google-tracks-you-privacy/">already extensive tracking</a> of consumers. </p>
<p>Google has left many <a href="https://www.wired.co.uk/article/google-buying-fitbit-health-data-privacy">questions unanswered</a> about how it would use the data. Consumers have reason to be sceptical about Google’s <a href="https://blog.google/products/hardware/agreement-with-fitbit">privacy promises</a>, and the competitive effects of the merger. </p>
<h2>Sharing your intimate details</h2>
<p><a href="https://www.fitbit.com/legal/privacy-policy#info-we-collect">Fitbit collects</a> highly personal information, including sleep patterns, heart rate, active minutes, height and weight, date of birth, food logs, mobile number, biography and precise location data. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">According to estimates by Forbes, Fitbit co-founders James Park and Eric Friedman will each receive as much as US$150 million (before taxes) as a result of selling their shares in Fitbit.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/techcrunch/48843669166/in/photolist-2hq9za1-2hq9zds-2hq9z2R-2hq7Fg5-2hqatFu-2hqatD5-2hq7DuV-gK72e8-gK85aV-v4bND4-onq9rn-K5d9iM-yF6L5x-yF2fNJ-HckB8b-K2cXLo-y1zRxj-yYpUqp-yWBmV9-yF2h3Y-MQCAUc-o4aupd-w1yGoX-oksFeJ-o4aGe3-yXChSp-yF2gwC-yXChcg-o4auZ1-o4aME4-yYpTJz-oiCtsm-oiCsUs-JXiS9P-o4aaab-okC9V5-JXj216-okCuEq-y1Jqi2-okEevr-oknxmr-o4arwE-okE3Hz-K5d7Nn-okEiRR-okEhDF-onqgXp-o4bAMZ-onqayT-okC7rY">TechCrunch/Flickr</a></span>
</figcaption>
</figure>
<p>For those using Fitbit’s live coaching services, it also collects wellness plans and goals, calendar events, and communications with a coach. If you’re a woman using “female health tracking”, data can also include your periods, fertile times, ovulation days and health symptoms. </p>
<p>The ACCC regards Fitbit data as having “<a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">unique attributes</a>”, noting that datasets from other wearable devices are “not as voluminous, reliable or broad”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-accc-is-suing-google-over-tracking-users-heres-why-it-matters-126020">The ACCC is suing Google over tracking users. Here's why it matters</a>
</strong>
</em>
</p>
<hr>
<h2>Google’s privacy reassurances are not binding</h2>
<p>Last November, Google and Fitbit were quick to <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">reassure consumers</a> that “Fitbit health and wellness data will not be used for Google ads”. A Google spokesperson told The Conversation: </p>
<blockquote>
<p>Similar to our other products, with wearables, we will be transparent about the data we collect and why. And we do not sell personal information to anyone.</p>
</blockquote>
<p>However, the ACCC points out <a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">Google is not bound</a> by its commitment to not use the data in its advertising businesses. As the competition watchdog’s <a href="https://www.accc.gov.au/media-release/digital-takeovers-transactions-may-harm-consumers">Chair Rod Sims</a> said:</p>
<blockquote>
<p>It is a stretch to believe any commitment Google makes in relation to Fitbit users’ data will still be in place five years from now.</p>
</blockquote>
<p>When Google acquired online advertising business DoubleClick, it reassured users it <a href="https://slate.com/technology/2016/10/google-changed-a-major-privacy-policy-and-no-one-really-noticed.html">would only combine personal data</a> from the two businesses if users opted into this combination. Eight years later, <a href="https://www.accc.gov.au/system/files/Digital%20platforms%20inquiry%20-%20final%20report.pdf">Google simply deleted this promise</a> from its privacy policy. </p>
<p>It’s also worth noting Google has not promised to refrain from using Fitbit data in its <em>non-advertising</em> businesses. This could include <a href="https://www.ft.com/content/50e1f042-06f3-11ea-a984-fbbacad9e7dd">health services</a> or, in future, <a href="https://www.ft.com/content/b7b3b08a-d4a3-11e9-8d46-8def889b4137">health or life insurance</a>. Google would not need to “sell” your data to use it for these commercial purposes.</p>
<h2>Google’s huge data advantage</h2>
<p>Google already has the most extensive collection of consumer data on the planet. This includes data from Google search, YouTube, Gmail, Google Maps, Google Nest, Android and Google devices – as well as consumer data collected from millions of third-party websites using Google’s services such as Google Analytics, Google Ads and reCAPTCHA. </p>
<p>The ACCC acknowledges Google already uses its pervasive data collection to create <a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">unique profiles of individual users</a>. It points out acquiring Fitbit would give Google “one of the largest and most detailed existing fitness and health datasets, as well as another avenue through which it can continue to gather consumer data”. </p>
<p>The ACCC is particularly concerned the proposed acquisition could substantially reduce competition between Fitbit, Google and others in “data-dependent health services” such as those supplying: </p>
<ul>
<li>tailored digital advice based on individual health signals to users of Fitbit and other wearables on how to improve their health or manage a medical condition</li>
<li>insights to insurance companies or employers wishing to compile risk profiles, reduce costs or enhance productivity </li>
<li>diagnostic tools for medical institutions and doctors to determine early indicators of chronic disease and</li>
<li>insights or raw data for health researchers. </li>
</ul>
<p>If Google acquires Fitbit’s user data, it could gain a significant advantage over other suppliers of these services and prevent them from accessing the dataset. </p>
<p>According to the ACCC, it could also have an incentive hinder rivals such as Apple, Samsung and Garmin, by removing their access to Google Maps, Google Play Store and Wear OS (a Google operating system for wearables).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/amazon-facebook-and-google-dont-need-to-spy-on-your-conversations-to-know-what-youre-talking-about-108792">Amazon, Facebook and Google don't need to spy on your conversations to know what you're talking about</a>
</strong>
</em>
</p>
<hr>
<h2>Entrenching Google’s power in digital advertising</h2>
<p>Google makes most of its annual revenue (more than US$100 billion) from online advertising services. Privacy advocates have <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3587239">criticised the ad tech industry</a>, including dominant players like Google and Facebook, for creating a “<a href="https://medium.com/clearcode/taming-the-wild-west-of-consumer-data-sharing-in-adtech-b3cab26adbe8">data free for all</a>” where consumers’ intimate information is exchanged between hundreds of companies engaged in targeted advertising.</p>
<p>The ACCC says it is concerned that by acquiring Fitbit’s datasets, Google could entrench its market power in certain ad tech markets. For example, it could “even more effectively target advertising to consumers with health-related issues”. </p>
<h2>What can the ACCC actually do about it?</h2>
<p>The ACCC plans to announce its final stance by mid-August on whether Google’s merger with Fitbit would contravene Australia’s competition legislation. If it decides the merger is likely to substantially lessen competition, it could seek orders from the Federal Court to prevent the merger.</p>
<p>But practically speaking, regulators will likely try to coordinate their response internationally, with the overall outcome decided in larger markets such as the United States and European Union. </p>
<p>The <a href="https://www.usnews.com/news/technology/articles/2020-06-16/eu-antitrust-regulators-set-july-20-deadline-for-google-fitbit-deal">European Commission</a> is expected to release its ruling in July. And past <a href="https://www.rferl.org/a/1096891.html">events indicate</a> the commission could impose conditions, or prevent the merger going ahead internationally – even if the US Department of Justice gives it the green light.</p><img src="https://counter.theconversation.com/content/141052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katharine Kemp receives funding from The Allens Hub for Technology, Law and Innovation. She is a Member of the Advisory Board of the Future of Finance Initiative in India, the Centre for Law, Markets & Regulation and the Australian Privacy Foundation.</span></em></p>The watchdog has voiced concerns over the proposed US$2.1 billion merger, from which both users and Australian health services could lose out.Katharine Kemp, Senior Lecturer, Faculty of Law, UNSW, and Academic Lead, UNSW Grand Challenge on Trust, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1088382019-01-13T09:21:42Z2019-01-13T09:21:42ZDNA sequencing can help fight epidemics – but there are privacy risks<figure><img src="https://images.theconversation.com/files/251225/original/file-20181218-27767-1de19kn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A portable DNA sequencer in action.</span> <span class="attribution"><span class="source">UGA CAES/Extension/Flickr</span></span></figcaption></figure><p>The Democratic Republic of Congo is battling an <a href="https://www.sciencemag.org/news/2018/12/ebola-vaccine-having-major-impact-outbreak-may-still-explode-west-africa">Ebola outbreak</a>. As is the case with any disease caused by pathogenic viruses – like Zika or influenza – Ebola spreads dangerously and unpredictably. This makes tracking the movement of viruses around the world a major challenge.</p>
<p>Researchers have increasingly turned to DNA sequencing to help identify and track these sorts of diseases. They use portable DNA sequencers, which are the size of a USB and can be easily carried for use in the field. One such sequencer, the <a href="https://nanoporetech.com/products/minion">MinION</a> from Oxford Nanopore Technologies <a href="http://www.zibraproject.org/about/">was used</a> during the 2016 Zika virus epidemic in Brazil. It’s also being used <a href="https://www.nature.com/articles/s41579-018-0130-0">to track</a> the DRC’s Ebola outbreak.</p>
<p>Some researchers hope it will soon be possible to combine sequencing data collected in this way with other information to tell us even more about disease outbreaks. Integrating different kinds of data into a global infectious disease surveillance system that continuously scans for new epidemics might make it possible to detect outbreaks and sequence viruses as they emerge, allowing public health responses to be suggested in real time.</p>
<p>There’s no doubt these efforts are driven by good intentions. But, as we argue in <a href="https://rgs-ibg.onlinelibrary.wiley.com/doi/full/10.1002/geo2.66">our new research</a>, this technology – which supporters hope will become increasingly available to <a href="https://www.theatlantic.com/science/archive/2016/04/this-technology-will-allow-anyone-to-sequence-dna-anywhere/479625/">members of the public</a> – could have serious privacy implications. </p>
<p>Metagenomic data – the kind that could be collected on a sequencer such as MinION or others such as the <a href="https://www.czbiohub.org/">Chan Zuckerberg Biohub’s</a> new platform IDSeq – contains an enormous amount of information about who we are and how we live. In combination with other widely available information someone could potentially use that data to work out where you live, or with whom you have a close relationship. </p>
<p>The reality is that, as improvements in data analysis methods allow us to extract new insights from old data (or <a href="https://www.theregister.co.uk/2015/10/02/s_korean_anonymised_health_data_sharing_a_breach_in_waiting/">de-anonymise anonymised data</a>), it’s impossible to be absolutely sure what the potential uses of data will be. </p>
<h2>Signing away your data</h2>
<p>Imagine having an app on your smart phone that allows you to analyse samples from the world around you. You could use it to sequence your pet cat’s DNA, or to figure out whether the mould growing in your shower is dangerous.</p>
<p>Sound far-fetched? It’s not. The technology required is already here. For example, the Chan Zuckerberg Biohub recently announced <a href="https://idseq.net/">IDSeq</a>, a new platform and database for infectious disease surveillance where registered users <a href="https://medium.com/czi-technology/a-platform-for-infectious-disease-detectives-253753026fe8">can upload</a> their metagenomic sequencing data to have it analysed for free.</p>
<p>There’s just one catch, as there would be with any sequencing app: you have to sign over permissions to the data. Most people will do this unthinkingly. Author Jamie Susskind <a href="https://www.theguardian.com/books/2018/dec/05/future-politics-by-jamie-susskind-review-when-life-changing-decisions-are-made-by-machines">has called</a> this pervasive and common arrangement “the data deal”: people accept whatever a company asks so they can use an app or product, and worry about the implications later.</p>
<p>This is the case with IDSeq. Initially enthusiastic researchers became <a href="https://twitter.com/firefoxx66/status/1052610954767331330">concerned</a> when they realised the platform’s terms and conditions contained a clause granting the Chan Zuckerberg Initiative “perpetual” permission to “use”, reproduce, distribute, display and create derivative works" from the data. </p>
<p>The current justification given for this clause is that it’s intended to permit users’ research data to be used for improving IDSeq. However, in principle the data could later be shared with <a href="https://assets.idseq.net/Privacy.pdf">“any third party that purchases”</a> part of the assets or organisation. </p>
<h2>A world of information</h2>
<p>So why does it matter if you share metagenomic data from your everyday life? Quite simply, because the data from that cat hair or mould sample might contain more information than you realise – and far more than you intended to sign away. </p>
<p>It could contain not only the DNA you wanted to sequence, but also DNA from your fingers when you loaded the sample, from the bacteria on your skin from the last person you hugged, or from the gardens your cat visited last night. In short, that data contains vital information about your <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426293/">microbiome</a> – the vast collection of microorganisms that live on and in our bodies. And your microbiome can tell someone an awful lot about you.</p>
<p>As we learn more about our microbiomes, we are beginning to understand how much they are personalised. Even if we could filter out the human DNA sequences from datasets, our microbiomes could <a href="http://doi.org/10.1073/pnas.1423854112">theoretically</a> still be used to identify us. </p>
<p>The microbiome contains information not only about our lifestyles, like our diet and drug intake, but also our social relationships, such as who we live with. That’s a lot of information to work with, in a world where we already share a great deal of data about ourselves via platforms like Facebook and Instagram, or personal fitness trackers. This data could feasibly be merged with metagenomic data, making it even more powerful. </p>
<p>There are ever more surprising examples of incidental data being used in dramatic and unexpected ways that are far removed from the original reasons for collecting it. Data from a murder victim’s Fitbit was <a href="https://www.nytimes.com/2018/10/03/us/fitbit-murder-arrest.html">used</a> to convict her killer. And data from users of the fitness app Strava inadvertently <a href="https://www.theguardian.com/world/2018/jan/28/fitness-tracking-app-gives-away-location-of-secret-us-army-bases">revealed</a> the location of secret US army bases. </p>
<p>There is every reason to believe that data from portable sequencers collected primarily for disease surveillance would contain information that could be used in similarly surprising, and concerning, ways. Metagenomic sequencing data is highly personalised. It contains implicit information about who we interact with and where we go, which makes it commercially valuable. </p>
<p>These concerns shouldn’t (and won’t) stop portable sequencers being used for infectious disease surveillance. Corporations and governments will promise great benefits from the use of this technology. For example, the IDSeq privacy notice justifies data collection by <a href="https://assets.idseq.net/Privacy.pdf">appealing</a> to “legitimate interest in investigating and stopping the spread of infectious diseases and promoting global health”. </p>
