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Smartwatches Keep Tabs on Your Overall Health While Still Tracking Your Fitness

Added features can keep you heart-healthy, give you peace of mind

spinner image a person looking at their smartwatch with health icons around it
Photo Collage: AARP (Source: Shutterstock)

As you get older, you may be more eager than ever to track your fitness activity and get a better handle on what’s happening inside your body.

Insights into your health may come straight from your wrist. Apple’s latest Series 9 smartwatch, which starts at $399, coupled with the watchOS 10 software upgrade that some older models can take advantage of, can help you measure your cardio fitness while also detecting irregular heartbeats, excessive exposure to loud noises and how much sleep you’re getting. Apple also allows family members to see health information if given permission — handy for caregivers and recipients who want an extra set of eyes on an aging adult.

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The watches can even remind you to wash your hands periodically. A 20-second countdown timer may automatically kick in to ensure you’re washing long enough. And recent Apple Watches can summon emergency medical assistance should you fall and become immobilized.

Rival wearables from Fitbit (now owned by Google), Samsung and other companies also are providing digital biomarkers that provide visibility into your health — well beyond the steps counted and calories burned that have long defined such devices.

Smart rings also track

If you want less weight on your hand but still want an unobtrusive way to monitor your health and sleep patterns, a smart ring could be the answer.

The first one debuted in 2013 and could unlock doors, start your car and make electronic payments with a tap. 

Because they don’t have a screen, you must view data from the ring’s various sensors on an app, but you can wait as long as a week between charges.

Google also sells a smartwatch these days under its own brand name. The Pixel Watch 2, starting at $299.99, bakes in some Fitbit features and runs off the latest version of Google’s Wear OS software platform, the flavor of Android designed for wearables. Google’s original Pixel Watch, still in the lineup, starts at $179.99.

Wear OS 5 is expected to be previewed at Google’s annual I/O developer conference this week at its Mountain View, California, headquarters. It remains to be seen if Google teases a new Pixel Watch or Fitbit hardware during the event.

“This is a new era where we have an opportunity to reach the patients outside the walls of the hospital,” says Nino Isakadze, M.D., a cardiologist at Johns Hopkins Hospital in Baltimore who studied atrial fibrillation (A-fib) and wristband technology during her residency. “Patients can be empowered by having this type of data and be able to track their progress and be more aware of their health overall.”

Smartwatches share data with companion health apps on your iPhone or Android devices. For those enrolled in Medicare Advantage or other insurance plans, note that some smartwatches are available at a discount as a member benefit.

Around 1 in 5 adults 50 and older who go online use a smartwatch, according to Cambridge, Massachusetts market researchers Forrester.

4 health features to watch out for

1. Electrocardiogram. In 2018, Apple took a major step in putting power in the hands of consumers when it added an electrocardiogram app to its Series 4 Apple Watch models, which has carried over to subsequent models. The app, which is called ECG rather than the more commonly known EKG abbreviation, can detect A-fib, an irregular heartbeat that is a major risk factor for blood clots and stroke.

It has clearance from the federal Food and Drug Administration (FDA). On May 1, the FDA announced that the “history” feature of Apple’s A-fib technology was the first to qualify under the agency’s Medical Device Development Tools (MDDT) program, meaning it can be used in clinical studies to check estimates of how often a patient was in A-fib and the effectiveness of treatments.

Google’s Fitbit also received regulatory clearance from the FDA for its own EKG app, now on the Fitbit Sense 2 health-oriented watch, starting at $199.95 and Charge 6 devices, as well as the Pixel Watch models.

Samsung has its own FDA-cleared heart-monitoring ECG app on the Galaxy Watch6 which starts at $299.99. Older models, such as the Galaxy Watch4 and Galaxy Watch5, which you might still find at reduced prices, also have the feature.

Electrocardiograms measure the timing and strength of the electrical pulses that keep your heart pumping. On the Apple Watch, the ECG kicks into action when you launch the app and hold your finger against the digital crown, the home button on the upper right side of the watch, for 30 seconds. Electrodes are built into the back crystal and digital crown of the watch.

If you receive a “sinus rhythm” result, it means the watch has detected a normal heartbeat, not A-fib. Regardless of the result, you’re urged to seek medical attention if you experience any symptoms. Apple makes it clear that its watch does not check for signs of a heart attack.

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Fitbit’s irregular heart rhythm notifications about possible A-fib work across several models and are powered by Fitbit’s photoplethysmography (PPG) algorithm, which passively assesses your heart rhythm in the background while you’re still or sleeping.

