Wearing the Future-Wearables to Empower Users to Take Greater Responsibility for Their Health and Care: Scoping Review

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Role of Technology in Promoting Heart Healthy Behavior Change to Increase Equity in Optimal Cardiovascular Health: A Scientific Statement From the American Heart Association

Populations most affected by cardiovascular health disparities, including underrepresented populations with lower socioeconomic status, people with disabilities, and those living in underserved rural communities, are disproportionately exposed to adverse social determinants of health. Specifically, economic instability and suboptimal living conditions within the neighborhood and built environment directly determine access to resources and opportunities for healthful behaviors. In this scientific statement, we examined the technology-enabled interventions that address cardiovascular health behaviors from adolescence to adulthood in populations most affected by health disparities. We used a broad definition of technology, including wearables, applications, and telehealth, for behavior tracking. Aligning with Life's Essential 8, we focused on interventions targeting behavior change related to physical activity, sedentary time, dietary intake, tobacco cessation, and sleep health to improve cardiovascular health. The digital determinants of health are important adjuncts to the social determinants and operate at the individual, interpersonal, community, and societal levels. The digital determinants of health include the impact of digital technologies (eg, wearables, telemedicine) across health outcomes. Evidence of effective interventions using technology to improve cardiovascular health through positive behavior change is critical for preventing cardiovascular disease events. Stronger evidence is needed to inform and implement effective approaches that are scalable and cost-effective across communities and health care institutions to advance digital equity in cardiovascular health. Dissemination of digital solutions to improve cardiovascular health in communities or across health care systems must ensure effective, feasible, available, and affordable solutions for populations most in need.

Feasibility and Acceptability of Smartwatches for Use by Nursing Home Residents

Smartwatch wearables are a promising health information technology to monitor older adults with complex chronic care needs. Pilot and feasibility studies have assessed smartwatch use with community-dwelling older adults, but less is known about their use in nursing homes. The purpose of this study was to test the feasibility and acceptability of smartwatch technology in a real-world nursing home setting to generate initial evidence about potential use. Using a qualitative descriptive approach, we conducted a pilot feasibility and acceptability study of smartwatch technology: Phase 1, pretrial semistructured interviews and focus groups with nursing home leaders, staff, and residents/families; Phase 2, a 7-day smartwatch trial deployment with residents; and Phase 3, posttrial semistructured interviews and focus groups. Themes related to feasibility findings included a part of the workflow and making the technology work . Themes related to acceptability findings included it's everywhere anyway , how will you protect me , knowing how you really are , more information = more control , and knowing how they are doing . These findings have important implications for the design of technology-supported interventions incorporating these devices within the unique context of residential nursing homes to best meet the needs of older adult residents, families, and staff caretakers.

Seasonal, weekly, and individual variations in long-term use of wearable medical devices for diabetes management

Wearable medical-grade devices are transforming the standard of care for prevalent chronic conditions like diabetes. Yet, adoption and long-term use remain a challenge for many people. In this study, we investigate patterns of consistent versus disrupted use of continuous glucose monitors (CGMs) through analysis of more than 118,000 days of data, with over 22 million blood glucose samples, from 108 young adults with type 1 diabetes (average: 3 years of CGM data per person). In this population, we found more consistent CGM use at the start and end of the year (e.g., January, December), and more disrupted CGM use in the middle of the year/warmer months (i.e., May to July). We also found more consistent CGM use on weekdays (Monday to Thursday) and during waking hours (6AM - 6PM), but more disrupted CGM use on weekends (Friday to Sunday) and during evening/night hours (7PM - 5AM). Only 52.7% of participants (57 out of 108) had consistent and sustained CGM use over the years (i.e., over 70% daily wear time for more than 70% of their data duration). From semi-structured interviews, we unpack factors contributing to sustained CGM use (e.g., easier and better blood glucose management) and factors contributing to disrupted CGM use (e.g., changes in insurance coverage, issues with sensor adhesiveness/lifespan, and college/life transitions). We leverage insights from this study to elicit implications for next-generation technology and interventions that can circumvent seasonal and other factors that disrupt sustained use of wearable medical devices for the goal of improving health outcomes.