<p>We need to continue scrutinising these organisations to make sure we understand exactly what’s being done with our data. The consequences of widespread portable sequencing, like emerging infectious diseases themselves, will be highly unpredictable.</p><img src="https://counter.theconversation.com/content/108838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers have increasingly turned to DNA sequencing to help identify and track diseases like Ebola.Liam Shaw, Computational biologist, University of OxfordNicola C. Sugden, PhD Researcher, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037322018-09-23T15:30:40Z2018-09-23T15:30:40ZWhy life insurance companies want your Fitbit data<figure><img src="https://images.theconversation.com/files/237563/original/file-20180923-129844-ypitj4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Industry representatives wear fitness trackers at the International Consumer Electronics Show in January 2014 in Las Vegas. Health and fitness information is being increasingly shared with insurance companies.</span> <span class="attribution"><span class="source">(AP Photo/Julie Jacobson)</span></span></figcaption></figure><p>I recently predicted that health data from electronic sources could soon be compiled <a href="https://theconversation.com/turning-your-health-data-into-a-wellness-score-might-not-be-good-for-you-100641">into a health or wellness report</a> and shared with insurance companies to help them determine who they’ll cover.</p>
<p>And now John Hancock, the U.S. division of Canadian insurance giant Manulife, <a href="https://www.cbc.ca/news/business/john-hancock-manulife-1.4831629">requires customers to use activity trackers</a> for life insurance policies in their Vitality program if they want to get discounts on their premiums and other perks.</p>
<p>Customers can withhold their fitness data, but that will result in higher premiums, which may put life insurance out of reach for low-income earners. This in turn could have an impact on whether would-be homeowners can take out mortgages, some of which can require a life insurance policy on the principle borrower.</p>
<p>The fact that insurance companies track the physical activities of customers <a href="https://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance/#bb045aa18bd5">has been making headlines for years</a>, but previous initiatives were pilot projects. </p>
<p>Now, customers who don’t want to offer up their health data to John Hancock have two choices: Don’t report it and pay higher premiums, or go somewhere else for their insurance. </p>
<p>But what’s going to happen if other companies follow suit? </p>
<h2>Figuring out when you’re having sex?</h2>
<p>Your privacy will be infringed upon by apps that pass on to your insurer all of the activities you do while wearing your smartwatch. </p>
<p>That could include steps walked, heart rate, blood pressure – your insurer may even be able to figure out when you’re having sex.</p>
<p>This is nothing new. We’ve long known that wearable technology records <a href="https://www.priv.gc.ca/en/privacy-topics/technology-and-privacy/digital-devices/02_05_d_73_wd/">“data about you and your condition, activities and day-to-day choices.”</a> </p>
<p>And we know that that data collected by these devices and through our internet activities “continually leak.” In fact, researchers have discovered that <a href="https://www.forbes.com/sites/leemathews/2017/06/13/70-percent-of-mobile-apps-share-your-data-with-third-parties/">70 per cent of third-party apps collect data that can then be used to create a profile of buying and spending habits</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tech-gifts-for-unsavvy-seniors-may-put-your-loved-ones-at-risk-88913">Tech gifts for unsavvy seniors may put your loved ones at risk</a>
</strong>
</em>
</p>
<hr>
<p>So is it really a problem that customers use wearable technology like Fitbit and report their healthy activities, such as workouts and healthy eating, to their insurer?</p>
<p>Well, yes. One problem is that this information is not always correct. <a href="https://help.fitbit.com/articles/en_US/Help_article/1136">Fitbit itself acknowledges</a> that “the algorithm is designed to look for intensity and motion patterns that are most indicative of people walking and running” and that it may not always be accurate in reporting other activities, such as riding a bike or working.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Will insurers be able to dictate how much time mothers need to recover from childbirth before they start exercising again?</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Then there’s the question of what happens with your premiums if you stop engaging in these activities. How much time will insurance companies allow women to recover from childbirth before they have to get back to their insurance plan’s requirements for physical activity? </p>
<p>What about people recovering from joint replacements or heart surgery? How long will these people have before their premiums go up?</p>
<h2>Older adults at risk</h2>
<p>Older adults are especially vulnerable to this sort of data-based gatekeeping. The glitches in wearable technology’s data collection may be amplified with older people, whose exercise behaviour might not be as strenuous as that of younger adults, and therefore subject to more recording errors. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older adults’ exercise activities may not be accurately detected by wearable technology.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In addition to the potential under-recording of their fitness activities, many people over 65 years old have at least one illness, which, when combined with data errors, may make them ineligible for discounted insurance programs. This could change the retirement opportunities for many older adults.</p>
<p>And what about the healthy lifestyles that insurance companies reward their customers for living? </p>
<p>Diet, fitness and medication regimes go in and out of favour. Taking “baby aspirin,” for example, to prevent heart attacks and stroke <a href="https://www.vox.com/2018/9/17/17869872/aspirin-heart-disease-cancer-prevention">has recently been shown to be ineffective</a> for healthy adults.</p>
<p>Another example of the fickleness of health trends involves healthy eating guru Brian Wansink, <a href="https://www.vox.com/science-and-health/2018/9/19/17879102/brian-wansink-cornell-food-brand-lab-retractions-jama">who’s had some academic articles retracted,</a> including those that told us not to go grocery shopping when we’re hungry and not to use large bowls when we’re eating. </p>
<p>This all suggests that the food and activity choices of insurance companies are linked to scholarly research. </p>
<h2>Conflict of interest?</h2>
<p>But what happens if a multinational business owns both insurance and manufacturing companies? Is it possible that insurance perks and discounts could be linked to purchases from their subsidiaries, disguised as “health initiatives?” </p>
<p>In other words, the insurer could reward customers for adhering to a health regimen that might be helpful, but could also be bogus or, in the worst-case scenario, harmful or exploitative while financially benefiting the insurance company.</p>
<p>If legislators don’t get involved, Big Business could end up literally dictating to us what we can and can’t do, or eat, if we want or need insurance. </p>
<p>For those who can’t afford healthy food or recreational fitness, and those who refuse to allow their data to be harvested, life insurance premiums, and other products like mortgages, may drift out of reach.</p><img src="https://counter.theconversation.com/content/103732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L.F. Carver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Insurer John Hancock now requires customers to use activity trackers for life insurance policies. Here’s how that will put life insurance and even mortgages out of reach for many people.L.F. Carver, Post Doctoral Fellow, Queen's University and Ageing + Communication + Technologies (ACT) (SSHRC funded), Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/980952018-06-19T14:33:17Z2018-06-19T14:33:17ZHow reliable is your wearable heart-rate monitor?<figure><img src="https://images.theconversation.com/files/223603/original/file-20180618-85858-jj0j42.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/407841229?size=medium_jpg">Sergey Nivens/Shutterstock.com</a></span></figcaption></figure><p>Fitbit, Garmin and other consumer heart-rate monitors are increasingly being used in clinical trials. The problem is, they’re not always very accurate.</p>
<p>A search of <a href="https://clinicaltrials.gov/ct2/results?intr=fitbit">ClinicalTrials.gov</a>, the world’s largest clinical trials database, reveals nearly 200 trials involving Fitbit devices. Makers of consumer heart-rate monitors, however, clearly state that they are not intended for medical purposes. For example, <a href="https://www.fitbit.com/legal/safety-instructions">Fitbit declares</a> that their product is “not a medical device” and “accuracy of Fitbit devices is not intended to match medical devices or scientific measurement devices”. Similarly, <a href="https://support.garmin.com/en-US/?productID=154886&tab=manuals">Garmin makes it clear</a> that its Vivosmart device is for “recreational purposes and not for medical purposes” and that “inherent limitations” may “cause some heart rate readings to be inaccurate”.</p>
<p>Despite these disclaimers, monitors that include a heart-rate reading can elicit consumer expectations. Disappointment with device performance has led to a <a href="https://www.lieffcabraser.com/pdf/Fitbit-060518-Order-re-Motion-to-Dismiss.pdf">class action lawsuit in California against Fitbit</a>, alleging that its heart-rate monitors are “grossly inaccurate and frequently fail to record any heart rate at all”. </p>
<p>So how do optical heart-rate monitors work, and why aren’t they always accurate?</p>
<h2>How they work</h2>
<p>The science behind optical heart-rate monitors is something called <a href="https://www.news-medical.net/health/Photoplethysmography-(PPG).aspx">photoplethysmography</a> (PPG): the measurement of artery volume using light. When light emitted by the monitor enters the skin, most of it is absorbed by body tissues, but some is reflected. The amount of reflected light depends on several factors, one of which is the volume of arteries near the skin’s surface. </p>
<p>Blood in the arteries absorbs light better than the surrounding body tissues so, as arteries contract and swell in response to the pulsating blood pressure, the intensity of the reflected light rises and falls. PPG devices detect this variation in reflected light and use it to estimate heart rate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=174&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=174&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=174&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=219&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=219&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=219&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Optical heart rate sensing. Left: lower pressure preceding the pulse wave means narrower arteries and less absorption (higher reflectivity) of the green light source. Right: a higher blood pressure pulse causes wider arteries and more light absorption (lower reflectivity).</span>
<span class="attribution"><span class="source">Tim Collins</span></span>
</figcaption>
</figure>
<p>The reflected light variation due to heart rate is typically no more than about 2% – a change that is imperceptible to the human eye. Physical movement, however, causes much greater effects, so much so that even small movements can make the much weaker pulse signal impossible to detect. Signal losses caused by movement at the sensor-skin interface can mean that simply walking can be enough to mask the pulse signal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=205&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=205&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=205&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=258&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=258&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=258&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">PPG sensor outputs. Left: while sitting still, showing an easily identified heart-rate signal. Right: the same sensor minutes later while walking.</span>
<span class="attribution"><span class="source">Tim Collins</span></span>
</figcaption>
</figure>
<p>It can be very difficult to accurately estimate heart rate from a corrupted PPG signal. Mathematical techniques can help in some cases, but often the motion interference and heart-rate signals overlap so much that the two are impossible to separate. For example, repeating interference signals caused by walking at 100 steps per minute can be indistinguishable from a heart rate of 100 beats per minute.</p>
<p>To reduce the chances of incorrect heart-rate readings, a common strategy is to stop recording when high levels of motion interference are detected. Unfortunately, this means that during periods of vigorous exercise, when many users are most interested in their heart rates, their PPG activity monitor might fail to record anything at all.</p>
<p>Detecting when a signal is corrupted is also not easy. Inevitably, some bad estimates of heart rate will be recorded in error. In <a href="https://www.researchgate.net/publication/325828687_Reliability_Assessment_of_New_and_Updated_Consumer-Grade_Activity_and_Heart_Rate_Monitors">recent experiments we conducted</a>, using four identical heart-rate monitors (two on each wrist), we observed recorded heart rates as low as half and as high as nearly double the person’s actual heart rate. Consistency between the devices varied depending, largely, on the level of activity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=216&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=216&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=216&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=271&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=271&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=271&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Example of experimental results comparing four identical Garmin VivoSmart 3 monitors during an 80 minute treadmill walking exercise. Walking speeds were increased every 20 minutes, from slow (2.4km/h) to vigorous (6.4km/h). Electrocardiogram (ECG) data for comparison was recorded using a chest-strap heart-rate monitor.</span>
<span class="attribution"><span class="source">Tim Collins</span></span>
</figcaption>
</figure>
<h2>Cheap and convenient</h2>
<p>The popularity of optical heart-rate monitors that can be worn on the wrist is largely due to the convenience and low cost of the devices. However, during periods of physical activity, accurately estimating a person’s heart rate using these devices remains challenging. And we should not expect dramatic improvements in reliability unless there are fundamental changes in the sensor technology. This is not a reflection of the quality of the devices, but rather an inevitable technological limitation of optical sensing. </p>
<p>Whether the labelling of these devices as a “heart-rate monitor” risks creating unrealistic expectations is a different matter.</p><img src="https://counter.theconversation.com/content/98095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Heart-rate monitors can be accurate – as long as you don’t move.Tim Collins, Senior Lecturer in Electronic Engineering, Manchester Metropolitan UniversityIvan Miguel Pires, PhD Researcher, University of Beira InteriorSalome Oniani, PhD Researcher, Georgian Technical UniversitySandra Woolley, Senior Lecturer, Software and Systems Engineering Research, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/898842018-01-11T14:42:04Z2018-01-11T14:42:04ZA brief history (and a look into the future) of fitness technology<figure><img src="https://images.theconversation.com/files/201617/original/file-20180111-60756-u6idf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kaunas-lithuania-febryary-06-2016-activity-373912909?src=8CO3imS85C5qsS8M2Jsk-w-1-23">Shutterstock</a></span></figcaption></figure><p>Have you recently taken ownership of a shiny new activity tracking device? For many people, the essential fitness kit now includes gadgets designed not for sitting and staring at a screen, but for encouraging users to get up and move. </p>
<p>And they even come with political recommendations. For the UK Government, apps like <a href="http://www.mapmyrun.com/">MapMyRun</a> and <a href="https://www.strava.com/">Strava</a> and wearable technologies made by <a href="https://www.fitbit.com/uk/home?utm_source=&utm_medium=paidsearch&dclid=CNj64svLz9gCFcmmUQodROcDpw">Fitbit</a> and <a href="https://jawbone.com/">Jawbone</a> are the future. According to <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/486622/Sporting_Future_ACCESSIBLE.pdf">one official document</a>: “[They] will define the world of sport and physical activity in the coming decade.”</p>
<p>But health and fitness technologies also have a long history. </p>
<p>At the beginning of the 20th century, physical activity was seen by some as a bulwark against the ills of modernisation, such as the increasingly sedentary nature of work. As the American educator Dudley Sargent <a href="https://archive.org/stream/physicaleducatio00sarg#page/44/mode/2up/search/whereas">put it</a> in his 1906 book <a href="https://www.amazon.co.uk/Physical-Education-Dudley-Allen-Sargent/dp/114263762X">Physical Education</a>:</p>