2. Skin sensor. Fitbit added an electrodermal (EDA) sensor to its Fitbit Sense watch and its successor, Fitbit Sense2. When you place your palm over the face of the device, sensors can detect subtle electrical changes in the sweat level of your skin. Factored with your heart rate, sleep and activity data, Fitbit calculates a stress management score of 1 to 100, with a higher number translating to fewer physical signs of stress and a lower number meaning more signs.

Similar sensors on Pixel Watch 2 can also detect stress.

Fitbit may recommend breathing exercises and other mindfulness tools to help you manage stress. But after a free trial period, you’ll have to sign up for a premium subscription service for a deeper dive into the metrics. The subscription costs $9.99 monthly or $79.99 annually.

Another sensor on the Fitbit Sense can detect variations in skin temperature. Apple added wrist temperature sensors to the Series 8 and later watches, including the more rugged $799 Apple Watch Ultra. For its part, Samsung added an infrared temperature sensor on Galaxy Watch5 and later smartwatches.

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3. Sleep tracking. Some devices, including high-end Fitbits and Galaxy smartwatches, track the quality of your slumber time right down to various sleep stages and the number of times you wake up in the middle of the night. Apple’s watch is more about setting up the conditions so you get a good night’s sleep, starting with a wind-down routine before bedtime. But it, too, has the ability to detect sleep stages.

Of course, if you’re planning to sleep with any of the smartwatches, make sure they are charged before you go to bed, and if needed, give them some extra juice when you wake up.

4. Blood oxygen. Fitbit/Google, Garmin, Mobvoi and Samsung all have models that can measure blood oxygen levels. The Apple Watch Series 6, Series 7 and Series 8 obtain a measurement from a quartet of clusters of green, red and infrared LEDs on its rear and four photodiodes spaced and isolated between them to determine the color of your blood.

Measurements are automatically collected throughout the day or when you’re asleep. You also can launch an app to take a manual reading by steadying your wrist on a table, with the watch display facing upward, tapping Start, and then waiting patiently while a timer counts down for 15 seconds.

But Apple removed the blood oxygen feature on its Series 9 and Ultra devices following a patent infringement dispute with an Irvine, California, company called Masimo. The watches are now for sale in the U.S. without the feature.

Masimo’s own $499 FDA-cleared W1 Medical watch includes real-time monitoring of a users’ oxygen saturation and pulse rate and is expected to be out this year.

While most healthy adults report blood oxygen levels between 95 percent and 100 percent, what does a lower reading signify? Blood oxygen is an indicator of early signs of circulatory, heart or lung function issues, such as anemia, neurological problems or sleep disorders, says Leslie Saxon, M.D., a professor of medicine and executive director at the Center for Body Computing at the University of Southern California.

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Keep results in perspective

Don’t freak out if any result is out of kilter. See how it compares with your baseline, yet don’t ignore warning signs.

“The most important thing is how one is feeling and the symptoms,” Isakadze says. “If someone is not feeling well, I would say no matter what the numbers show on the oxygen levels or the ECG, it would still be very important to seek care.”

These are still early days for what smartwatches can track. Neither the Apple Watch nor the Fitbit can monitor blood glucose levels or high blood pressure without the use of other devices right now, which would provide a huge benefit to patients with diabetes or hypertension.

In fact, the FDA issued a warning in February that noninvasive ways of measuring your blood sugar — meaning without a prick of a needle as with a continuous glucose monitor — pose a life-threatening risk to diabetes patients because of inaccuracies.

Splurge on cell service to keep connected

If you don’t want to carry your smartphone with you when you’re out for a run or doing other exercise, get a smartwatch that has a cellular connection. This will give you much of a phone’s functionality on your wrist. Smartwatches without cellular connectivity are more like an extension of your phone and will work well only when near that device.

Meanwhile, data culled from the wrist is becoming fertile ground for researchers.

In 2020, Apple announced a study with Anthem and the University of California, Irvine, to examine how its watch might help individuals manage asthma. Another Apple study, with the Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre in Toronto, investigated how its watch might lead to better outcomes for patients with heart failure.

“Looking at data from wearables such as Apple Watch and partnering to understand the patient experience, coupled with the information from sensor technology, is a way for us to develop the knowledge that will allow us to take better care of patients. This is the future,” says Heather Ross, M.D., at the University of Toronto. 

Behavioral health experts at the University of California, Los Angeles have been collaborating with Apple on a digital health study to measure how factors like sleep, physical activity, heart rate and daily routines relate to symptoms of depression and anxiety. Data comes from the Apple Watch and iPhone.

While the results of research studies typically take time, you can learn a lot by looking at your wrist right now.

This story, originally published Sept. 28, 2020, was updated to reflect newer models and industry developments.

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