Motivations for Use, User Experience and Quality of Reproductive Health Mobile Applications in a Pre-Menopausal User Base: A Scoping Review

Background: The global mHealth market is growing at an unprecedented rate and is expected to reach an estimated value of $187.7 billion by 2033, with many apps now addressing women's health and the menstrual cycle. This scoping review (ScR) aimed to comprehensively assess and describe the existing peer-reviewed literature on motivations for use, user experience, and reproductive health app quality. Methods: The protocol and review were conducted according to the JBI methodology and PRISMA guidelines for scoping reviews. Studies published in English since 2010 were included and searched in MEDLINE, Embase (Ovid platform), Scopus (Elsevier), ACM Digital Library, and IEEE Xplore. Studies were screened independently by two reviewers and the data explored through charting and synthesis. Results: Data were extracted from 58 papers published in English between 2014 and 2023. Several major themes related to motivations for app use, user experience, and app quality were identified and are reported on. Conclusions: Users were motivated to engage in reproductive health apps for education, contraception, and conception. This ScR identified several benefits, such as improving menstrual health literacy. We also identified limitations of current reproductive health apps that adversely affect user experience. Recommendations for future studies include increasing diversity, exploring perspectives of different user groups, and investigating the role healthcare providers may have in app development and patient education.

Prehabilitation Strategies: Enhancing Surgical Resilience with a Focus on Nutritional Optimization and Multimodal Interventions

Surgery imposes significant physiological and psychological stress, often leading to complications, delayed recovery, and prolonged hospital stays. Prehabilitation, a proactive strategy to optimize patients' resilience before surgery, has emerged as a transformative approach in perioperative care. Nutritional prehabilitation specifically addresses metabolic dysregulation, muscle loss, and immune suppression caused by surgical stress. This review highlights the critical role of nutritional prehabilitation within a multimodal framework, integrating exercise, psychological support, and emerging technologies. Although some evidence supports the effectiveness of prehabilitation in enhancing functional outcomes and improvements in rates of complications and mortality, its implementation faces challenges such as resources, lack of standardized protocols, and variability across healthcare settings, highlighting the need for greater standardization. Physical training as part of prehabilitation also improves mood, fosters patient engagement, and instills a sense of control over the disease process. These psychosocial benefits, alongside enhanced patient-reported outcomes and qualitative measures, reflect the holistic value of prehabilitation. Emerging technologies, such as wearable devices and telemedicine, offer scalable and personalized solutions for delivering prehabilitation, particularly in resource-limited settings. Future research should prioritize refining protocols, exploring long-term outcomes, and addressing the unique needs of high-risk populations. By emphasizing a proactive approach to perioperative care, this review aims to highlight the potential of nutritional prehabilitation as a foundational component of multimodal strategies designed to optimize surgical resilience, empower patients, and transform surgical recovery into a proactive and patient-centered journey.

Personalised Risk Modelling for Older Adult Cancer Survivors: Combining Wearable Data and Self-Reported Measures to Address Time-Varying Risks

Recent advancements in wearable devices have significantly enhanced remote patient monitoring, enabling healthcare professionals to evaluate conditions within home settings. While electronic health records (EHRs) offer extensive clinical data, they often lack crucial contextual information about patients' daily lives and symptoms. By integrating continuous self-reported outcomes related to vulnerability, anxiety, and depression from older adult cancer survivors with objective data from wearables, we can develop personalised risk models that address time-varying risk factors in cancer care. Our study combines real-world data from wearable devices with self-reported information, employing process mining techniques to analyse dynamic risk models for vulnerability and anxiety. Unlike traditional static assessments, this approach recognises that risk factors evolve. Collaborating with healthcare professionals, we analysed data from the LifeChamps study to create two dynamic risk models. This collaborative effort revealed how activity and sleep patterns influence self-reported vulnerability and anxiety among participants. It underscored the potential of wearable sensors and artificial intelligence techniques for deeper analysis and understanding, making us all part of a larger effort in cancer care. Overall, patients with prolonged sedentary activity had a higher risk of vulnerability, while those with highly dynamic sleep patterns were more likely to report anxiety and depression. Prostate-metastatic patients showed an increased risk of vulnerability compared to other cancer types.