<blockquote>
<p>A large portion of the population never use half their faculties, and if they pursue the same employment for a term of years they are apt to acquire defects of structure, if not of constitution and character, that are transmitted to the next generation. </p>
</blockquote>
<p>Physical activity as a leisure pursuit became highly significant. Mechanical apparatus such as wall-attachable weight-pulley devices were designed to guard against such “defects of structure” – and of character, too. In other words, the point was to bolster the body and mind. According to some, this would ensure the well-being of the population.</p>
<p>These were not just devices for men. The 1904 book Physical Culture for Women, authored by the world champion woman bag-puncher Belle Gordon, <a href="https://archive.org/stream/physicalculturef01gord#page/n97/mode/2up/search/exerciser">featured an advertisement</a> for the “Fox Exerciser” weight-pulley machine. As a resistance training device, the Fox Exerciser was similar to exercise equipment promoted by other proponents of physical culture, such as famous strongman <a href="https://archive.org/stream/strengthandhowt00sandgoog#page/n36/mode/2up/search/exerciser">Eugen Sandow</a>.</p>
<p>Nearly a century later, another movement was afoot: the fitness boom of the 1970s and 1980s. At this point, electronic technology became especially important in combating the sedentary nature of modern living. </p>
<p>Electronic technology meant communication devices like the VCR (videocassette recorder). Actress Jane Fonda’s exercise videos modelled what an “ideal” body looked like and <a href="http://www.sunypress.edu/p-2843-sport-and-postmodern-times.aspx">how it might be attained</a>. And they sold in their millions.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/deKHYCsjseg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Meanwhile, devices such as electronic treadmills and exercise bikes became staples in fitness gyms, and were also widely available as home equipment. In its July 1989 edition, outdoors magazine Field and Stream highlighted the merits of these electronic devices, <a href="https://books.google.co.uk/books?id=8ZO7cJuYfFsC&pg=PA64&lpg=PA64&dq#v=onepage&q&f=false">claiming they were</a> “smoother and quieter, more convenient to use than most mechanical systems, and provide a workout customised to your fitness level”.</p>
<h2>The future of fitness</h2>
<p>Today, digital and wearable health and fitness technologies are seamlessly integrated into our everyday lives. Your smartphone itself is a <a href="https://www.routledge.com/Fitness-Technology-and-Society-Amusing-Ourselves-to-Life/Millington/p/book/9781138948037">fitness tracking device</a>. So what makes our present day technologies unique?</p>
<p>For one thing, their personalisation. The health and fitness entrepreneurs of the early 1900s spoke to the masses, but while the treadmills of the 1970s and 1980s marked an important step towards customisation, today’s wearable devices and health and fitness apps are deeply personal. They track and monitor seemingly everything, from what we eat, to how we sleep, to how often we move, to the composition of our bodies.</p>
<p>Then there’s portability. In the late 1800s, the American orator, preacher, and educator <a href="https://archive.org/details/physicalculture00collgoog">Charles Wesley Emerson</a> lamented that while exercise equipment such as dumb bells <a href="https://archive.org/stream/physicalculture00emer#page/18/mode/2up/search/rings">had value</a>, they hindered mobility: “We cannot carry gymnasiums about with us.” Even near the end of the 20th century, health and fitness practices were largely confined to the gymnasium and the home. </p>
<p>Today’s technologies are for anywhere and anytime. They travel with us <a href="https://doi.org/10.1080/15295036.2014.973429">wherever we go</a>. Technology facilitates, rather than hinders, mobility.</p>
<p>A final factor is commercialisation – that is, beyond the simple selling of Fox Exercisers and Jane Fonda workout videos. Whereas in the past it was just the technologies themselves that were sold for profit, today, so is our data. <a href="http://adage.com/article/privacy-and-regulation/ftc-signals-focus-health-fitness-data-privacy/293080/">A study</a> by the US Federal Trade Commission found that 12 health and fitness apps shared user data with 76 third parties, advertisers among them. Or, as a Wall Street Journal report bluntly <a href="https://www.wsj.com/articles/SB10001424052748704694004576020083703574602">put it</a>: “Your apps are watching you.”</p>
<p>So where next? We should expect the health and fitness technologies of the future to be even more personalised in assessing our bodies and daily habits. We should also expect them to be further integrated into our daily lives, to the point where their presence is undetectable. And we should expect technologies to be more sophisticated than ever in producing data from which value can be extracted (such as helping companies know consumer habits and preferences).</p>
<p>For the UK government, the future of health and fitness technology is cause for optimism. But ever more personalisation should not overshadow what we know about the <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf">social determinants of health</a>, meaning the wider conditions in which people are born, grow, live and work. </p>
<p>The combination of ever more intimate data and the profit motive to mine these data is also cause for concern when it comes to <a href="https://openeffect.ca/fitness-tracker-privacy-and-security/">privacy and security</a>. So while trackers might make us feel like we have more control and a more personal relationship with fitness, a degree of scepticism would be healthy.</p><img src="https://counter.theconversation.com/content/89884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brad Millington receives funding from the Social Sciences and Humanities Research Council of Canada. He is the author of the book "Fitness, Technology and Society: Amusing Ourselves to Life" (2018, Routledge, <a href="https://www.routledge.com/Fitness-Technology-and-Society-Amusing-Ourselves-to-Life/Millington/p/book/9781138948037">https://www.routledge.com/Fitness-Technology-and-Society-Amusing-Ourselves-to-Life/Millington/p/book/9781138948037</a>).</span></em></p>Fitbits and other trackers are just the latest iteration of the fitness industry’s relationship with technology.Brad Millington, Lecturer, Department for Health, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/890802017-12-19T19:24:00Z2017-12-19T19:24:00ZThe social factors that influence whether you’ll use your wearable device<figure><img src="https://images.theconversation.com/files/199611/original/file-20171218-17884-lqxhud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sales of Apple smartwatches are increasing, while Fitbit sales are on the decline.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3ASmartwatch-828786.jpg">By Crew [CC0 or CC0], via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Christmas is upon us, and the New Year fast approaching. Many of us are buying wearable self-tracking devices for loved ones, or as part of our own New Year self-improvement regimes. </p>
<p>Wearable devices, as the name suggests, are technologies with digital sensors that can be worn in various ways on the body. It’s estimated that worldwide shipments of wearables this year will reach <a href="https://www.idc.com/getdoc.jsp?containerId=prUS42818517">125 million</a>. </p>
<p>But how useful are they, and what benefits do they provide to users?</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/fitbits-decline-is-a-reflection-of-the-end-of-the-over-hyped-promise-of-wearables-73823">Fitbit's decline is a reflection of the end of the over-hyped promise of wearables</a>
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<h2>The wearable craze</h2>
<p>There is a now <a href="https://www.amazon.com/Wearable-Technology/b?ie=UTF8&node=100487000110">huge range</a> of wearable devices available: smart sneakers to analyse your walking pattern, smartwatches to count your calories, wristbands to assess your sleep quality, and smart gloves to help you with your golf swing.</p>
<p>It makes sense that the companies that sell wearables, and the entrepreneurs who develop them, talk up these devices. However, industry blogs and market research suggest the excitement is beginning to wear off. </p>
<p>While sales for smartwatches, such as the Apple Watch, <a href="https://techcrunch.com/2017/08/01/apple-watch-sales-up-over-50-since-last-year">are healthy</a>, Fitbit – one of the market leaders – has seen its <a href="https://www.smartcompany.com.au/technology/one-five-australians-use-wearables-business-smartwatch-friendly/">fortunes decline</a>. </p>
<p>Most research into wearable use involves surveys. For example, <a href="https://www.smartcompany.com.au/technology/one-five-australians-use-wearables-business-smartwatch-friendly/">a 2016 survey of the Australian market</a> showed that fewer than one in five respondents used wearables. </p>
<p>Colleagues and I have conducted three different qualitative studies with Australians aged from 18 to 75 years old about their use of wearables and smartphone apps for health and fitness. </p>
<p><a href="http://journals.sagepub.com/doi/pdf/10.1177/2053951717700924">The first study</a> involved ten male and eight female cyclists who used digital devices to monitor their rides. <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3085751">The second study</a> included 40 people (split evenly by gender) who were self-tracking for any purpose. The final study involved 55 women using a range of digital health technologies.</p>
<p>The research revealed some of the key reasons people use wearables and health apps, and why they give them up. </p>
<h2>What wearables are good for</h2>
<h3>Taking control over health and wellbeing</h3>
<p>Michael, a 35-year-old father, uses apps to track his food intake and physical activity. In his interview, he said,</p>
<blockquote>
<p>To be a responsible husband, father and son, I need to track things, whether it be health or finances. </p>
</blockquote>
<h3>Providing motivation to achieve personal bests</h3>
<p>Damon, 48, is a keen cyclist who uses a bike computer to monitor his cycling trips and he uploads his data to the cycling platform, Strava. In his interview, he confessed that,</p>
<blockquote>
<p>I’m kind of obsessed with going for local course records or testing myself on certain courses.</p>
</blockquote>
<h3>Spurring healthy competition</h3>
<p>Embarking on fitness tracking together with others can also increase motivation. Valerie, 62, uses the same type of fitness band as her husband. She commented that,</p>
<blockquote>
<p>It’s fair to say that we engage in a little friendly competition. </p>
</blockquote>
<p>This may mean that one of them sets out for a late-night walk, just to reach their target for the day.</p>
<h3>Giving real-time feedback</h3>
<p>Fitness trackers that allow users to review data in real-time can spur them to work harder to improve their numbers. Valerie said that,</p>
<blockquote>
<p>If I actually get up to my 10,000 steps, you get the buzz and the flashing lights….So that’s pretty exciting!</p>
</blockquote>
<h3>Learning healthy behaviours</h3>
<p>Some fitness trackers are useful for a limited time while they teach users healthy behaviours. </p>
<p>Jessica, 22, is a keen team sports player, and uses a calorie-counting app to help her lose weight and eat better. She commented that after using the app for some months,</p>
<blockquote>
<p>I can now take a look at a plate of food and pretty accurately guess how many calories it has. </p>
</blockquote>
<h3>Creating a sense of community</h3>
<p>Devices that plug into an online community of fellow fitness trackers can support efforts to improve fitness. Danielle, 35, shares her Fibit and Strava data and photos of her cycling trips with her friends. She said,</p>
<blockquote>
<p>All my friends are very encouraging and I’m encouraging of them, particularly when they’re getting into cycling.</p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/downside-of-fitness-trackers-and-health-apps-is-loss-of-privacy-69870">Downside of fitness trackers and health apps is loss of privacy</a>
</strong>
</em>
</p>
<hr>
<h2>Why people give up on wearables</h2>
<h3>Goals feel unachievable</h3>
<p>At times, fitness trackers can become a source of negativity by reminding users of what they’re failing to achieve. </p>
<p>Carolyn, 33, is a new mother who used to wear a Fibit to track physical activity, energy expended and sleep patterns. However, now that she has a small baby, she doesn’t want a device to make her feel even worse about her poor sleep and lack of exercise through detailed monitoring. She said,</p>
<blockquote>
<p>My baby’s having a clingy day today - I could barely put him down this morning. As if I’m going to get 10,000 steps! </p>
</blockquote>
<h3>Reminders can become annoying</h3>
<p>If circumstances prevent users from reaching fitness targets, constant alerts can prompt them to switch off. Valerie has a demanding desk-bound job and can’t easily jump to her feet just because her device is asking her to. She describes her wearable as sometimes “pestering” her.</p>
<h3>Lack of community support</h3>
<p>If friends, partners or family members aren’t supportive, this can make a big difference to success with wearables. </p>
<p>Friends of sportswoman Jessica sometimes criticise her for paying so much attention to her diet and weight using a calorie-counting app. She said,</p>
<blockquote>
<p>I think there’s a real stigma about calorie counting. It’s like a bad thing and it means you’re preoccupied with the way you look or you’re not happy within yourself. </p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-way-we-walk-can-be-used-to-power-and-secure-our-devices-76152">The way we walk can be used to power and secure our devices</a>
</strong>
</em>
</p>
<hr>
<p>As these participants’ stories show, people’s social networks, employment conditions and life stages are integral to their use of wearable devices. Understanding how these factors have an impact on the use of fitness trackers can help you make the best use of your wearable device.</p>
<p>So if you’re considering buying a Fitbit for a relative who’s a new mother, you should think about whether she has the time or inclination for self-tracking right now. If you’re chained to a desk job, you might choose a device that won’t send you alerts during the day. And if your friends and family won’t support your self-tracking activities, you might want to join an online community that will.</p><img src="https://counter.theconversation.com/content/89080/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that people’s social networks, employment conditions and life stages all impact their use of wearable devices. Understanding these factors can help you achieve your fitness goals.Deborah Lupton, Centenary Research Professor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/844252017-09-28T23:13:15Z2017-09-28T23:13:15ZHow to stop sitting yourself to death<figure><img src="https://images.theconversation.com/files/187902/original/file-20170927-20330-1fkp19r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When we sit, we accumulate calories and excess fat which can cause obesity, diabetes, cancer, heart disease and death. The solution may be as simple as counting.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Sitting is probably killing you slowly — whether you exercise vigorously every day or not. Sitting has been referred to as <a href="http://www.techrepublic.com/article/is-sitting-really-the-new-smoking-an-in-depth-discussion-with-the-experts/">the new smoking</a>. And a recent study shows that <a href="http://annals.org/aim/article/2653704/patterns-sedentary-behavior-mortality-u-s-middle-aged-older-adults">risk of death begins to rise if bouts of sitting persist for longer than 10 minutes</a> at a time.</p>
<p>How do we reverse this evolutionary trend towards laziness? This question preoccupies me, as a cardiologist and a senior scientist with the Toronto Rehabilitation Institute and University Health Network. In my clinical practice, I make certain that patients receive appropriate medical therapies to improve their quality of life and longevity. But physical activity is one therapy I cannot prescribe as effectively. </p>
<p>One solution is to think of physical activity as a “pill.” As with other medical prescriptions, this “pill” requires a preparation, a quantity and a strength. </p>
<p>To know how much to take, we must monitor our behaviours. We must count the number of minutes per week we embark on moderate to vigorous physical activity. We must count the number of hours per day we remain sedentary and count the number of minutes we remain sitting at any one point in time. </p>
