Research shows fitness wearables can impact individuals’ health — but to see real public health benefits, healthcare systems need to go beyond just tech.GETTY IMAGES
Wearable tech and health apps promise transformation by way of data. Whether it’s an Oura ring, an Apple Watch or the step tracker preloaded on your smartphone, the pitch stays consistent: Track enough data, endure enough passive-aggressive push notifications and you’ll be nudged, gamified and guilted into a healthier, happier life.
The logic follows, at least in theory: If wearable tech is ubiquitous, improved health outcomes should be, too. If each Fitbit represents one person hitting ten thousand steps a day and lowering their risk for chronic disease, then a nation of smart-device owners should be trending healthier by default. Right?
Maybe, says Emmanuel Stamatakis, a professor of physical activity and population health at the Mackenzie Wearables Research Hub at the University of Sydney in Australia.
“There is some good peer-reviewed evidence that consumer-grade wearable trackers can improve physical activity,” says Stamatakis. He cites two large-scale studies that synthesised about 50 previous studies and concluded that, on average, wearables add between 1,300 and 1,800 daily steps and 40 to 60 minutes a week of moderate-to-vigorous activity.
“This is a substantial amount of daily physical activity, especially for a previously inactive person,” he says. And it matters, given that 31 per cent of adults and 80 per cent of adolescents aren’t getting the minimum recommended levels, despite well-established links to disease prevention, improved mental health and overall wellbeing.
Another key finding – and a crucial caveat – is that wearables tend to work best when they’re part of a larger support system that includes things like behavioural coaching.
“In other words, for a physically inactive person who is not sporty and has no innate desire for structured exercise, it’s unlikely that the provision of the tracker alone will improve behaviour or long-term health,” Stamatakis says. “However, when the tracker is combined with personal support, there is a lot of promise. Physically inactive and unfit people are those who can benefit the most from such an intervention.”
That’s why Stamatakis is skeptical of any public health strategies that dole out wearable tech en masse, such as those recently announced by the U.K. and the U.S.
“These are very welcome plans, but only as first steps. There is a lot of apparent naivety in implying that handing out a wearable will solve all health problems and in a healthier way,” he says. “Bottom line for any healthcare system: wearables are not magical bullets – they are only tools.”
While we don’t yet have any large-scale studies of their impact on overall public health, we can examine the past decade or so that these devices have been available.
“Since these devices have been around, public health hasn’t changed,” says Stuart Phillips, a professor of kinesiology at McMaster University. He adds that if fitness wearables were driving large-scale behaviour change, we would have seen the evidence by now.
An Oura ring wearer himself, Phillips hypothesizes that this may reflect who’s opted in to the “test group” so far.
“We’re the converted. It’s a self-fulfilling thing. I look at it and get enjoyment out of the metrification of my activity,” he says. “I was sold already on physical activity anyway, but for the average person it hasn’t really changed behaviour that much.”
Anecdotally, Dr. Zainab Abdurrahman, an allergist in Mississauga, Ont., has seen a modest shift in a more positive direction.
“I have a really large mix of patients, many from equity-deserving populations, so I don’t see them using them as much,” says Abdurrahman, who is also the president of the Ontario Medical Association. “But I do notice people who do use them. They will comment, ‘I do use it to look at my steps to see how much I’m moving.’”
Step tracking, she says, is one of the simplest features where she sees a behaviour shift: people walk more because they’re watching the numbers. “They’ll say, ‘Sometimes I come home at the end of the day and I notice I haven’t taken as many steps, so it pushes me to go for a walk.’”
Abdurrahman also discusses health apps with patients, including one that reminds users when their EpiPen is about to expire, though she points out that a simple calendar alert would achieve the same goal. “I want it to be simple, so you don’t need a fancy phone,” she says. “And that is very important.”
She adds that other doctors have told her they use wearable tech to encourage patients to be more involved in their own health. “They’ll say, ‘When you have diabetes and you’re tracking your sugars, what trends are you seeing?’ It allows them to have these further discussions,” she says.
More critically, the populations most affected by chronic conditions are often the least likely to have access to wearable tech.
“I don’t need it to be an Apple Watch, but perhaps we could get Fitbits for certain communities for them to log how many steps they’re taking,” Abdurrahman says, noting that seniors, unlike younger users, are far less likely to carry their phones everywhere to accurately log their steps. “We’re often trying to prescribe activity for our patients, but we don’t have a good way to capture how much they do. It can also help reinforce to them that they are doing some movement.”
That’s why, at the population level, Dr. Abdurrahman sees promise in wearables, especially for early detection and prevention. For example, there are already wearable devices that can flag cardiac arrythmias, detect seizures and note changes in blood pressure and glucose levels.
Still, she cautions that they shouldn’t replace the basics, like encouraging movement or time in nature.
“It doesn’t have to detract from aspects of social prescribing like passes to go to a national park in the summer, or other things that keep movement up,” she says. “I wouldn’t want people to give up those efforts just to focus on devices.”
