Hal Johnson started using a fitness tracker long before our watches transformed into microcomputers capable of monitoring our heart rate while playing music and making calls.
In fact, back in 1992, he and BodyBreak co-founder Joanne McLeod launched their own, tracking exercise and calorie counts from data users manually inputted. The tracker was, however, on a 5.25-inch floppy disk.
The husband-and-wife duo known for their 90-second health-tip segments that aired on Canadian TV in the ’90s and 2000s have been living their “keep fit and have fun” motto for over three decades. These days, working remotely from their studio gym in their home in Muskoka, Ont., Johnson and McLeod track their workouts and close their daily goal rings with (decidedly more portable) Apple Watches.
Since the first clip-on Fitbit debuted in 2008, wearable fitness trackers have been a growing market for users looking to log their 10,000 steps a day and more. That market exploded by a whopping 22 percent in 2020—today, at least one in four Canadians owns one. From Garmins to Whoop to the Oura Ring, the wearable technology industry is projected to grow to approximately $68.5 billion by 2023, according to GlobalData forecasts.
But in the same way that cellphones are no longer simply for phone calls, fitness trackers have evolved far beyond fitness. Over the past decade, health-oriented metrics have become a staple on these trackers, enabling users to potentially get ahead of health issues like a heart attack, stroke or even COVID.
“It’s one of my most important devices now,” says Johnson, 65, over the phone on a chilly winter afternoon. “It’s not only about the fitness but the health stuff in [the Apple Watch]. It’s just so convenient.” Johnson has just come back from the first of his daily workouts: a 16-kilometre skate on a track through the woods near the couple’s home. McLeod, 63, meanwhile, is deep into training for an Ironman 70.3 she’s entering in September. “I’ve always used my wearable tech as a motivator,” says McLeod, who uses an Apple Watch to track open water swims and stay on top of her training calendar.
Likewise, Johnson, an admitted tech junkie, wears his Apple Watch every day to fuel his fitness progress. But two years ago, his smartwatch became more than just a way to gamify his workouts. It very likely saved his life.
Back in February 2020, Johnson was playing hockey with his local 55+ league, and midway through the game he checked the workout measurements on his Apple Watch out of habit. To his surprise, within the first hour of the game, he had burned 450 calories more than what was normal for him. “I thought, wow, that’s unusual—so I checked my heart rate, and it was extremely high,” he recalls.
Johnson used the electrocardiogram (ECG) function on his watch, which measured how steadily his heart was beating. At the time, this tech was a new idea: press a button and get a measurement that was once only available in a health care setting. Even more novel was the response from Johnson’s watch: “Your heart is in A-fib. Go to the hospital.”
Atrial fibrillation (or A-fib) is a form of irregular heart rhythm—or arrhythmia—that affects up to 200,000 Canadians, putting them at risk of stroke or heart failure. Risk for the disease increases with age, but for a fitness buff like Johnson, it wasn’t even on his radar. In fact, he was shocked, particularly since it’s not in his family history. “I mean, I’m Hal Johnson,” he says with a laugh. “You think, I’m out doing stuff, and watching what I eat. And all of a sudden, [a major health issue] happens.”
The data from Johnson’s watch was confirmed by hospital testing. He was ultimately given blood thinners and, after a few weeks, underwent an electrical cardioversion to shock and reset his heart to normal sinus rhythm.
The idea of strapping on a device to better understand your health is certainly appealing—as a recent survey out of HEC Montréal discovered, two-thirds of those surveyed are already regularly tracking one or more aspects of their health. And wearable devices need a medical device licence from Health Canada before they can offer functions like ECG. Yet some studies warn that putting advanced health tools onto the wrists of consumers, who lack medical training to interpret the results, can contribute to anxiety and potentially overtreatment. The question becomes: Is 24/7 access to health monitoring helpful or hurtful?
Image: Saty + Pratha
Mary Louise Adams is a sociologist of sport and fitness in the School of Kinesiology and Health Studies at Queen’s University. She notes that while the phenomenon of wearables is relatively new, the concept of self-monitoring health has roots reaching back to the 1980s. “The alternative health movement was a big critique of the kind of medical system that made people like my mother absolutely never ask a question to a doctor,” she says. “That kind of overbearing, treat-the-patient-as-a-child-no-matter-how-old-they-are medical system.”
The movement encouraged people to take more agency for their own health—that not everything needed to be dealt with at the doctor’s office. Zoom forward to 2022, two years into a worldwide health crisis, sales of self-monitoring devices are booming—and heart rate and ECG on-the-go aren’t the only measurements today’s wearable devices can track.
Many wearables can clock blood oxygen levels, typically used to assess cardiovascular health. A recent study out of Mount Sinai Hospital in New York City found that heart rate variability (HRV), essentially a measure of the time between heartbeats, from consumer wearables could even predict the onset of COVID-19 symptoms. Garmin, Samsung Galaxy and Apple Watch all have “fall detection”—should the wearer take a tumble and be immobilized for more than a minute, their emergency contacts will receive a text alert with their location. And in some cases, the watch can call 911 outright when the user finds themselves in distress.
Johnson and McLeod are semi-regular users of that function themselves—McLeod once fell off her bike and received a call from her daughter moments later. “Anytime you can alert somebody to do a wellness check on you, I think that’s a good thing,” says McLeod. (Johnson also uses the feature but jokes he “falls too much.” “Joanne will call and say, ‘What did you do now?!’” he laughs.)