Eco-Friendly Conductive Hydrogels: Towards Green Wearable Electronics

The rapid advancement of wearable electronics has catalyzed the development of flexible, lightweight, and highly conductive materials. Among these, conductive hydrogels have emerged as promising candidates due to their tissue-like properties, which can minimize the mechanical mismatch between flexible devices and biological tissues and excellent electrical conductivity, stretchability and biocompatibility. However, the environmental impact of synthetic components and production processes in conventional conductive hydrogels poses significant challenges to their sustainable application. This review explores recent advances in eco-friendly conductive hydrogels used in healthcare, focusing on their design, fabrication, and applications in green wearable electronics. Emphasis is placed on the use of natural polymers, bio-based crosslinkers, and green synthesis methods to improve sustainability while maintaining high performance. We discuss the incorporation of conductive polymers and carbon-based nanomaterials into environmentally benign matrices. Additionally, the article highlights strategies for improving the biodegradability, recyclability, and energy efficiency of these materials. By addressing current limitations and future opportunities, this review aims to provide a comprehensive understanding of environmentally friendly conductive hydrogels as a basis for the next generation of sustainable wearable technologies.

Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study

Background

Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems.

Objective

This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults' psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults' intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults' intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3).

Methods

A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60-85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention.

Results

Health consciousness positively influenced all intrinsic motivation factors-competence, autonomy, and relatedness-while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults' intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without.

Conclusions

This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation-particularly competence-in older adults' adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults' motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management.

Purposes of Smartphone Health Care Apps and the Practicality of Their Functions in Disaster Situations: Qualitative Function Assessment Study

Background

Japan has experienced various natural disasters, including the Great East Japan Earthquake in 2011. It becomes crucial to focus on strengthening self-help measures through health care apps that are used in normal times to help people during disasters. However, little is known about what health care apps would be useful in times of disaster.

Objective

This study aimed to investigate the prevalent functionalities and purposes of using health care apps during normalcy, explore their potential utility, and propose strategies for disaster response through their utilization.

Methods

We focus on highly ranked health care apps (within the top 100 in the health care category for iPhones by Apple, Inc for a certain period) and reclassify their purpose of use, such as sleep, relaxation, and exercise, in detail. We also investigate the functions within each health care app (measurement, recording, advice, content provision, and guidance to actual services), based on which we determine their potential utilization during disasters and anticipate potential solutions to address disaster-related challenges. We also consider the ideal framework of health care apps in disaster response, exploring possibilities such as the necessity of new disaster-specific apps or the adaptation of existing health care apps for disaster scenarios.

Results

Among the 70 free apps, the predominant functions included "recording" (n=60 cases, 86%) and "measurement" (n=47 cases, 67%), primarily encompassing the mechanical functions of wearable devices and smartphones. A similar trend was seen in the 77 paid apps, but "content provision" (n=54 cases, 70%) was the most prevalent. Furthermore, the "content provision" function was particularly common in the "purposes of use" categories "sleep" (χ211=29; P<.001), "relaxation" (χ211=14.6; P<.001), and "exercise" (χ211=9.3; P=.002). This suggested the possibility of using the content provision function in existing health care apps to support mental and physical health even during a disaster.