<h2>What’s wrong with sitting anyway?</h2>
<p>We know that physical inactivity has significant adverse implications to our health. <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31634-3/fulltext">A recent study</a> examining more than 130,000 patients from more than 17 countries worldwide estimated that one in 12 deaths could be prevented if everyone exercised 30 minutes per day, five days per week at just moderate intensity. </p>
<p>Exercise prevents many chronic diseases, including heart attacks, strokes, diabetes and cancer. It <a href="https://www.ncbi.nlm.nih.gov/pubmed/2795824">improves our cardiopulmonary fitness levels</a> — a measure of how efficiently our oxygen is extracted from our blood into our organs and tissues throughout our body — and is linked closely to our overall health and survival.</p>
<p>Now evidence suggests that our <em>sitting times</em> and sedentary behaviour also have important impacts on health, irrespective of physical activity levels. For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25599350">a recent review by our team</a> found that sedentary times of six to nine hours or more per day are associated with a higher risk of death, cancer and cardiovascular disease. The greatest risks are linked to type II diabetes. In this study, moderate physical activity only partially reduced, but did not eliminate, the risks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A new generation of smartwatches allows people to count their steps and count their minutes of sedentary activity, as well as measuring heart rate and sleep quality.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The <em>duration</em> we sit at any one time may also count against our health. Patients who sit for prolonged periods burn fewer calories than those who stand or move frequently throughout the day. Insufficient calorie expenditures may result in excessive fat, which may be <a href="https://insights.ovid.com/crossref?an=00003677-900000000-99797">toxic to our metabolism</a>. Such toxicity can <a href="https://www.ncbi.nlm.nih.gov/pubmed/17987311">give rise to chronic diseases</a> such as obesity, diabetes, cancer, heart disease and death. </p>
<p>In sum, while moderate to vigorous physical activity may improve our fitness levels, sedentary behaviour may accumulate calories and fat. <a href="http://circ.ahajournals.org/content/134/13/e262">Each behaviour affects our health and survival</a> in different ways. </p>
<h2>Laziness: A new evolutionary trend?</h2>
<p>As humans, we are primed to move. One needs only to look at babies and toddlers who, once they have acquired the motor development skills to crawl and walk, rarely keep still. To explore their environment, they need to move through space. </p>
<p>Then, at some point, a child becomes more sedentary. Perhaps through their first exposure to TV, their first video game or Internet search, children realize that their quest for self-discovery need not involve movement. The seeds of the disease known as physical inactivity are planted, with devastating <a href="http://www.cps.ca/en/documents/position/screen-time-and-young-children">physical and psychosocial health impacts</a>. Parents may offer little treatment to their children, for they too have been inflicted.</p>
<p>Of course, things weren’t always this way. From an evolutionary perspective, we were once hunters and gatherers. This necessitated high amounts of physical activity throughout the day just to procure water and food for survival. It has been estimated that between one third and one quarter of the total energy consumed by our ancestors was burned through physical activity. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One 2012 Canadian study found that children who watched just an hour of TV per day were 50 per cent more likely to be overweight than those who watched less.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Contemporary humans <a href="https://books.google.ca/books?hl=en&lr=&id=uMohwgMMrBgC&oi=fnd&pg=PA49&dq=evolution%3B+calorie%3B+ancestors+vs.+contemporaries%3B+physical+activity&ots=IhvDLBb9IF&sig=fFcIhFogBNH1GNj4x1AYZhFuCOA#v=onepage&q&f=false">burn a much smaller component of their total energy</a> through physical activity. Even when compared against highly agricultural societies, the physical activity levels of most adults pale by comparison. For example, one study demonstrated that average daily steps taken in the U.S. population are <a href="https://www.ncbi.nlm.nih.gov/pubmed/20980470">less than half of that among older order Amish communities</a>.</p>
<p>Perhaps not surprisingly, the decline in physical activity levels over the last several decades has come from <a href="https://www.ncbi.nlm.nih.gov/pubmed/24658411">non-recreational physical activity</a>, i.e. work. Most alarming has been the dramatic reduction in physical activity among youth and adolescents. </p>
<p>If this evolutionary trend continues, we are looking at a bleak future.</p>
<h2>Counting can help you survive</h2>
<p>How to reverse this trend? Well, assuming that optimal health requires patients to both undertake moderate to vigorous physical activity and avoid excessive sedentary behaviour, solutions seem rather intuitive. Move more, and sit less. </p>
<p>To avoid sitting yourself to death, you can follow some simple strategies:</p>
<ol>
<li><p><strong>Take frequent standing or walking breaks.</strong></p></li>
<li><p><strong>Limit sitting episodes to under 30 minutes (particularly at work).</strong></p></li>
<li><p><strong>Take 10,000 steps or more per day.</strong></p></li>
<li><p><strong>Engage in 150 minutes of moderate to vigorous physical activity per week.</strong></p></li>
<li><p><strong>Engage in resistance (strength) training two days per week.</strong></p></li>
</ol>
<p>Strength training improves muscle mass and resting metabolism, minimizes weight gain and helps prevent osteoporosis.</p>
<p>While humans are primed to move, urbanization, technology and societal norms have resulted in our physical stagnation. We have become sedentary, physically inactive creatures. And the solution may be as simple as counting. </p>
<p>As I sit here, I am reminded by my cellphone alarm that my 30 minutes of uninterrupted sitting must come to an end. My writing of this article must cease. I ask my nine year old to stop playing video games and to join me for a few minutes of catch outside. He reluctantly agrees, and proceeds by asking Alexa to turn off his TV on his behalf. </p>
<p>Oh well, at least it’s a start.</p><img src="https://counter.theconversation.com/content/84425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. David Alter has received external funding, as part of a research grant from the Heart and Stroke Foundation of Canada. He is also a Research Chair in Cardiovascular and metabolic rehabilitation, Toronto Rehabilitation Institute-University Health Network.</span></em></p>If you sit all day at work, then cancer, diabetes, heart disease and death are the likely outcomes. A cardiologist explains how the simple act of counting can reverse this evolutionary trend.David Alter, Associate Professor of Medicine and Senior Scientist, Toronto Rehabilitation Institute, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/725652017-02-17T02:00:57Z2017-02-17T02:00:57ZCould your Fitbit data be used to deny you health insurance?<figure><img src="https://images.theconversation.com/files/157171/original/image-20170216-17922-xw57nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A log of your preexisting conditions?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/timo_w2s/31731774776/">Timo Newton-Sims/timo_w2s/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Wearing a fitness tracking device could earn you <a href="http://www.investopedia.com/news/fitbit-healthcare-deal-unitedhealth">cash from your health insurance company</a>. At first, this sounds lucrative for the people who participate, and good for the companies, who want healthier insurance customers. But it’s not quite so simple.</p>
<p>Under the program, people who have certain health insurance coverage plans with UnitedHealthcare can elect to wear a Fitbit activity tracker and share their data with the insurance company. The data would be analyzed by Qualcomm Life, a company that processes medical data from wireless sensors for doctors, hospitals and insurance companies. Depending on how active participants are, as measured by the Fitbit, they could <a href="https://www.uhc.com/news-room/2017-news-release-archive/wearables-and-wellness-program">earn as much as US$1,500</a> toward health care services each year.</p>
<p>Interest in wearable fitness trackers is <a href="https://www.fool.com/investing/general/2016/03/20/7-wearable-tech-trends-to-watch-over-the-next-5-ye.aspx">booming</a>. More than half of people who already own one believe their devices will help them <a href="http://www.digitaltrends.com/wearables/wearables-healthcare/">increase their life expectancy by 10 years</a> – even though it’s impossible to actually know that because the clinical trials necessary would take at least a decade. Adding free money to the mix only makes the devices seem more attractive.</p>
<p>Before we celebrate this new partnership, though, it’s important to consider potential costs to the patients. We are not far from days when wearable health devices will be able to diagnose illnesses. While this is not legal now, if Obamacare were repealed, as Republicans have vowed to do, corporate partnerships like this one with UnitedHealthcare and Fitbit could pave the way for insurance companies to use fitness tracker data to deny coverage or hike up rates for consumers.</p>
<h2>Diagnosis by device</h2>
<p>There are positive elements to pairing wearable fitness trackers with health data. </p>
<p>An existing flu treatment medication <a href="http://dx.doi.org/10.1016/S0140-6736(00)02288-1">works best when administered within 24 hours of onset of symptoms</a>. But it’s difficult to catch the flu so quickly. A Fitbit could make that much easier. If the device measures a sudden decrease in the number of steps the person takes per day, plus perhaps an elevated resting heart rate, that <a href="https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781455750177003640?scrollTo=%23hl0000450">could signal the presence of a virus</a>.</p>
<p>If an insurance company has access to those data, it could send a message to the patient. If the person really was feeling poorly (rather than just having decided to watch TV all day or gotten snowed in), she could be directed to go to her doctor or an urgent care clinic. The person could see a health professional quickly, get an effective treatment and be on the mend sooner – thanks to her Fitbit data. </p>
<p>This ability will only increase in the future. There are <a href="http://www.mobihealthnews.com/content/21-clinical-trials-are-using-fitbit-activity-trackers-right-now">more than 20 clinical trials using Fitbits underway</a>, studying the role of activity in treating pediatric obesity and cystic fibrosis, and even how it can boost chemotherapy’s effectiveness and speed in recovery from surgery. As those studies are published in the coming years, researchers and doctors will get even better at identifying signals of specific diseases in wearable devices’ data.</p>
<h2>Beyond the Fitbit</h2>
<p>Similar efforts include one to <a href="https://pdfs.semanticscholar.org/d31e/26af4fbe33f99f86597ef3af89bf500d611f.pdf">detect influenza with a portable heart-rate monitor</a>. Other researchers are <a href="https://www.technologyreview.com/s/603200/voice-analysis-tech-could-diagnose-disease/">analyzing voice and speech patterns</a> to reveal neurological disorders and other diseases – and are <a href="https://www.newscientist.com/article/2120426-algorithms-crunch-calls-to-health-insurer-for-signs-of-disease/">using calls to a health insurance company</a> as a data source. Even <a href="https://doi.org/10.1109/MC.2013.339">eye-tracking software could measure cognitive understanding</a>, which could identify signs of dementia. Detecting symptoms earlier through Fitbit data could allow faster, more effective treatment.</p>
<p>The biggest push, though, is coming from Qualcomm, which has offered a <a href="http://tricorder.xprize.org/">$10 million prize</a> to the team who can develop a specific type of multifunction medical device. Without involving a health care worker or facility, the device must be able to accurately diagnose 13 health conditions, including pneumonia and diabetes. It must also be able to capture in real time five vital signs, such as heart rate and breathing rate, and process the data locally.</p>
<p>The global competition is down to finalists; the winner will be announced early this year. That could bring wearables’ insights to doctors – and insurance companies – much sooner than we might think.</p>
<h2>Cause for concern</h2>
<p>Wearables’ data can definitely be used to help patients. But it could also be used to harm them, particularly in light of recent political developments. With the passage of the <a href="https://www.gpo.gov/fdsys/granule/PLAW-111publ148/PLAW-111publ148/content-detail.html">Affordable Care Act</a> (also called Obamacare), insurance companies were barred from denying coverage to customers who had preexisting medical conditions at the time they signed up for insurance. If that rule is <a href="https://www.washingtonpost.com/powerpost/obama-to-huddle-with-democrats-on-protecting-his-signature-health-care-law/2017/01/04/34b655e8-d1f9-11e6-945a-76f69a399dd5_story.html">lifted by Republicans in Congress</a>, insurers might look to wearable devices for evidence they could use to refuse to pay for patients’ health care.</p>
<p>This development would have enormous consequences. According to the Centers for Medicare and Medicaid Services, as many as <a href="https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/preexisting.html">half of all Americans</a> have some sort of condition that could be used to exclude them from coverage, such as asthma, cancer or mental illness. Might insurance companies ask prospective customers for their Fitbit data, in addition to – or even in lieu of – a physical exam or laboratory tests? If that provision of Obamacare were repealed, could insurance companies set rates based on what those data show – or deny coverage entirely? </p>
<p>Car insurance companies are already using similar methods. Some insurers provide their customers with <a href="https://www.allstate.com/tools-and-resources/car-insurance/telematics-device.aspx">devices to install in their cars</a>, measuring drivers’ behavior and calculating the risk involved – and the rate they pay for coverage.</p>
<h2>Assembling the data</h2>
<p>At the moment, the algorithms connecting activity tracker data and health conditions are still under development. But the biggest thing UnitedHealthcare would need is a large data set of customer Fitbit measurements, so it can link them to insurance claims. Its new cash-for-data program will begin to assemble that information.</p>
<p>As insurance customers signed up to use a Fitbit and get some extra cash for sharing their data, United would be able to match their Fitbit measurements with any health conditions identified in their medical records. Over time, the company could build up enough information from, say, people with asthma and people without it to be able to tell asthma patients apart by looking just at their data. The company could do this for other common diseases, too, or even adapt the algorithms from the contestants in the Qualcomm competition. </p>
<p>It’s unclear what the company would do with what it learned. But one possibility is that when evaluating a prospective customer, the company could look at his data and know all about any preexisting conditions. That might mean a person doesn’t get insurance, or has to pay more for coverage.</p>
<h2>Making coverage decisions</h2>
<p>The <a href="https://dx.doi.org/10.1007/978-3-319-28887-1_22">financial power of the health insurance industry</a> is enormous. Not only are there many large companies, but they have the ability to determine whether a sick person gets well or doesn’t – and whether the cost is ruinous or merely expensive.</p>
<p>Would people feel able to object if insurance companies required customers to wear fitness trackers or other monitoring devices? Would new patients provide access to past data a Fitbit collected? Could an insurance company consider it fraud if a user didn’t wear the device?</p>
<p>If used – and regulated – well, the devices can help individual patients change their daily habits to become healthier, saving insurance companies money, and passing some of those savings along to customers. Alternatively, the devices could provide justification for denying coverage to the inactive or unhealthy, or boosting their insurance rates.</p>
<p>Consumers should not assume their insurance companies will use their data only to improve patient care. With millions of dollars on the line, insurers will be sorely tempted. With the legal landscape around preexisting conditions in flux, people should think twice before signing up.</p>
