Scott Webb (Host): Wearable technology, like smartwatches, are undeniably cool and convenient for many of us. They help us track our steps, monitor our heart rate, sense when we've had a fall, and so much more. And joining me today to discuss the many benefits of wearable technology and encourage us all to use these devices responsibly is Dr. Carl Von Harten IV. He's a Family Medicine Doctor with BayCare. 

Welcome to BayCare HealthChat. I'm Scott Webb. Doctor, it's nice to have you here today. And we're going to talk about fitness watches for monitoring health. And I know that my Apple watch is often telling me to breathe. And I don't know if it means it literally or figuratively. But that's essentially what we're going to do, is talk about the advances in these wearables and how they can help us and working with our medical professionals to make sure we get this right. So, let's just start there. What are some of the wearable technology trends that we need to know about?

Dr. Carl Von Harten: I'm sure you're aware, fitness watches are becoming increasingly popular. Last year in 2024, about 27% of Americans were wearing a smartwatch consistently. And we see an increase every year of about 1%, especially over the past 10 years. And so, newer smartwatches, they're always being released in the market. They're going to be equipped with the newest sensors, algorithms, mobile apps, as the technology continues to progress. And the ratio of smartwatch users, it's about 60% males to 40% females. And we see that men are typically early adopters of the technology compared to women, because they're usually more easily impressed by the technical specifications and likely to purchase the product because of those parameters. However, it's actually been shown that women technically give more importance to the value that the technology brings to their lives. The highest demographics of fitness watch-wearers is in those 25 to 35-year-old range, which is comparable to most modern technology. And the overwhelming hope with these fitness watches is that it can help with the increasing deficit that our society has as it relates to physical activity.

You know, the World Health Organization recommends 150 minutes of moderate intensity physical activity each week for adults, and then 60 minutes each week for children and adolescents. And unfortunately, only about 30% of women and 22% of men are reaching this recommended target. And so, the hope is that these fitness watches are going to kind of help us get to those goals that have been set.

Scott Webb: Yeah. That they will help us to sort of track things, encourage us, not shame us, of course, along the way. Just wondering, what are some of the current technology trends that are out there that we need to know about? As you say, you know, like for me, what drew me to these smartwatches, my Apple watch was maybe being a fan of Star Trek, you know, and just this cool wearable technology and then figuring out how do I use this to get my 150 minutes and keep track of all that and, you know, stay focused and motivated. So, what are some of the trends that are helping folks?

Dr. Carl Von Harten: Yeah, the technology really has come a long way. You know, it started out with pedometers or step trackers, and that pretty quickly advanced to more accurate accelerometers, which is the current gold standard for collecting physical activity data. All fitness watches are going to have that accelerometer. And then, there's a lot of newer technology, gyroscopes, magnetometers, which are measuring more of the gravitation, the orientation, angular velocity, and all of these are really just to provide more accuracy. And all of these technologies are combining to form this inertial measurement unit, which is what these smart watches are using to estimate your type of movement, to count your steps, calculate your energy expenditure, energy intensity, and also helps to estimate sleep patterns. And then, there's even additional technology, barometers, altimeters, GPS receivers, which are now being built in. And all of these are really just to help track more data, your position, your speed, your altitude.

And then, one of the more impressive recent technologies is something that's called photoplethysmography or PPG. And this newer technology is now seen in wearables and it's an optical technique, which estimates your heart rate by monitoring changes in the blood volume that's beneath the skin. And how it works is basically through a light that's emitted onto the skin. And it's affected by that heart rate and just reflects back to the sensor. So, all of these are some of the newer technologies that we're seeing.

Host: Yeah, Doctor, it's really amazing. I was thinking about the watch I had when I was a kid that was also a calculator and how cool I thought I was that I had a watch and a calculator on my wrist. But when we think about the wearables today, I want to have you talk about sort of the experience, the user experience and like kind of what folks are seeing on their watches or these devices and, you know, how they're interacting with it, like all that good stuff.