Conclusions

The widespread use of apps during normal times could minimize hesitation in adopting them during disasters. The findings emphasize the potential for augmenting disaster-specific content within existing apps rather than developing new ones. This approach aligns with the likelihood of preinstalled app use during emergencies, indicating a pragmatic strategy for enhancing disaster response content within prevalent apps.

What Clinicians Should Tell Patients About Wearable Devices and Data Privacy: A Narrative Review

The recent growth of wearable medical device technology in fitness trackers, smartwatches, smartphone apps, and patient monitoring systems has created people-generated health data (PGHD) that may benefit medical science with large amounts of continuous real-world data. The prevalence of these devices speaks to their broad popularity and user-friendliness and may lead us one day to a more fully "connected healthcare system." Meanwhile, data security, confidentiality, and privacy issues have emerged in these hackable systems. Despite the promise of anonymized data, data can sometimes be re-identified. However, even without that step, data breaches may reveal information (name, address, date of birth, social security number, and so on) sufficient for identity theft. Clinicians are often asked about the utility and value of wearable devices or monitors. Still, most are unaware that data from these systems may be transmitted, stored, and even sold without the user's specific knowledge. Despite the confidentiality of medical information, cybersecurity surrounding wearables and monitors remains relatively lax, making them comparatively easy targets for cyber villains. It is also important that efforts be made to make PGHD more secure since medical data may be of great value to telehealth applications and AI-physician assistants. Clinicians should actively inform patients about the risks and benefits of wearables and similar devices.

Mobile/wearable digital devices for care of active cancer patients: a survey from the ESC Council of Cardio-Oncology

Aims

The Council of Cardio-Oncology of the European Society of Cardiology developed an on-line anonymous survey to provide an overall picture of the current practice on the use of mobile and wearable digital devices in cardio-oncology and the potential barriers to their large-scale applicability.

Methods and results

Between June 2023 and January 2024, an online anonymous questionnaire was completed by 220 healthcare professionals from 55 countries. The greatest number of respondents reported that mobile/wearable digital devices have a role in all active cancer patients for measuring heart rate (33.9%), blood pressure (34.4%), body temperature (32.0%), physical activity (42.4%), and sleep (31.2%). In the setting of atrial fibrillation detection, respondents were evenly split between applying these technologies in all patients (33.0%) or only in selected patients (33.0%). Regarding QTc interval monitoring, 30.6% reported that mobile/wearable digital devices play a role only in selected patients. The decision to use the device was taken by the patient in 56.6% of cases and the physician in 43.4%. The most important barrier reported to mobile/wearable device implementation in the setting of cardiac rhythm monitoring and QTc measurement was their cost (weighted average: 3.38 and 3.39, respectively).

Conclusion

Mobile/wearable digital devices are considered to play an important role in different settings of cardio-oncology, including monitoring of patients' parameters and arrhythmia detection. Their role in monitoring physical activity and QTc interval appears more nuanced. The most important perceived barrier to mobile/wearable digital device implementation is considered their high cost.

Wearable and Flexible Sensor Devices: Recent Advances in Designs, Fabrication Methods, and Applications

The development of wearable sensor devices brings significant benefits to patients by offering real-time healthcare via wireless body area networks (WBANs). These wearable devices have gained significant traction due to advantageous features, including their lightweight nature, comfortable feel, stretchability, flexibility, low power consumption, and cost-effectiveness. Wearable devices play a pivotal role in healthcare, defence, sports, health monitoring, disease detection, and subject tracking. However, the irregular nature of the human body poses a significant challenge in the design of such wearable systems. This manuscript provides a comprehensive review of recent advancements in wearable and flexible smart sensor devices that can support the next generation of such sensor devices. Further, the development of direct ink writing (DIW) and direct writing (DW) methods has revolutionised new high-resolution integrated smart structures, enabling the design of next-generation soft, flexible, and stretchable wearable sensor devices. Recognising the importance of keeping academia and industry informed about cutting-edge technology and time-efficient fabrication tools, this manuscript also provides a thorough overview of the latest progress in various fabrication methods for wearable sensor devices utilised in WBAN and their evaluation using body phantoms. An overview of emerging challenges and future research directions is also discussed in the conclusion.