<p><em>Editor’s note: This article was updated to correct the spelling of UnitedHealthcare’s corporate name and the fact that Fitbits cannot detect tremors, and also to reiterate that the Affordable Care Act presently bars insurance companies from denying coverage to patients with preexisting conditions.</em></p><img src="https://counter.theconversation.com/content/72565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Boyd receives funding from the National Institute of Health, National Institute of Aging, National Center for Advancing Translational Sciences, McKesson Foundation, Agency for Healthcare Research and Quality. He has previously received research funding from the Department of Defense, Baxter, Office of the National Coordinator for Health Information Technology.</span></em></p>Soon, wearable fitness devices will be able to diagnose diseases. Could that lead insurers to deny coverage to people based on their data alone?Andrew Boyd, Assistant Professor, Biomedical and Health Information Sciences, University of Illinois ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/650792016-09-08T22:18:28Z2016-09-08T22:18:28ZApple Watch pivots to fitness – and focuses on a different style of self-help<p>When Apple <a href="https://youtu.be/bdyVH5LqneU">unveiled its original watch in 2014</a>, the California company touted <a href="http://web.archive.org/web/20150509040832/http://www.apple.com/watch/">three tent-pole features</a> of the new wearable: style, communication and fitness. <a href="http://www.apple.com/apple-events/september-2016/">Rolling out</a> the second-generation Apple Watch this week, Apple has positioned fitness, and fitness alone, as the device’s main selling point. High-end fashion, and friend-to-friend gestures like the <a href="http://www.imore.com/how-send-someone-your-heartbeat-apple-watch">heartbeat share</a>, were hardly mentioned. Exercise was the unrivaled star of the watch reveal. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/p2_O6M1m6xg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Introducing Series 2 – with an emphasis on physicality.</span></figcaption>
</figure>
<p><a href="http://www.apple.com/apple-events/september-2016/">Tim Cook’s keynote</a> introduced the new <a href="http://www.apple.com/watch/">“Series 2” device</a> with a <a href="http://www.apple.com/apple-watch-series-2/">promotional video</a> dominated by sports: color bursts of swimming, tennis, basketball, cycling, stairs, skateboarding, jogging and on and on. The watch’s featured hardware changes, in addition to the requisite processor upgrade, were a GPS chip and a new “swimproof” water rating.</p>
<p>The upgraded operating system, <a href="http://www.apple.com/watchos/">watchOS 3</a>, is all about fitness too: new Activity watch faces, workout sharing, additional health metrics, and a new “Breathe” app. Cook called the watch the “ultimate device for a healthy life.” He said he expected the new version to be “especially popular with runners” – and proceeded to invite Nike’s brand chief to introduce a full-fledged, standalone unit: the <a href="http://www.apple.com/apple-watch-nike/">Apple Watch Nike+</a>. The Nike version, with its own specialized bands and watch faces, was hailed as the “perfect running partner.”</p>
<p>The Series 2 announcement did include a brief mention of new Hermés bands, as well as enhanced emojis and a “Scribble” finger-drawn input system. But the original tripartite pitch – style, communication and health – was reduced to a single, focused sell: the Apple Watch is a fitness device. And with that shift Apple has substituted a strand of self-improvement – disciplined and quantitative – for its longstanding appeals to iconoclastic self-expression. </p>
<h2>Forget fashion, follow the market to fitness</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=773&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=773&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=773&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=971&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=971&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=971&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fitness doesn’t appear to be top of mind for this high-fashion model sporting the original Apple Watch.</span>
<span class="attribution"><a class="source" href="http://cdn.macrumors.com/article-new/2014/10/voguecover.jpg?retina">Vogue China</a></span>
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<p>Recall that the original watch was promoted with <a href="https://youtu.be/dAFEoUc3JNw">videos narrated by designer Jony Ive</a>, with purring, pornographic attention to design and exotic materials. Crucial to the original roll-out campaign was a relentless effort to link the watch to the fashion world: the <a href="http://www.self.com/flash/celebrity-blog/2015/02/march-cover-girl-candice-swanepoel-apple-watch/">Self</a>, <a href="http://www.macrumors.com/2015/04/02/apple-watch-flare-magazine/">Flare</a> and <a href="http://www.digitaltrends.com/wearables/apple-watch-vogue-china-cover-iphone-6-preorders-start/">Vogue China</a> covers, the <a href="http://www.digitaltrends.com/apple/apple-watch-splashed-across-12-pages-of-vogues-march-issue/">12-page ad spread</a> (and <a href="http://www.vogue.com/1415025/apple-design-genius-jonathan-ive/">glowing Ive profile</a>) in U.S. Vogue, the in-store boutiques at <a href="http://www.theverge.com/2015/4/10/8380993/apple-watch-tokyo-paris-london-shopping">Galleries Lafayettes and Selfridges</a>, the high-profile hires from Burberry to L.V.M.H.</p>
<p>Equally prominent, in that <a href="https://youtu.be/bdyVH5LqneU">first unveiling</a>, were the watch’s communication features. The Dick Tracy phone calls, the intimate “Digital Touch” messaging, the dedicated “Friends” side button: The stress, back in 2014, was on new, “subtle ways to communicate.” With the Series 2 version, most of that fell away. Even the side button has been repurposed as an app-loading dock. And now it’s your Activity rings – the addictive circles that track standing, movement and exercise – you’re <a href="http://www.apple.com/apple-watch-series-2/">encouraged to share</a>.</p>
<p>The business angle of Apple’s pivot to fitness isn’t that interesting. The company is following its customers and the broader wearables market – where lower-cost wristbands like Fitbit are reportedly <a href="http://www.cnbc.com/2016/09/07/heres-why-apple-needs-a-new-watch-sales-are-plunging.html">picking up market share</a>. The Nike+ deal isn’t an aspirational bid to tap an underserved market. Instead, right now at least, exercise tracking is the reason consumers are buying smart watches and “basic” wearables like the Fitbit.</p>
<p>The intriguing thing about Apple’s shift in marketing is its elevation of self-improvement over self-expression. The original watch was promoted as a custom display of personal style – as an identity statement on par with clothing. Cook <a href="https://youtu.be/bdyVH5LqneU">described the original watch</a> as the “most personal device Apple has ever created,” and the device’s <a href="http://web.archive.org/web/20150509040832/http://www.apple.com/watch/">web copy</a> reinforced the point: Apple Watch is “more than a tool. It’s a true expression of your personal taste.” Or, in a <a href="http://web.archive.org/web/20160406034110/http://www.apple.com/watch/">later rendition</a>: “From the way it works to the way it looks, Apple Watch isn’t just something you wear. It’s an essential part of who you are.”</p>
<p>The <a href="http://www.apple.com/apple-watch-series-2/">new web copy</a>, however, drops all the expressive language: The Series 2 Watch is “designed for all the ways you move,” full of features that “help you stay active, motivated and connected.”</p>
<h2>Apple switches its flavor of self-help</h2>
<p>The shift represents a victory of one mode of self-help over another. As sociologist Micki McGee observed in <a href="https://global.oup.com/academic/product/self-help-inc-9780195337266?cc=us&lang=en&">Self-Help, Inc.</a>, a pair of ethics have long competed in the American self-improvement market, one emphasizing self-mastery and the other self-discovery. Think <a href="https://www.tonyrobbins.com/">Tony Robbins</a> versus Oprah Winfrey: Robbins asks us to treat ourselves as objects to (relentlessly) work on, while Winfrey preaches meditative fulfillment.</p>
<p>Each ideal, in turn, <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674824263">draws on a different strand of Western individualism</a>: the notion that the self is something we own, versus the competing idea that the self is to be discovered and expressed. The first ethic, the <a href="http://www.oupcanada.com/catalog/9780195444018.html">possessive individualism</a> of philosopher John Locke, helped provoke the second notion of self discovery, as expressed in the <a href="https://muse.jhu.edu/article/508124">literary and artistic Romanticisms</a> of the 19th century. Since then – for <a href="http://www.worldcat.org/title/fables-of-abundance-a-cultural-history-of-advertising-in-america/oclc/30547687">over a century in the American case</a> – these two ideals have been hitched to selling consumer goods. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/mpM5nzSEyXE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Apple’s traditionally been more about self-expression than self-mastery.</span></figcaption>
</figure>
<p>Apple has traditionally wrapped its products in the second ideal of self-expression and discovery: the iconic <a href="https://m.youtube.com/watch?v=R706isyDrqI">1984 sledgehammer ad</a>, the “<a href="https://en.wikipedia.org/wiki/Think_different">Think Different</a>” and “<a href="https://en.wikipedia.org/wiki/Get_a_Mac">I’m a Mac/I’m a PC</a>” campaigns, <a href="https://en.m.wikipedia.org/wiki/IMac_G3">candy-colored iMacs</a> and all those <a href="https://m.youtube.com/watch?v=mpM5nzSEyXE">silhouetted iPod dancers</a>. Apple is selling the Series 2 Watch, by contrast, on the self-mastery ethic. It’s less “<a href="https://m.youtube.com/watch?v=tjgtLSHhTPg">Here’s to the crazy ones</a>” and more <a href="http://www.apple.com/apple-watch-series-2/">lap-counts and “achievement” badges</a>.</p>
<p>What’s novel about Apple’s move is that self-discipline is getting delegated to a device. In a sense, watch wearers are outsourcing their superegos to a publicly traded company, the world’s most valuable. With every tap-to-stand and Activity report – “<a href="http://www.apple.com/apple-watch-series-2/">a nudge when you need it</a>” – the watch becomes more like a personal trainer, one coded by Apple engineers. By baking in fitness-sharing (“<a href="http://www.apple.com/apple-watch-series-2/">Healthy loves company</a>”), the new watch appeals to social comparison and competition too – “whether it’s to send encouragement or a little smack talk.” And Apple’s exercise-centric messaging is built around <a href="http://www.polity.co.uk/book.asp?ref=9781509500598">quantitative self-monitoring</a>, via bar graphs and calorie counts and beats-per-minute tallies. The Series 2 “tracks all the ways you move throughout the day,” reads new <a href="http://www.apple.com/apple-watch-series-2/">web copy</a>. “Select up to five metrics to view at once.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Will this pivot affect the physical health of Apple zealots?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/shinyasuzuki/16924905779">Shinya Suzuki</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Exercise is a good thing. But we shouldn’t pretend the design and promotion of devices like the Apple Watch are value-neutral. By the time they’re slotted under flawless in-store glass, they already have a <a href="http://www.worldcat.org/title/social-shaping-of-technology/oclc/39713267">set of ideals preinstalled</a>. In the Apple Watch case, those values reflect their California origins: Our selves are objects to work on, to sculpt and measure, in competition with others. Indeed, the watch echoes the subculture of <a href="http://www.polity.co.uk/book.asp?ref=9781509500598">dedicated self-quantifiers</a>, who – to a deliberate extent – define themselves in metrical terms. </p>
<p>The watch’s new <a href="http://www.apple.com/apple-watch-series-2/">“Breathe” app</a> is a fascinating case in counterpoint. The app, which encourages periodic deep breathing, is meant to “help you practice mindfulness every day.” Here is a reminder of Silicon Valley’s <a href="http://press.uchicago.edu/ucp/books/book/chicago/F/bo3773600.html">long flirtation with New Age mysticism</a> – as well as the <a href="http://revije.ff.uni-lj.si/as/article/view/3941">gauzy repurposing of Buddhist meditation</a> for the self-help industry. If anything, the Breathe app is a throwback to Apple’s expressivist marketing campaigns. And in that respect the new watch echoes a century-old American injunction: <a href="http://www.jeffpooley.com/pubs/PooleyConsumingSelf2010.pdf">If you want to get ahead, go find yourself</a>.</p><img src="https://counter.theconversation.com/content/65079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jefferson Pooley does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Forget high-end design and cutting-edge communication. The new Watch is a fitness device and heralds a shift for the company – from enabling self-expression to nudging users toward self-mastery.Jefferson Pooley, Associate Professor of Media & Communication, Muhlenberg CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/501232016-02-21T19:03:22Z2016-02-21T19:03:22ZImagine what we could learn if we put a tracker on everyone and everything<figure><img src="https://images.theconversation.com/files/101520/original/image-20151111-21201-de6ac4.jpg?ixlib=rb-1.1.0&rect=595%2C70%2C3552%2C2151&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Imagine if all these people were gathering valuable data for public benefit?</span> <span class="attribution"><span class="source">Scott Cresswell/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>We can learn a remarkable amount of information about an individual, such as their health or safety, and about the surrounding environment simply by placing a tracking device on them.</p>
<p>For example, consider the recent <a href="http://www.bbc.co.uk/news/world-asia-china-33844084">Tianjin chemical warehouse explosions</a>, which killed 173 people. Investigators found that the explosions occurred because the warehouse was storing hazardous material <a href="http://www.pddnet.com/news/2016/02/chinese-investigators-blame-illegal-chemicals-tianjin-port-explosion">both unsafely and illegally</a>. </p>
<p>What if authorities had received early warning of this illegal stock limit, or of the condition of the nitrocellulose which sparked the fire when it dried out and overheated?</p>
<p>This is where tracking can help solve problems and, most importantly, save lives. At CSIRO’s <a href="http://www.csiro.au/en/Research/D61">Data61</a>, we have developed a personal safety badge for ensuring safety in the workplace. </p>
<p>The badge tracks the wearer’s position both indoors and outdoors via Bluetooth and GPS, and picks up exposure to harmful gases and radiation through dedicated sensors. The primary aim of the badge is to detect any elevated levels of exposure to chemicals or radiation and to notify the worker and the employer for remedial action.</p>
<p>Workers using the safety badge effectively become mobile sensors that can tell us what is happening in the entire workplace site. Because they move around, the badges can sample the area at different locations and times, allowing us to cover the site much more effectively and affordably than with current fixed sensors. </p>
<p>If workers at chemical warehouses such as Tianjin were wearing such badges with the appropriate sensors, elevated levels of harmful chemicals could have been detected early to alert the authorities and prevent any disasters from occurring.</p>
<h2>Micro in size, macro in potential</h2>
<p>Tracking of individual animals is equally insightful. We placed tiny solar-powered tracking devices on flying foxes that included GPS and other sensors that could monitor temperature, pressure, solar exposure and sound. </p>
<p>The information from these sensors not only tells us a great deal about how bats disperse seed across the landscape, but also gives us insight into the animal’s capacity to spread viruses.</p>
<p>The tagged animals also effectively become mobile environmental sensors. They can reveal valuable information about the environmental conditions in large swathes of the landscape for which we never before had access to. </p>
<p>For instance, temperature data from moving sensors tells us about conditions at the locations where the animals are travelling. A microphone can even capture the soundscape from remote and inaccessible areas.</p>
<p>Similarly, one can place trackers with gas or noise sensors on public transport fleets, such as shared public bicycles, buses, trains, trams and ferries. These vehicles then provide a mobile pollution or noise monitoring infrastructure for the city for minimal cost.</p>