Dr. Carl Von Harten: Right. There's a lot of good technology and how is that related to the users? So, some of the most valuable data that these watches are able to provide is actually regarding heart health. And that starts with the heart rate. Many of these devices can tell you if your heart rate is high or low, and more specifically can tell you your resting heart rate, your heart rate with physical activity, and your heart rate variability. And some of the newer technology can now actually identify irregular rhythms. And this is using that optical heart sensor to detect the pulse wave at the wrist and looking for that variability in the beat to beat intervals when you're at rest. And this irregular rhythm feature has actually received clearance from the FDA, so, very well researched. And it's recommended for those users over 22 years, so, pretty much most adults. And there was actually a clinical study that compared fitness watches to EKGs as a reference point. It showed that the irregular rhythm feature had a sensitivity of 89% and a specificity of over 99%. So, it really has been shown to be very accurate.

And then, even more recently, fitness watches utilize an electrical heart sensor to record a single lead EKG, which is similar to lead one in an EKG. So, we have to remember that your standard EKGs are 12 leads. And therefore, EKGs produced by fitness watches do not include all of the information that we see on an EKG done in office, but they can find sinus rhythm, atrial fibrillation with an elevated heart rate, and sometimes they're also just inconclusive.

 And these watches, they can also show mobility metrics. It can show your cardiac fitness, which presents as your VO2 max. It can show other metrics that help measure your walking quality, such as your walking speed, your step length, your double support time, your walking asymmetry. And then, some fitness watches also, they track your body temperature, which can let you know if you're getting overheated, if you're running a fever. The temperature reader in some watches also helps users track fertility. So, a lot of good benefits there.

But I'd say the one aspect of fitness watch technology that I actually find to be the most beneficial, and especially for our older population, is actually the fall detection technology. If a user has a hard fall that's detected, there's an alert that appears on the watch and allows the user to easily call emergency services, or they can dismiss the alert if it's a false alert. And if the user is unresponsive for about a minute, an emergency call will actually be placed automatically. So, the technology really is quite useful and robust.

Host: Yeah. And I've heard that about AFib, spoken with some experts, that more and more younger folks are being diagnosed with AFib. And so, I naturally asked, was it that younger folks are just, you know, experiencing more AFib than they used to? And really, what I got back from one of the experts was that it's actually the wearable technology that is assisting in the diagnosis of AFib. And it's causing, you know, younger folks to go in and speak with their providers and be fully tested. So, it's not so much that there's this epidemic of AFib more so than there ever was, it's that more and more folks are being diagnosed and wearables are contributing to that, right?

Dr. Carl Von Harten: Yeah. There really are a ton of benefits, and it's allowing the user to really put their own health in their hands and allow for them to feel more connected to their health outside of just going to the doctor's office. And there really are a lot of great benefits that come with the technology. But at its core, these watches actually get the most benefit. When we think of how they hold the wearer accountable, if you're someone that benefits from accountability, you may find that a smartwatch that shares your activity levels with friends or families can be a good motivator. Or if none of your friends are into fitness watches, some of the apps or devices can set daily or weekly challenges for you to meet. And all of this is really to provide motivation to help you set goals. When you're setting these incrementally higher fitness goals, you can increase your overall activity to consistently improve your health. There's been a good study out there that shows if you're hitting that 10,000 steps per day, that alone can lower your risk of cardiovascular disease by over 20%, your risk of premature death by almost 40%. So hopefully, these watches can help guide us towards similar health benefits. We also mentioned the ability of those fitness watches to monitor our VO2 max. That's kind of a newer technology, and having a higher VO2 max number typically means you're in good cardiovascular shape, which can also increase your VO2 max by losing body fat. And as you become more fit, you can expect your VO2 max to trend upwards within a few months. And for most of the population, this is a useful parameter to help calculate your calories burned at different levels of exercise intensity, but it can even be used for top professional athletes to help establish very regimented exercise programs at specific training levels.

So, these fitness watches really can benefit the vast majority of the population. And then, there's also the benefits from just the tracking ability that these watches have. You can track your hydration, you can track menstrual cycles, you can set medication reminders, help with eating healthier. And really, with eating healthier, it's less about meticulously counting calories and more just to get a better sense of what type of foods you need more or less of in the day. So overall, these watches really can benefit people and especially those people that like to have access to those larger amounts of data that is now available at their fingertips.

Host: Right. As you say, just putting the control, or more control anyway, into the hands of users and patients. I'm wondering though, Doctor, are there some limitations that we need to be aware of?