Step Count Accuracy of the Life Plus Connected Watch at Different Localizations and Speeds in Healthy Adults, Patients With Cardiovascular Disease, and Patients With Peripheral Artery Disease: Step Count Validation Study in Laboratory Settings

Background

Smartwatches are increasingly used to monitor and motivate physical activity. Patients with cardiovascular disease (CVD) and peripheral artery disease (PAD) often do not meet national physical activity recommendations. They may, thus, benefit from a physical activity program using smartwatches. The Life Plus smartwatch is designed to facilitate activity monitoring by counting steps, but its validity needs to be determined, particularly in patients who may not have a normal gait, such as those with cardiovascular pathology.

Objective

This study evaluates the accuracy of the Life Plus smartwatch (versions 2 and 3) in healthy adults, patients with CVD, and patients with PAD at different walking speeds (1.8, 2.5, 3.2, and 4 km/h) and different localizations (wrists, hips, and ankles) to determine best accuracy.

Methods

In total, 34 participants, comprising healthy individuals (n=10), patients with CVD (n=14), and patients with PAD (n=10), wore 6 Life Plus watches simultaneously (3 of version 2 and 3 of version 3), located on wrists, hips, and ankles. Participants walked on a treadmill for 3-minute sessions at speeds of 1.8, 2.5, 3.2, and 4 km/h; they then performed a 10-minute free walking on the ground and again walked for 3-minute sessions on a treadmill at the same speeds. Actual step counts were recorded through video footage.

Results

When worn at the wrist, no significant difference between the actual number of steps and step count by version 2 watches was found in each group independently (healthy group: P=.25; CVD group: P=.50; and PAD group: P=.37). Significant differences were found with the version 2 watches at the wrist in the healthy group at 3.2 (-5.26%; P=.01) and 4 km/h (-6.13%; P=.008) and in the CVD group at 2.5 (-5.94%; P=.008), 3.2(-13.1%; P=.008), and 4 km/h (-13.96%; P=.004). When worn at the wrist, no significant difference between actual number of steps and step count by version 3 watches was found in the healthy group (P=.02) and the PAD group (P=.90). Significant differences were found with the version 3 watches at the wrist in the CVD group at 3.2 (-6.43%; P=.001) and 4 km/h (-7.3%; P=.01) and in the PAD group at 4 km/h (-5.77%; P=.04).

Conclusions

For optimized counting when worn at the wrist, healthy individuals should prefer version 2 watches for slow walking (1.8 and 2.5 km/h) and version 3 for higher speeds (3.2 and 4 km/h). Patients (CVD and PAD) should prefer version 2 watches at 1.8 km/h and version 3 watches for higher speeds (2.5, 3.2, and 4 km/h).

Home Environment as a Therapeutic Target for Prevention and Treatment of Chronic Diseases: Delivering Restorative Living Spaces, Patient Education and Self-Care by Bridging Biophilic Design, E-Commerce and Digital Health Technologies

A high prevalence of chronic diseases exposes diverse healthcare pain points due to the limited effectiveness of pharmaceutical drugs and biologics, sedentary lifestyles, insufficient health literacy, chronic stress, unsatisfactory patient experience, environmental pollution and competition with commercial determinants of health. To improve patient care and long-term outcomes, the impact of the home environment is overlooked and underutilized by healthcare. This cross-disciplinary work describes perspectives on (1) the home environment as a therapeutic target for the prevention and treatment of chronic diseases and (2) transforming health-centric household goods e-commerce platforms into digital health interventions. We provide a rationale for creating therapeutic home environments grounded in biophilic design (multisensory, environmental enrichment) and supporting physical activities, quality sleep, nutrition, music, stress reduction, self-efficacy, social support and health education, hence providing clinical benefits through the modulation of the autonomic nervous system, neuroplasticity and behavior change. These pleiotropic "active non-pharmacological ingredients" can be personalized for people living with depression, anxiety, migraine, chronic pain, cancer, cardiovascular and other conditions. We discuss prospects for integrating e-commerce with digital health platforms to create "therapeutic home environment" interventions delivered through digital therapeutics and their combinations with prescription drugs. This multimodal approach can enhance patient engagement while bridging consumer spending with healthcare outcomes.