Research teams across Canada are hard at work assessing the potential medical value of these tools. A team at Kingston General Hospital studied Fitbit Charge HR as a means of monitoring the heart rate of 50 ICU patients (and they continue to use Fitbits to monitor how well 12 older patients recover from critical care). In Toronto, the University Hospital Network’s Peter Munk Cardiac Centre has paired with Apple Watch to see how it could help with monitoring the health of patients with worsening heart failure—comparing the data the watch produces with those cardiac tests traditionally performed in a hospital setting. “It is tremendously exciting to see the consumer wearable device field evolve,” says Dr. Heather Ross, division head of cardiology at the centre. “It’s going to be crucial to ensure that new technologies are validated in a rigorous way so that we are certain that the data that they are collecting is the ‘ground truth’ in comparison to accepted medical-grade technologies.”
The results of the study could determine whether doctors might be able to accept an ECG report that’s generated from an Apple Watch. After his A-fib incident, Johnson brought his own report to his cardiologist team at the hospital, but—perhaps not surprisingly—they weren’t particularly interested in it. “Everything I told them, they really didn’t trust it,” he says.
Dr. Harriette Van Spall is an academic cardiologist and researcher at McMaster University who provides care to patients with cardiovascular disease. She often recommends wearable activity sensors for her patients because people often overestimate just how active they are. “I find it’s a great motivator for patients,” she says. “And research studies show that these devices can be quite useful in increasing your step counts, decreasing your sedentary time and maintaining that for a period of months.”
As for tracking biometrics like blood pressure, oxygen levels or arrhythmia, she says that there is a lot of potential, but not yet enough studies to validate the data that biometric sensors (available in some wearable tech, and also in things like special textile or ECG patches) can measure. For these tech wearables, she notes, “in healthy people, the yield for detecting abnormal heart rhythms is very, very, very low.” She points to an Apple study of 420,000 people that found A-fib in just 0.5 percent of them (who were commonly older and men)—meaning they received alerts regarding abnormal rhythms. These people were sent ECG patches to wear, but ultimately only 1 in 5 returned the patch to submit data. Of those who returned them, about a third had atrial fibrillation and it’s unclear if detecting this warranted treatment or even if treatment improved their health. Thus, only 0.03 percent of all people screened had A-fib. So the implications are unclear.
And while Van Spall appreciates that people can feel a sense of safety and empowerment when wearing one of these trackers, she cautions that they can’t be their only touchpoint with health care. “We don’t know how many people who have a normal rhythm on these devices are actually normal in terms of their heart rhythm,” she says. “So receiving the alerts doesn’t mean that you have an arrhythmia, and on the other hand, not receiving the alerts doesn’t mean that you don’t have the arrhythmia.”Of course, there are times when all of this health data tracking can be just…too much.
Jen Ng was 45 when she was diagnosed with high blood pressure, so for her birthday, she bought herself a Fitbit Charge 4. “I decided to give myself the gift of health,” says the Vancouverite, who works in supply chain management. “I knew I was getting into that age zone when people talk about women getting heart attacks. And especially as a single female, you have to be taking care of yourself.”
While heart health was her primary goal, she decided to start monitoring her sleep performance as well. “At first, it’s novel, it’s cute,” she says. “You look at your phone app when you wake up and see what score you got. It’s like a video game you’re playing.”
The problem was, she couldn’t get her Fitbit sleep score to report anything higher than 84 percent—nor was it clear what it was measuring or what she needed to do to change that result. “Not to stereotype, but culturally speaking, that’s a failing grade!” laughs Ng, who is Chinese Canadian. “I can’t even get an A+ when I’m asleep?”
She started to develop anxiety around her sleep “performance,” especially as her scores began to get worse. Ultimately, she quit wearing the watch for four months. Once she felt ready to strap the Fitbit on again, she put boundaries firmly in place. “I only wear it during the day, I track my steps and I check that I’m in the cardio or fat-burning zone.”
Ng isn’t an isolated case. A 2020 study out of the University of Copenhagen found that while data from wearable devices may be a resource for self-care, it can also create uncertainty, fear and anxiety. Vancouver-based naturopathic doctor and performance coach Dr. Jason Marr has seen such tracking anxiety come up at his practice. “You’re relying now on an external device to tell you how you’re feeling,” he says. “It often reduces agency—some people don’t feel as empowered, like they don’t have as much control of their health when things are going wrong, sometimes leading to lack of mindfulness or awareness of what is going on.” Though Marr also notes that there’s a lot of potential with wearable tech to “help us understand our body and our health, but the data has to be used properly and appropriately in context to be effective and beneficial.”
Image: Saty + Pratha
In a lot of ways, the health-monitoring capabilities of wearable tech are still very much in their early days. Apple is studying tremor tracking for Parkinson’s patients as a means of monitoring the effectiveness of their medication and changes in symptoms. Oura has partnered with the University of California San Diego to use its metrics as a means of mapping the physiological aspects of pregnancy. On Johnson’s personal wish list is the ability to monitor his blood pressure.
Van Spall also sees high potential in more readily accessible—and clinically validated— blood pressure measurements on wearable tech. “So many of our heart failure treatments reduce blood pressure, and we track [it] to make sure that it’s not too low,” she says. “It would be wonderful if, instead of putting your arm through a blood pressure cuff, you’re just wearing a watch.”
Johnson and McLeod continue to gamify their fitness on their Apple Watches, and often jokingly challenge each other with how low they can get their resting heart rate—a sign of great heart health. But Johnson recognizes he needs to keep his boundaries in check when he’s monitoring his health stats. “It’s good to know just the basics,” he says.
And as for Ng, she’s keeping a more careful eye on her reactions to the data as she cautiously moves back into wearable tech. “I have a blood pressure problem—but is monitoring my heart rate a good thing or bad thing, and how is it correlated?” says Ng. “No one is teaching you how to read these metrics, or how they’re evaluating and looking at other variables. And it’s hard to be objective. You can turn anything into something in favour of what you’re obsessed with. And that’s dangerous, too.”
Next: How to Protect Your Health Data on Your Tech
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