<p>As sensors shrink in size, it will become feasible to incorporate more of them on the trackers. Sensors that detect threats to human health or the nation’s biosecurity will soon find their way into these tiny devices. As a result, the mobile trackers will be able to provide early warning of harmful threats in their vicinity.</p>
<p>Naturally, ethical and legal questions around privacy, data ownership and reuse will have to be considered in both public and private sectors.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=328&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=328&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=328&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=412&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=412&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101517/original/image-20151111-21223-gsrks0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=412&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We already gather a lot of information about our selves via devices such as FitBit.</span>
<span class="attribution"><span class="source">Denis Kortunov/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Playing phone tag</h2>
<p>However, tracking need not rely on dedicated devices. The smartphones and wearable devices we carry every day already track our location and record information about our environment. While the public has become increasingly aware and concerned with the privacy implications, there is a silver lining for tracking people.</p>
<p>In fact, recent research has shown that location information for mobile phone use can help pinpoint the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675794/">sources of infectious diseases</a>, such as <a href="https://theconversation.com/au/topics/malaria">malaria</a>, at a national scale. A similar approach could be applied to other outbreaks of infectious disease. In fact, global airport traffic patterns can predict the timing of the spread of an epidemic across countries and continents.</p>
<p>In Australia, we are working on projects that use multiple types of available data on people movement, from geo-tagged Tweets to mobile phone records, to predict and preempt the spread of mosquito borne diseases like <a href="https://theconversation.com/au/topics/dengue-fever">dengue fever</a>. Such efforts offer clear potential benefits to public health outcomes, from reducing the infection rates to higher confidence in government responses.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=330&fit=crop&dpr=1 600w, https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=330&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=330&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=414&fit=crop&dpr=1 754w, https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=414&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/112098/original/image-20160219-1274-1tttvr7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=414&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mobile phones can reveal useful information, such as where locals (blue) and tourists (red) take photos.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/walkingsf/4671519459/in/photolist-bih5kZ-87NKYX-rDpvJS-6akRDL-9NBTQp-9NCE48-9NEKvf-5nQjPo-bsAMRW-5nQ4FW-ow7KT4-5ZkYbp-5Zqc1C-d1ooZj-4eRh8T-4CVeF7-2M3Ls5-6NShHf/">Eric Fischer/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Eyes everywhere</h2>
<p>However, the benefits need not come at the cost of loss of privacy for individuals. It is critically important that such human tracking efforts follow strict ethical frameworks in the use of data. For instance, eliminating any identifiable information from any study is a first step, but this is insufficient.</p>
<p>Movement patterns of individuals could be used to infer their identity by tracing their most frequented locations to street addresses. Fortunately, the studies that use people movement as a proxy for disease spread can typically proceed on aggregate data from the population.</p>
<p>In that scenario, the patterns of individual movement are combined to capture how the major flows are occurring within the landscape. These flows can then be used to project the areas of highest risk of disease spread and guide targeted management actions in response to those risks.</p>
<p>Two domains where such tracking might yield the first benefits are health and biosecurity. This technology could be applied to track the geographical progress of infectious diseases, assisting with both prevention and preparation. </p>
<p>Electronic tagging of consignments of goods entering the country could assist with biosecurity, allowing us to quickly pinpoint the source of pest incursions. Transport is not far behind, with map-based applications offering updates on traffic conditions in return for sharing your position and speed.</p>
<p>Information is incredibly valuable, and tracking technology can provide a wealth of information about us and our environment. It already does so for wildlife, and it can do the same for people.</p>
<p>If we can solve the privacy and security issues, then the technology to track ever smaller things for longer durations can provide a wealth of data for building new services of public benefit. </p>
<p>The question remains: how much privacy are we happy to give up for the potential benefits new tracking technology can do for mankind?</p><img src="https://counter.theconversation.com/content/50123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Raja Jurdak does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If we can solve the privacy issues, placing trackers on people and the things we make can teach us a great deal about ourselves and the world around us.Raja Jurdak, Group Leader of Distributed Sensing Systems, CSIROLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/526112015-12-23T11:15:39Z2015-12-23T11:15:39ZWill fitness trackers damage our relationships with our doctors?<figure><img src="https://images.theconversation.com/files/106958/original/image-20151223-27880-1mc6i8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Wearable fitness trackers are likely to have been on many people’s Christmas lists this year. Marketed simultaneously as <a href="http://www.latimes.com/business/technology/la-fi-fitness-tracker-jewelry-20151002-story.html">fashion accessories</a> and the answer to our obesity problems, wristbands and other gadgets that monitor and analyse our calorie consumption and exercise levels <a href="http://www.theguardian.com/lifeandstyle/2015/dec/04/fitness-trackers-healthy-sales-despite-lack-of-evidence-work">have recently shot up</a> <a href="http://blogs.wsj.com/moneybeat/2015/11/30/fitbit-shares-pop-as-shoppers-snap-up-wearables/">in popularity</a>. And <a href="http://www.forbes.com/sites/unitystoakes/2015/12/20/2016-predictions-digital-healths-second-wave-and-thirteen-transformative-healthcare-trends/">this is predicted</a> to grow further in 2016.</p>
<p>Some argue that wearable fitness trackers and mobile health apps might not only help us monitor our own health but also <a href="http://qz.com/467145/the-next-wave-of-fitness-wearables-will-send-data-directly-to-doctors/">enable our doctors</a> to gather more information about us. This could allow them to offer more effective, personalised treatment and even <a href="http://www.huffingtonpost.com/2015/02/20/doctors-say-fitness-track_n_6720990.html">intervene in our health</a> without us having to report concerns first.</p>
<p>The problem is little is known about what impact these technologies can actually have on health and care. Even if it emerges that fitness gadgets and apps can change our eating and exercise habits <a href="https://theconversation.com/how-we-discovered-the-dark-side-of-wearable-fitness-trackers-43363">for the better</a>, we don’t really how doctors will respond to these technologies or how they could change our relationships with healthcare professionals.</p>
<p>Will the data collected act as a carrot that encourages us to become more active or as a stick for our doctors to beat us with when we don’t follow their advice? What will this do to the privacy and trust that underpins medical practice? And how might technology erode the social and caring aspects of medicine, so that a consultation becomes the equivalent of a text message exchange?</p>
<h2>Robotic relationships</h2>
<p>Several studies have examined how patient monitoring technologies could play a significant role in managing long-term and often complex health conditions, with varying results. In <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455407/">one study</a> looking at how a mobile phone-based diabetes service influenced prescriptions, the effects on doctors’ behaviour were actually modest. By contrast, <a href="http://www.jmir.org/2012/1/e25/">research into</a> mobile phone-based monitoring for heart failure led to patients taking greater care of themselves. But the patients were also concerned about long-term surveillance and dependency on the technology. And their doctors were worried about increased workloads because of the frequent alerts and volume of data they received.</p>
<p>This suggests that rather than simply acting as a tool to help our doctors, digital health technology has the potential to separate us from them. It might improve the frequency and content of communications and is particularly promising for the delivery of care in rural and remote areas, but the trade off is less human contact. <a href="https://theconversation.com/connections-arent-conversations-while-technology-enables-it-can-also-interfere-51689">Connections are not conversations</a> and technology might actually interfere in the quality of our relationships with our doctors.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106961/original/image-20151223-27897-1axpl9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cyber patient.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>More frequent opportunities for communication might in theory create more chances for personal relationships, but if it’s mostly done through electronic messaging then <a href="http://www.unboundmedicine.com/medline/citation/14728122/TLC_Asthma:_an_integrated_information_system_for_patient_centered_monitoring_case_management_and_point_of_care_decision_support_">interactions may actually become standardised</a>, even when that is not an explicit intention. This creates the possibility that diagnosing and managing illnesses could become robotised, leading to a situation where doctors stop listening and using their intuition and patients stop communicating how they really feel.</p>
<h2>Bedside manner</h2>
<p>Interactions between doctors and patients are the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.1982.tb01213.x/abstract">cornerstone of medical practice</a> and their relationships have even been <a href="http://www.theguardian.com/books/2015/apr/24/adventures-in-medicine-i-journey-through-the-body-every-day">described as sacred</a>. If these are radically transformed and most healthcare becomes delivered through technology rather than traditional practices, we may lose our appreciation for good bedside manner. How this might impact on health outcomes is <a href="http://onlinelibrary.wiley.com/doi/10.1111/soc4.12226/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=">yet to be explored</a>.</p>
<p>Our relationships with healthcare professionals could also be damaged if we feel they are effectively spying on us, or that the data being collected could be shared more widely. Sending messages via the internet is not the same as a quiet conversation <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494903/">in a private room</a>. Recent high-profile <a href="https://theconversation.com/talktalk-hack-perhaps-well-finally-take-cybersecurity-seriously-50144">online security breaches</a> show that we are also still trying to understand whether we can really make our data secure. This has particular implications for sending and storing large amounts of personal heath information via the internet.</p>
<p>We’re still in the early days of digital healthcare and we’ve yet to determine how serious these issues may or may not be or whether other problems will become even more pressing. But the ubiquity of remote monitoring technology and the need to do more for less that will come with an ageing population and a growing number of people with chronic conditions will increase the urgency to find out.</p><img src="https://counter.theconversation.com/content/52611/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Morgan's current work is funded by The Wellcome Trust through the University of Aberdeen’s Institutional Strategic Support Fund under Grant RG12724-13.</span></em></p>Wearable technology could help us manage our own health but separate us from our doctors as they drown in data.Heather May Morgan, Research Fellow, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413492015-09-28T05:25:54Z2015-09-28T05:25:54ZHealth Check: is your sleep app keeping you up at night?<figure><img src="https://images.theconversation.com/files/96395/original/image-20150928-24249-1fmwhbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We now have the technology to do track our sleep through the night, but that may be doing more harm than good. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/marisa_sea/13542034695/">Marisa/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Sleep is as important to health as diet and exercise and, thanks to new technology, tracking sleep is now routine in monitoring overall well-being. But are the devices used to do this actually useful, or have we simply found a more sophisticated way to clock watch?</p>
<p>We’ve long been fascinated by what happens when we go to sleep. We now know that <a href="http://sleephealthfoundation.org.au/fact-sheets-a-z/223-sleep-myths.html">sleep is not a passive state</a> where everything turns off and we disconnect for several hours. The recognition of sleep medicine as a separate discipline, and the steady increase in sleep research leading to public education messages regarding the importance of sleep, have helped people realise its importance in physical and mental health, productivity, accident prevention and overall well-being. </p>
<p>Not surprisingly, people want to monitor how much sleep they’re getting and how well they’re sleeping. We now have the technology to do this – but that may be doing more harm than good. </p>
<h2>Bad tracking</h2>
<p>The introduction of activity trackers and sleep apps for smartphones has made monitoring sleep relatively simple. The most popular activity trackers are the wristband ones, such as the Fitbit, Jawbone and Garmin. </p>
<p>The sleep information you can obtain from these devices includes sleep duration and quality, assessed by how often you wake up during the night. And, depending on the device, it may also tell you how long you were in deep sleep or light sleep. </p>
<p>The devices and apps work using <a href="https://en.wikipedia.org/wiki/Accelerometer">accelerometer technology</a>. This means the device senses movement – or the lack thereof – over a specified time period (called an epoch) and applies an algorithm to designate whether the person is asleep or awake. </p>
<p>Only a few <a href="http://www.ncbi.nlm.nih.gov/pubmed/26158896">scientific studies</a> have looked at <a href="http://www.ncbi.nlm.nih.gov/pubmed/26118555">how effective</a> these devices are at <a href="http://www.ncbi.nlm.nih.gov/pubmed/21971963">measuring sleep duration and quality</a>. For the most part, they’ve shown they’re fairly good at picking up when someone is asleep; they’re not so good at assessing the number of times someone wakes up during the night and how restless they are. </p>
<p>They also cannot, with any accuracy, determine whether you’re in deep or light sleep, simply based on movement.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96396/original/image-20150928-24239-plv6ad.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The trick is not to take your sleep app too seriously.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/anneh632/5514297666/">Anne Swoboda/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>When we’re in <a href="https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep">rapid eye movement</a> (REM) sleep (dreaming sleep), for instance, our body has no muscle movement whatsoever, except for around the eyes. Sleep monitoring devices will recognise this as deep sleep, when it’s actually a light stage of sleep as we’re easily woken when in REM sleep. </p>
<p>And the sensitivity between devices varies greatly, not only in the hardware’s ability to detect movement, but also in the algorithms used to determine sleep time and awake time. What one device determines as awake, another might say is sleep, or vice versa.</p>
<h2>Losing sleep</h2>
<p>So should you disregard the sleep component of these devices altogether? Not at all. There’s no doubt they can provide an understanding of your sleep and wake patterns over a period of time. </p>