V3+ extends the V3 framework to ensure user-centricity and scalability of sensor-based digital health technologies

We propose the addition of usability validation to the extended V3 framework, now "V3+", and describe a pragmatic approach to ensuring that sensor-based digital health technologies can be used optimally at scale by diverse users. Alongside the original V3 components (verification; analytical validation; clinical validation), usability validation will ensure user-centricity of digital measurement tools, paving the way for more inclusive, reliable, and trustworthy digital measures within clinical research and clinical care.

The Potential of Wearable Sensors for Detecting Cognitive Rumination: A Scoping Review

Cognitive rumination, a transdiagnostic symptom across mental health disorders, has traditionally been assessed through self-report measures. However, these measures are limited by their temporal nature and subjective bias. The rise in wearable technologies offers the potential for continuous, real-time monitoring of physiological indicators associated with rumination. This scoping review investigates the current state of research on using wearable technology to detect cognitive rumination. Specifically, we examine the sensors and wearable devices used, physiological biomarkers measured, standard measures of rumination used, and the comparative validity of specific biomarkers in identifying cognitive rumination. The review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on IEEE, Scopus, PubMed, and PsycInfo databases. Studies that used wearable devices to measure rumination-related physiological responses and biomarkers were included (n = 9); seven studies assessed one biomarker, and two studies assessed two biomarkers. Electrodermal Activity (EDA) sensors capturing skin conductance activity emerged as both the most prevalent sensor (n = 5) and the most comparatively valid biomarker for detecting cognitive rumination via wearable devices. Other commonly investigated biomarkers included electrical brain activity measured through Electroencephalogram (EEG) sensors (n = 2), Heart Rate Variability (HRV) measured using Electrocardiogram (ECG) sensors and heart rate fitness monitors (n = 2), muscle response measured through Electromyography (EMG) sensors (n = 1) and movement measured through an accelerometer (n = 1). The Empatica E4 and Empatica Embrace 2 wrist-worn devices were the most frequently used wearable (n = 3). The Rumination Response Scale (RRS), was the most widely used standard scale for assessing rumination. Experimental induction protocols, often adapted from Nolen-Hoeksema and Morrow's 1993 rumination induction paradigm, were also widely used. In conclusion, the findings suggest that wearable technology offers promise in capturing real-time physiological responses associated with rumination. However, the field is still developing, and further research is needed to validate these findings and explore the impact of individual traits and contextual factors on the accuracy of rumination detection.

Monte Carlo Simulation of the Effect of Melanin Concentration on Light-Tissue Interactions in Reflectance Pulse Oximetry

Over the past ten years, there has been an increasing demand for reliable consumer wearables as users are inclined to monitor their health and fitness metrics in real-time, especially since the COVID-19 pandemic. Reflectance pulse oximeters in fitness trackers and smartwatches provide convenient, non-invasive SpO2 measurements but face challenges in achieving medical-grade accuracy, particularly due to difficulties in capturing physiological signals, which may be affected by skin pigmentation. Hence, this study sets out to investigate the influence of skin pigmentation, particularly in individuals with darker skin, on the accuracy and reliability of SpO2 measurement in consumer wearables that utilise reflectance pulse oximeters. A Monte Carlo model is developed to assess the effect on simulated reflectance pulse oximetry measurements across light, moderate, and dark skin types for oxygen saturation levels between 70 and 100%. The results indicate that a one-algorithm-fits-all calibration approach may be insufficient, and root mean square errors (RMSEs) of at least 0.3956%, 0.9132%, and 8.4111% for light, moderate, and dark skin are observed when compared to transmittance calibration algorithms. Further research is required to validate these findings and improve the performance of reflectance pulse oximeters in real-world applications, particularly in the context of consumer wearables.