Dr. Carl Von Harten: Absolutely. With every good thing, there's always potential for the opposite. And I would say the most glaring limitation is that over the long term, people actually tend to lose interest after about two to three months. They get a new fitness watch. And once that novelty wears off, the device either ends up not being worn anymore, or they're still wearing it without utilizing some of those health and fitness features that they may have utilized earlier on. And really, to combat this, we recommend consistently adjusting your goals, sharing your milestones. And when you get those movement reminders or stand goals, make sure that you're responding to them because they do add up in the long run.

And there are some more specific limitations to the technology. One of the largest one most recently is that some companies have made claims that you're able to monitor your sugar levels. However, the FDA has made a direct statement that none of the devices currently are approved or accurate, which is in contrast to CGMs, or continuous glucose monitors, which are very reliable, accurate, and are a valuable tool for both patients and physicians. And so really, with that being said, as many of the glucose smartwatch companies are still experimenting with the technology, I believe that eventually we will have a reliable application implemented in our fitness watches. We're just not quite there yet.

And then, some of the other smaller things, some of the calorie counting features can be off by a little bit. For sleep, fitness watches do a really good job of determining our total time of sleep, but not quite as effective at determining things like our stages of sleep or our awakenings.

And then, I would say one of the most important things in regards to heart health is that fitness watches are not approved to diagnose heart attacks. If you have chest pain, but your EKG on your fitness watch is normal, that does not necessarily mean that you are fine. So if that is the case, you know, please reach out to your healthcare provider and make sure that you're having the appropriate follow up.

And then. The last thing I would say is that in terms of the accuracy of measuring oxygen levels, which is also a newer aspect to some of the fitness watches, this really can be variable. If you have a respiratory condition such as COPD where they're requiring ongoing monitoring, it really would be recommended to invest in a dedicated pulse oximeter instead of just relying on a fitness watch.

Host: Yeah, I want to talk to you about some of the emerging concerns. My wife used to be obsessed with her step count, constantly monitoring and updating me about how many steps she had or needed to get and all of that. And I just want to talk to you a little bit about that, the sort of obsession over step count and just overall mental health and the connection to wearables.

Dr. Carl Von Harten: Yeah, that really is the largest concern, is that watches do have the ability to cause health anxiety. If you find yourself stressing or obsessing over the data points that your watch is providing you, then you may benefit from not actually wearing your watch all the time. We want people to view exercise as an enjoyable experience, not simply just meeting certain parameters that they're seeing on their wrist.

And the other thing is I sometimes have to remind patients Fitness watches do not replace medical-grade monitoring equipment. That is still the gold standard. And we also want patients to remember to listen to their body, right? Your body is going to let you know if there is something going on, just to make sure that you're not fully relying on the fitness watch and the data that's being shown to you.

Host: Yeah. We Still need to see our doctors, go for our, you know, annual checkups, those kinds of things, right?

Dr. Carl Von Harten: Exactly. Yes.

Scott Webb: That's good stuff today. You know, I love my Apple watch. It looks cool. It gives me lots of great information. I try not to obsess over it. I try to use it when and where possible to the maximum benefits, as you say, to motivate and certainly not to shame me into working harder and doing more.

I just want to give you a chance at the end here, take us through, you know, how you would recommend someone sort of working with their medical professional, their doctor, primary, whomever, in creating a plan and incorporating wearable technology into that plan.

Dr. Carl Von Harten: Fitness watches are a great starting point. We want to remember that they are not a replacement to standardized healthcare. so, just always remembering that these devices really do serve as an opportunity to be an active participant in your health. And using fitness watches can allow for closer monitoring outside of the doctor's office.

And then, finally, what I always tell patients is do your research. You know, there's a lot of numerous great fitness watches out there, and one may be more beneficial for your individual journey than another. And so, I do think that, overall, fitness watches are a great tool as long as they're used responsibly. And I really think we have only scratched the surface of the technology that we're going to eventually see with these watches in the future.

Host: Yeah. You gave us a sense there, a little sneak preview of some of the things that the FDA hasn't approved yet because the technology isn't quite there, but it seems like there's reason for optimism anyway, that it's going to cover some of those things and probably more that we haven't even thought about yet. So, lots to think about when it comes to our wearables and how to use them and be responsible and all that good stuff. So, thank you for your time.

Dr. Carl Von Harten: Wonderful. Thank you so much.

Host: And to find a BayCare doctor, visit BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.