<p>By monitoring what’s going on in your life, seeing how this affects when you go to bed and how much sleep you get, and thinking about how you ultimately feel during the day, you can try to improve your sleep patterns.</p>
<p>This will have a flow-on effect for sleep quality. But there is a downside. </p>
<p>Not sleeping well can be a source of anxiety for many people, whether as a result of a sleep disorder, such as <a href="http://sleephealthfoundation.org.au/fact-sheets-a-z/188-insomnia.html">insomnia</a>, or <a href="http://sleephealthfoundation.org.au/fact-sheets-a-z/216-delayed-sleep-phase-syndrome-dsps.html">delayed sleep phase syndrome</a>, which is when people struggle to get to sleep at a desired time, or simply because of increased stress or illness. Paying too much attention to the sleep apps then becomes just another form of clock-watching. </p>
<p>The trick is not to take your sleep app too seriously. Remember the data is unlikely to be entirely accurate, especially for how much or how long you were awake during the night. Clearly, if you’re obsessively monitoring the statistics and it’s becoming a source of anxiety, then it’s not helpful for you to keeping using your device or app to monitor sleep. </p>
<p>There are other ways to do so anyway. If you really want to know what’s going on with your sleep, listen to your body. You don’t need an app to tell you that you’re not sleeping well and feel terrible. </p>
<p>If you feel you have a sleep problem, seek help from a medical professional. Your body and brain – not your app or device – will thank you for it.</p><img src="https://counter.theconversation.com/content/41349/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Biggs does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tracking sleep is now routine in monitoring overall well-being. But are the devices used to do this actually useful, or have we simply found a more sophisticated way to clock watch?Sarah Biggs, Postdoctoral Fellow, Paediatric Sleep, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/434502015-06-19T12:18:33Z2015-06-19T12:18:33ZWhen it comes to Fitbit’s 10,000 steps, one size doesn’t fit all<figure><img src="https://images.theconversation.com/files/85714/original/image-20150619-3386-rpp1ad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long walk to fitness</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The rise of wearable fitness technology is something of a paradox. The <a href="http://www.cnet.com/news/fitness-trackers-rise-and-fall/">surge in popularity</a> of devices that monitor the amount of exercise you do suggest more people than ever are interested in maintaining regular fitness regimes. Just witness the success of the company behind fitness tracking bracelet Fitbit, which investors have just deemed <a href="http://www.ft.com/cms/s/0/f4c51d3e-1543-11e5-9509-00144feabdc0.html">worth US$4.1bn</a> (£2.6bn) after it floated on the stock market. Yet this comes at a time when physical inactivity has reached levels of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/pdf/nihms385288.pdf">global pandemic proportion</a>.</p>
<p>This shows how important it is that the public understand and follow science-based health and behaviour advice. The advantage of wearable fitness technology is that it can provide a way for personalised data to shape how much extra physical activity (including exercise) a person needs to do and when.</p>
<p>The <a href="http://www.nhs.uk/Livewell/loseweight/Pages/10000stepschallenge.aspx">well-publicised</a> recommendation to take “10,000 steps a day” is a perfect example. The <a href="https://books.google.co.uk/books?id=EQ3OxfuICAMC&pg=PP5&dq=Manpo-Kei:+The+Art+and+Science+of+Step+Counting+hatano&hl=en&sa=X&ei=YeKDVZr1KMP0UMr-lvgO&ved=0CCAQ6AEwAA#v=onepage&q=Manpo-Kei%3A%20The%20Art%20and%20Science%20of%20Step%20Counting%20hatano&f=false">figure actually originates</a> from Japanese walking clubs and a marketing slogan for pedometers more than 40 years ago. But step counts <a href="http://rubytec.eu/downloads/yamax/f-2004-m.pdf">have been shown</a> to provide a reliable measure of daily activity in healthy adults. They also provide a meaningful everyday metric that allows individuals to self-monitor their physical activity and walking.</p>
<p>The self-monitoring (observing and evaluating one’s behaviour) and goal setting that come with devices like Fitbit are two of the most complementary and potent ways of changing people’s physical activity behaviour. Combining activity trackers, which allow the wearer to observe their steps in real-time and review at their leisure, with goals such as <a href="http://her.oxfordjournals.org/content/26/2/372.full.pdf+html">walking 10,000 steps</a> can make people more motivated and more able to increase or maintain their physical activity levels.</p>
<h2>More is better</h2>
<p>But it is important to realise that 10,000 steps is not a magic threshold. Increasing our time spent walking, regardless of our starting point, is beneficial. At a population level, the biggest changes to health come from improvements at the lower end of the scale. For example, going from 2,000 steps to 4,000 steps will produce greater overall health benefits than going from 4,000 steps to 6,000 steps. At the same time, the <a href="http://www.cmaj.ca/content/174/6/801.full.pdf+html">more active we are</a> (or more steps we take) each day <a href="http://circ.ahajournals.org/content/124/7/789.full.pdf+html">the better</a>. So taking 6,000 steps a day is still better for your health than 4,000 steps.</p>
<p>With the emergence of a large number of activity trackers, a new challenge has emerged for the promotion of 10,000 steps. The <a href="http://www.health.utah.edu/peak/docs/Tudor%20Locke%20Paper.pdf">data behind the recommendation</a> was derived from pedometers which are conventionally worn on the hip. Today, manufacturers tend to produce devices for the wrist because they are more comfortable and convenient for self-monitoring. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Step-by-step improvement.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But devices worn on the extremities will pick up extra movement <a href="http://iopscience.iop.org/0967-3334/35/11/2191/pdf/0967-3334_35_11_2191.pdf">compared with hip-worn monitors</a>. That means they may miscount other large movements from daily life, such as sweeping the floor or doing the dishes, as steps. As a result, it is important for people to be aware that wrist-worn devices may inflate their daily step count.</p>
<p>In general, we should remember that, when it comes to physical activity, “some is good but more is better”. But we can also use step counters to tackle the problems of long periods of sedentary behaviour (sitting). For example, many of us will have particular times of the day (perhaps during work or during the evening) where we spend most of our time sitting. By continuing to accumulate steps during these periods we can simultaneously target reductions in our sitting time.</p>
<p>By monitoring our sitting behaviours alongside the aim of achieving 10,000 steps, we can start to break up these extensive sedentary periods with bouts of activity. Not only would we take more steps but also we would spend less time sitting for long periods. <a href="http://sites.garmin.com/en-US/vivo/vivofit/">Some fitness trackers</a> have started implementing this idea by prompting the wearer when they have been inactive for “too long”.</p>
<h2>Lifestyle medicine</h2>
<p>The difficulty with physical activity promotion is that one size doesn’t necessarily fit all. For individuals with health conditions that impact their ability to accumulate higher levels of physical activity, such as rheumatoid arthritis or severe respiratory impairment, it is likely to be more feasible to prescribe lower step-count targets to begin with.</p>
<p>People who spend a lot of time sitting during work, such as taxi drivers, will likely need to accumulate <a href="http://bit.ly/1Rfe1S5">higher step counts</a> to help compensate for the negative effects of prolonged sitting. This has contributed to the concept of “<a href="https://www.mja.com.au/system/files/issues/190_03_020209/egg10622_fm.pdf">lifestyle medicine</a>” (preventing and managing health conditions through lifestyle choices).</p>
<p>If we can get the message out that physical activity trackers need to be combined with this kind of individual goal setting, then we might see both increases in physical activity and reductions in sitting across populations.</p><img src="https://counter.theconversation.com/content/43450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Orme does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fitness devices like Fitbit set an automatic goal of 10,000 steps a day. But this isn’t the magic threshold some make it out to be.Mark Orme, PhD Candidate, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413202015-05-19T05:11:48Z2015-05-19T05:11:48ZThe rise of wearable health tech could mean the end of the sickie<figure><img src="https://images.theconversation.com/files/81890/original/image-20150515-25441-zf7ix8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is your smartwatch spying on you?</span> <span class="attribution"><span class="source">wearables by Alexey Boldin/shutterstock.com</span></span></figcaption></figure><p>Now that the sun is shining and the temperature is rising, it’s officially sickie season: go to work, or get struck down with “flu”, a “24-hour virus”, or that faithful stand-by, the dodgy prawn takeaway.</p>
<p>Figures show that <a href="http://www.confused.com/press/releases/a-third-of-uk-workers-admit-pulling-a-sickie">over a third of employees</a> in the UK admit to pulling a sickie at some point or other. But things may be changing soon – wearable tech such as the Apple Watch, <a href="https://www.microsoft.com/microsoft-band/en-gb">Microsoft Band</a>, <a href="http://www.fitbit.com/uk">Fitbit</a>, or <a href="https://jawbone.com/up">Jawbone Up</a> may become mainstream within a few years, bringing health monitoring capabilities that reveal how your body is performing. It’s not inconceivable that in time this same data could be used to prove how well, or unwell, you are – such as when phoning in sick.</p>
<p>Wearable health tech is still in its early days. These devices come with sensors that can record how many steps and how much exercise you’ve taken, how well and long you‘ve slept, stress levels, blood pressure, sun exposure, even what you’ve have <a href="http://www.cnet.com/uk/news/apple-watch-app-will-track-your-glucose-levels/">eaten</a>. Added together, all this could easily demonstrate that you’re not so sick after all.</p>
<p>Since some wearables are aimed at being fashionable accessories, employers might be minded to tap into the trend. So next time you’re pulling a sickie, you might need the data to back up your story. With GPS-equipped devices there’ll be no opportunity to escape your sickbed to a barbeque or trip to the beach, while ultraviolet sensors will detect the increase in sunshine and motion sensors detect movement not typically associated with bed rest.</p>
<h2>Using your data against you</h2>
<p>What if employers and health insurance companies move in the direction that <a href="http://www.which.co.uk/money/insurance/guides/black-box-car-insurance/black-box-car-insurance-how-it-works">the car insurance industry has taken</a>, where every health transgression (a boozy night out, a Christmas feast, or too many lazy days on the sofa) could increase your health premium rates? Such a scenario isn’t so far away, and this should concern us. Apple is clearly making a beeline for the health and fitness industry with Watch and its integrated HealthKit software, <a href="https://www.apple.com/uk/ios/whats-new/health/">now integrated with its iOS mobile operating system</a>, and it is the only firm to do so.</p>
<p>Typically, health insurers use body mass index (a calculation of body fat that takes into account your age, weight and height) to set premiums, and some insurers set rates based on basic data from wearables, such as the number of steps we take <strong>link?</strong>. Fitbit and Jawbone Up are both already playing a bigger role in how health insurance is calculated, with more employers opting to monitor data generated by such wearable trackers. And here’s the catch: employers are <a href="http://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance">holding their insured staff to account</a> with penalties and rewards as part of an increasing number of so-called “corporate-wellness programmes”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/81887/original/image-20150515-25403-bigg8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Is your wearable spying on you?</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Fitibit_Flex.jpg">MorePix</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>For example, at BP staff are given Fitbits for free <a href="http://smartcompliance.co/wearable-technology-utilized-health-insurance-companies">as long as the company has access to their data</a>. The more physically active an employee is (as measured by the device) the more points they’re awarded. Higher points lower the company’s insurance premium. Other companies are adopting <a href="http://www.employeebenefits.co.uk/benefits/healthcare-and-wellbeing/how-could-wearable-technology-change-workplace-health/105859.article">similar wellbeing employee health insurance programmes</a> too.</p>
<h2>Consent, for now</h2>
<p>Wearable tech is still far from perfect, and that means inventive workarounds will be found. A few acquaintances of mine who shall remain nameless have found creative ways of racking up a few more miles, while actually continuing their usual, less-than-active habits. These include holding and shaking the device for a few minutes at a time, or attaching it to their cat or dog, or offering pocket money to other, younger and fitter family members to wear. Obviously insurers and developers are aware of these, so it won’t be long until such loopholes are closed.</p>
<p>For now, we can consent to share our health data from wearables with employers or insurers in exchange or lower premiums or cheaper travel. But how long before the company wearable is a mandatory part of the uniform?</p><img src="https://counter.theconversation.com/content/41320/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emmanuel Tsekleves does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As wearables record more personal and physical activity data about us, we risk giving away more than we’d imagine.Emmanuel Tsekleves, Senior Lecturer in Design Interactions, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/373182015-03-09T09:59:47Z2015-03-09T09:59:47ZWill next-generation wearable sensors make us healthier?<figure><img src="https://images.theconversation.com/files/74104/original/image-20150306-13550-1r2be7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Still a few kinks to be worked out.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/doctorow/15659135172">Cory Doctorow</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>There is certainly no shortage of headlines on wearable sensors these days. “A contact lens <a href="http://www.washingtonpost.com/business/technology/googles-smart-contact-lens-what-it-does-and-how-it-works/2014/01/17/96b938ec-7f80-11e3-93c1-0e888170b723_story.html">measures your glucose level</a>.” “New electronic tattoos could help <a href="http://www.technologyreview.com/news/512061/electronic-sensors-printed-directly-on-the-skin/">monitor health during normal daily activities.</a>” A “headband can <a href="http://www.newsweek.com/muse-headband-can-read-your-brainwaves-using-eeg-262502">read your brainwaves</a>.” Numerous wearable sensors are currently on the market that can monitor body data including <a href="http://www.fitbit.com/one">activity and sleep</a>, <a href="https://www.fitbit.com/purepulse">heart rate</a>, <a href="http://www.bodymedia.com/the_science.html">galvanic skin response</a>, and <a href="https://www.zioreports.com/Application.html#XT_PATCH_INFO_ANONYMOUS">electrocardiogram (ECG)</a>. But are these wearables making any difference? Are they actually making us healthier?</p>
<p>The answer is not clear yet. And the challenges are plenty.</p>
<h2>Working against wearables</h2>
