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The potential of public health’s future may rest in your hands—or more precisely, on your wrist. Researchers are utilizing smartwatches and fitness trackers to conduct extensive large-scale studies that were once unfeasible. This emerging trend has the potential to significantly enhance our understanding of various diseases.
Calum MacRae, MD, PhD, Vice Chair of Scientific Innovation for the Department of Medicine at Brigham and Women’s Hospital, states, “There’s virtually no disease that won’t be impacted by this form of research.”
Currently, wearables are being employed in the research of heart, respiratory, neurological, and liver diseases, as well as gynecological conditions, specific cancers, diabetes, sleep quality, autism, and mental health.
In a recent example, up to one million iPhone and smartwatch users have the opportunity to contribute data concerning their menstrual cycles and other health and lifestyle factors such as sleep and stress. The Apple Women’s Health Study, a decade-long collaboration between Harvard, Apple, and the National Institute of Environmental Health Sciences (NIEHS), has already enrolled 100,000 participants, making it an unprecedented project in terms of size and scope.
Medical professionals recognize that an irregular menstrual cycle can indicate a range of conditions, including infertility, heart disease, diabetes, or cancer. Despite this, menstrual and reproductive health research has been insufficiently funded and studied. By including a larger and more diverse group of participants, researchers hope to advance the diagnosis and treatment of health issues linked to menstrual cycle irregularities.
Shruthi Mahalingaiah, MD, one of the study’s principal investigators and an assistant professor of environmental, reproductive, and women’s health at the Harvard T.H. Chan School of Public Health, explains, “We’re able to ask questions we couldn’t ask before.”
The Rise of Wearables: According to a 2022 survey, nearly half of Americans wear smartwatches or fitness trackers. These devices can provide information beyond tracking calories and steps, including data on breathing rate, heart rate, blood oxygen levels, and sleep duration through smartphone apps.
Academic medical centers are collaborating with tech giants like Apple, Google, Samsung, Alphabet, Amazon, as well as tech startups and nonprofits. The COVID-19 pandemic accelerated the adoption of wearables in healthcare, as medical institutions began using them to monitor patients remotely, develop symptom checkers, and track outbreaks.
While wearable trials for data collection still account for less than 1% of all global trials, the number has been steadily increasing, with several hundred added in recent years according to clinicaltrials.gov. This trend extends beyond wrist-based wearables to include “smart” glasses, rings, necklaces, “hearables,” and even clothing. The availability of medical-grade wearables, such as smart patches, blood pressure devices, and continuous glucose monitors, is also expanding.
Ray Dorsey, MD, a professor of neurology at the University of Rochester Medical Center’s Center for Health Technology in New York, highlights the significance of this trend, saying, “You can live anywhere in the country and participate in research using wearables.” This eliminates the need for volunteers to travel to medical centers for tests and updates, thereby broadening the scope of studies.
Big Tech’s Role in Big Studies: Tech companies like Apple, Samsung, and Google have introduced open-source platforms that enable researchers to create secure apps and tools for collecting health information from wearable users. In 2015, a smartphone app developed by Dorsey’s URMC team used Apple’s ResearchKit in a Parkinson’s disease trial, enrolling over 2,000 volunteers in a single day. This study, which ultimately included over 9,000 participants, provided valuable insights into the day-to-day variations in Parkinson’s symptoms.
In 2017, the Apple Heart Study, in collaboration with Stanford University School of Medicine, enrolled more than 400,000 Apple Watch users across all 50 states in just eight months. This study demonstrated that smartwatches could detect irregular heart rhythms like atrial fibrillation, leading to the FDA classifying the watch’s electrocardiogram (EKG) app as a medical device. Subsequently, EKG apps from Fitbit, Samsung, and Garmin received similar clearances.
The Apple Women’s Health Study, launched in 2019, is among the ambitious projects, along with the Apple Heart and Movement Study and the Apple Hearing Study. These studies aim to include a more diverse demographic by race, ethnicity, age, socioeconomic status, and location compared to previous studies. Data collected covers exercise, sleep, environmental factors, and behavioral patterns, with monthly surveys capturing personal details not available through the app alone.
Early results from the Apple Women’s Health Study have revealed insights, such as the temporary nature of slightly longer menstrual cycles caused by COVID vaccines. Additionally, the study has found that irregular and infrequent periods are more common in Black and Asian individuals, while longer menstrual cycles are prevalent among Asian, Hispanic, and overweight individuals. An analysis of over 50,000 participants has provided valuable information about the connections between abnormal menstrual cycles and health conditions like polycystic ovary syndrome, endometrial hyperplasia, and cancer.
Future investigations will delve deeper into the data to explore the impact of environmental factors, behavior, and stress on menstrual cycles, according to Shruthi Mahalingaiah.
Challenges and Future Outlook: While wearables hold promise, they also face challenges. Ensuring that these devices provide clinical-grade data requires further testing. Privacy and cybersecurity concerns persist within the healthcare sector, as highlighted by research from Deloitte.
These innovative studies have limitations. Participants must own smartwatches and smartphones, which are less common in underrepresented and rural populations, and they must have reliable internet access.
Nevertheless, as acceptance of these devices grows among consumers and healthcare providers, this trend is expected to expand. Urvi Shah, a senior manager in Deloitte Consulting’s Life Sciences and Health Care, predicts, “I don’t see a world where this kind of research slows down.”