<p>First, there is the quick abandonment issue. A recent study conducted by Endeavor Partners found that one-third of American customers <a href="http://endeavourpartners.net/assets/Endeavour-Partners-Wearables-and-the-Science-of-Human-Behavior-Change-Part-1-January-20141.pdf">stopped using their wearable activity trackers</a> after just six months. Some attribute this problem to the fact that every so often the user needs to <a href="http://www.mddionline.com/article/wearables-fad-or-future-02-06-15">take off and recharge the device</a>. Every time you remove a wearable sensor, it’s an opportunity to forget to put it back on again.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=664&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=664&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=664&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=834&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=834&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74106/original/image-20150306-13579-14w4mvj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=834&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The joy of tracking loses its luster over time.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/factoryjoe/7556205054">Chris Messina</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Others believe current wearables get cast aside because they <a href="http://www.drjohnm.org/2015/01/will-wearables-and-other-gadgets-make-us-healthier/">don’t possess the magic ability</a> to change human behaviors. Don’t we all know that regular exercise, eating healthy food and sleeping well are good for our health? Wearing a wristband alone will not make us do such things. Unless wearables can provide additional actionable incentives or insights that lead to long-term behavior change, their impact is rather limited. The million-dollar question is: what will such actionable incentives for users look like? </p>
<p>It’s also not clear what’s the best format for wearable sensors. The majority of wearables in the market today are wristbands or watches. However, it’s very difficult to get reproducible clinical-quality data from the wrist, as Apple discovered when developing its upcoming Apple Watch.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=711&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=711&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=711&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=894&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=894&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74109/original/image-20150306-13576-1qrppjb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=894&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Even Apple couldn’t get some features to work well.</span>
<span class="attribution"><a class="source" href="http://www.apple.com/pr/products/apple-watch/Apple-Watch.html">Apple</a></span>
</figcaption>
</figure>
<p>According to the Wall Street Journal, after a long and costly development process, Apple had to abandon some of the health monitoring functions, such as ECG and skin conductivity sensors, because “these features <a href="http://www.wsj.com/articles/challenge-of-apple-watch-defining-its-purpose-1424133615">didn’t perform consistently</a> on some people, including those with hairy arms or dry skin. Results also varied depending on how tightly the person wore the Watch.” If Apple cannot pull it off, it is certainly a challenging task.</p>
<p>Before wearable sensors can deliver their promise, they must overcome some serious technological challenges. </p>
<h2>What wearables must do</h2>
<p>What will next-generation wearable sensors do in order to succeed? Here’s my guess.</p>
<p>First, future wearable sensors should be “wear-and-forget.” After the sensor is put on, it should simply disappear into the background and quietly acquire data without the need for recharge, without disturbing the user’s daily life and without others even noticing it. Instead of wrist-worn, future unobtrusive wearable sensors may look like something that is completely indistinguishable from a normal wedding ring.</p>
<p>One way to solve the recharging problem is to harvest energy from the environment. For example, radio frequency (RF) waves are ubiquitous and always around us due to cellular networks, WiFi and radio stations. Researchers at University of Washington have built a complete ambient <a href="http://sensor.cs.washington.edu/pubs/wisnet_ambient_rf_energy.pdf">RF-powered sensor for wireless temperature measurements</a>.
Another always-on energy source for wearables is the body’s own heat. Recent work from the University of Virginia and University of Washington demonstrated a <a href="http://dx.doi.org/10.1109/JSSC.2012.2221217">body heat-powered ECG sensor</a> which is the size of a grain of rice (2.5mm by 3.3mm) and consumes only 19uW (about 10 millionth of the power needed by a regular light bulb). Unless it’s broken, this device can last forever and track the user’s ECG continuously as a skin patch.</p>
<p>Such technological breakthroughs may one day enable truly wear-and-forget sensors which users never need to worry about once put on.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74126/original/image-20150307-13564-18dh886.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nanoparticles, like in this artist’s rendition, can deliver chemotherapy drugs directly to cancer cells. Will wearable sensors be able to monitor their progress from outside the body?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/argonne/14730293770/">Argonne National Laboratory</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Future wearable sensors should also be able to measure disease-specific markers inside the body, not just the physiological signals or vital signs from the body surface. For example, Google X is working on <a href="http://www.technologyreview.com/news/532181/reality-check-for-googles-nanoparticle-health-tests/">magnetic nanoparticles circulating in the body to search for cancer</a>, with the results to be read out by a wearable device. This is a tall order and we don’t yet know if they can successfully pull it off.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74127/original/image-20150307-13543-121d9fe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This temporary tattoo can measure glucose in the fluid between skin cells.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jsoe/16240068472/">Jacobs School of Engineering/UC San Diego</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Another promising way to sense what’s happening inside the body might be to measure chemicals from sweat. For example, researchers from the University of Cincinnati and the University of California, San Diego are working on wearable sensors that can measure <a href="http://spectrum.ieee.org/biomedical/diagnostics/sweat-sensors-will-change-how-wearables-track-your-health">electrolytes, metabolites and other molecules from the sweat</a>. If such capabilities become a reality, wearable sensors’ clinical values will increase dramatically by providing molecular information that is more specific to a certain condition, such as cortisol level in chronic stress.</p>
<h2>Prove clinical utilities</h2>
<p>Finally, the single most important factor that will determine next-gen wearable sensors’ success or failure is whether they can actually contribute to better health outcomes. </p>
<p>Many physicians and researchers, including me, believe in the transformative potential of wearable health sensors. Just as smartphones decentralized computing and communication, wearable sensors hold the potential to decentralize and democratize health care, changing it from reactive to proactive, from one-size-fits-all to personalized medicine. With the right wearable sensors, consumers gain the power to continuously monitor their own health status; at doctor’s appointment, the patient can provide both quantitative baseline and abnormal health data to the physician. This scenario could fundamentally change how health care is delivered.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=811&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=811&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=811&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1019&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1019&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74128/original/image-20150307-13546-145hnv7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1019&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What will the next generation of sensors detect?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/westkastle/13870745994">WestKastle</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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</figure>
<p>However, the burden is now on wearable sensor developers to provide unambiguous proof that such sensors can improve health. We need to make the jump from just collecting the data that’s easy to collect, to collecting and using data for real medical purposes. Recently, some wearable sensor makers, such as iRhythm, started to provide <a href="http://www.irhythmtech.com/healthcare-clinical-evidence.php">clinical study data</a> that support their device’s clinical value. Such trends will likely continue for future wearable sensors.</p>
<p>Are wearable sensors fad or the future? The answer to this question will ultimately depend on clear evidence that they do make us healthier.</p><img src="https://counter.theconversation.com/content/37318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zhenyu Li does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We can already track plenty of body data, but to really make a difference, wearables need to consistently collect clinically valuable information that can be used to improve health.Zhenyu Li, Assistant Professor of Biomedical Engineering, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/344952014-11-24T03:35:51Z2014-11-24T03:35:51ZFitness tracking data in courts – persuasive, but not conclusive<figure><img src="https://images.theconversation.com/files/65284/original/image-20141124-1040-pu4si0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No longer restricted to elite athletes, personal fitness data can be collected from people jogging, going to the gym – even sleeping.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mediaflex/4186679237">Josh Janssen/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Beyond simply counting steps, fitness tracking technology creates personal black boxes that archive everything we do – even sleeping. </p>
<p>So it’s not surprising to see that a <a href="https://www.mcleod-law.com/news/vivametricas-analytics-platform-supports-personal-injury-claims">Calgary law firm</a>, representing a fitness instructor injured more than four years ago, announced last week it will <a href="https://theconversation.com/how-your-fitbit-data-can-and-will-be-used-against-you-in-a-court-of-law-34580">use data</a> taken from the plaintiff’s <a href="http://www.fitbit.com/au">FitBit</a> as an “objective” measure of activity in a personal injury lawsuit in order to show a reduction in physical activity post-injury. </p>
<p>With the inevitability that self-tracking data, like social media profiles, will become accessible to courts, there’s a range of issues that self-trackers, legal professionals and others will need to consider. Deborah Lupton touched on the topic of <a href="https://theconversation.com/wearer-be-warned-your-fitness-data-may-be-sold-or-used-against-you-31283">privacy</a> before, but should fitness data be treated as conclusive evidence?</p>
<p>In this particular case the data is being given over voluntarily. But data from your FitBit, <a href="https://theconversation.com/apple-delivers-smart-watch-but-you-might-want-to-think-twice-about-getting-one-31526">Apple watch</a> or any number of other devices and apps used to measure and log information about yourself could be subpoenaed by courts in a range of different circumstances including some where the data could be used against the wearer. </p>
<p>Entities – especially those based in the US – such as <a href="http://www.ihealthbeat.org/insight/2014/digital-health-tools-are-a-growing-part-of-workplace-wellness-programs">employers</a> and <a href="http://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance/">health insurers</a> and even certain retailers (for their customer loyalty schemes) have shown interest in collecting health and fitness information about individuals.</p>
<p>In this light, perhaps it is not a surprise that self-tracking data is also of interest to those involved in various types of legal proceedings.</p>
<h2>Analysing the data</h2>
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<p>Most devices available to consumers work by using small sensors including accelerometers and altimeters that measure the amount and intensity of movement. The software, coupled with these devices, rely on algorithms to convert data from the sensors into useful information. </p>
<p>Given that most people who self-track want to achieve a certain goal – taking 10,000 steps per day, getting more sleep or reducing calorie intake – little thought is given to the ways in which the raw data collected by the device could be re-purposed (and by whom). </p>
<p>The majority of fitness tracking devices on the market are not able to tell the difference between the type of activity a user is engaging in. For the data to be more accurate, users have to manually specify certain activity types like running or bike riding via a web account or mobile app. This leaves fitness tracking systems open to abuse by users who could create fraudulent data sets. </p>
<p>The law firm representing the plaintiff in Calgary will make the data available to <a href="http://www.zdnet.com/vivametrica-unveils-open-source-healthcare-analytics-platform-for-wearables-7000033727/">Vivametrica</a> a company specialising in standardising and comparing self-tracking data at the population level. The scope and application of self-tracking data is likely to become more complex as the major players like FitBit allow <a href="http://www.fitbit.com/apps">developers access</a> to their application programming interfaces (APIs). </p>
<p>Reverse engineering and <a href="http://www.openyou.org/about/">open source development</a> in health technology also allows users and third parties greater freedom to modify the devices. This access to direct tracking is often in violation of software licences, presenting a range of potential abuses and legal quagmires.</p>
<h2>So is fitness data conclusive?</h2>
<p>It remains to be seen whether self-tracking data from wearable devices will be used to the same extent as DNA evidence or fingerprints in litigation. But the treatment of these kinds of evidence may provide some guidance as to how data from wearable technology should be approached in the courtroom. </p>
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<p>While DNA and fingerprint evidence may generally be considered as admissible in proceedings – and authoritative – there have still been challenges as to their use in certain instances. Indeed, miscarriages of justice have been <a href="http://www.theguardian.com/politics/2009/may/05/miscarriages-justice-dna-evidence">remedied</a> and <a href="http://www.bbc.com/news/uk-scotland-17771778">caused</a> by these types of evidence. </p>
<p>The quality of the evidence is of high importance, and encompasses factors including the methods used to collect the sample and analyse it in a laboratory. For DNA evidence, the laboratory analysing it must be <a href="http://www.alrc.gov.au/publications/44-criminal-proceedings/reliability-dna-evidence">accredited</a> to ensure quality control. An expert witness may also be called to discuss the sample and the methods for collection. </p>
<p>Accordingly, similar questions should be asked of self-tracking data obtained via wearable devices: data science experts could be called to discuss how reliable or accurate the data is. More could also be done to educate judges and the legal profession more generally about this kind of data gathering.</p>
<p>In practice, courts should not view the data collected from wearable devices as the objective truth about that individual’s state of health, fitness or activity. At most this data should constitute “opinion” rather than “fact” and should be treated as persuasive at most, but certainly not definitive of “truth”.</p>
<p>While DNA evidence or fingerprints are used to determine whether a particular individual was present at the crime scene, self-tracking data and its analysis is used to try to answer more nebulous and less binary questions about a person’s state of health or level of fitness. </p>
<p>Since there will be various other ways of making these determinations – and various assumptions underpinning each method, such as precisely what being healthy or fit means – courts should at most regard this kind of evidence as indicative or persuasive rather than conclusive.</p><img src="https://counter.theconversation.com/content/34495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Daly is a member of the Australian Privacy Foundation's board of directors.</span></em></p><p class="fine-print"><em><span>Suneel Jethani does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Beyond simply counting steps, fitness tracking technology creates personal black boxes that archive everything we do – even sleeping. So it’s not surprising to see that a Calgary law firm, representing…Suneel Jethani, Lecturer and PhD Candidate Media and Communications, The University of MelbourneAngela Daly, Research Fellow in Media and Communications Law, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.