Acceptability of a smart lighter for tracking cigarette smoking: A focus group study

Background

Smart lighters track cigarette smoking episodes, which can help identify smoking patterns and intervention approaches to promote cessation. We gauged the acceptability of smart lighters among individuals with low socioeconomic status (SES), a target population for a newly developed smoking cessation mobile intervention, to evaluate their potential use during the intervention pre-quit period.

Methods

Twelve virtual focus group discussions were conducted with 38 current cigarette smokers, 18-29 years old, who were not 4-year college-educated nor enrolled in a 4-year college as an SES indicator. Focus groups were audio recorded, transcribed, and analyzed using a deductive thematic approach. Themes captured sentiment (i.e., negative, neutral, positive) and constructs from the Second Unified Theory of Acceptance and Use of Technology (i.e., effort expectancy, facilitating conditions, hedonic motivation, performance expectancy, social influence).

Results

Sentiment toward smart lighters was positive (54.36%). Prominent themes relevant to acceptance of smart lighters were facilitating conditions (33.98%), performance expectancy (29.12%), and effort expectancy (16.50%). Concerns about privacy, lack of awareness of smart lighters, and their unaffordability were the primary facilitating conditions discussed. Smart lighters were considered easy to use and useful cessation aids because they minimize user burden in tracking smoking behavior. Skepticism about their usefulness centered on the possibility of inadvertently triggering cravings and subsequent smoking.

Conclusions

Ensuring the affordability, awareness, and usability of smart lighters can increase their acceptability. Use of smart lighters in cessation interventions can provide insights into smoking patterns with minimal user burden. Consideration must be given to their potential unintended effects as cueing smoking.

Patient Experiences of Using Wearable Health Monitors During Cancer Treatment: A Qualitative Study

INTRODUCTION

Wearable health monitors (WHM) offer minimally invasive, ambulatory monitoring of physiological parameters and activity. WHMs are being used increasingly in healthcare but adoption for patients undergoing cancer treatment is limited in part due to a lack of understanding of patient intentions as they receive treatment. The aim of this study explores the patient experience of using WHMs during their cancer pathway, including barriers and enablers of WHM use.

METHODS

A phenomenological qualitative approach was used with single semi-structured interviews conducted in focus groups with individuals enrolled in the EMBRaCE-GM study, where WHMs were worn for up to six months prior to, during and after treatment of either colorectal, lung, or head and neck cancer, or leukaemia/lymphoma.

RESULTS

We identified three major themes: perceived patient benefits, barriers to the adoption of WHMs and the importance of treatment partnerships between patients and healthcare professionals. WHMs promoted positive behaviour change, prioritisation of own health, and represented a form of 'digital advocacy'. Potential barriers were aesthetic, experiential and technological. WHM introduction was time-sensitive, with patients finding their use acceptable at different stages in their cancer pathway. Patients desired reciprocal interaction with WHMs and were less concerned with data accuracy.

DISCUSSION

This study identifies factors influencing patient decisions to use WHMs as part of cancer treatment. Novel findings include the optimal time to start wearing WHMs and the validity of measurements perceived as less of a concern for patients (in contrast to clinicians) who use wearable data with their own experiences as part of a sense-making exercise. Future work should focus on balancing patient and clinician expectations to provide guidance on the feasibility of WHM in routine clinical practice.

From Wristbands to Implants: The Transformative Role of Wearables in Heart Failure Care

BACKGROUND

Heart failure (HF) management increasingly relies on innovative solutions to enhance monitoring and care. Wearable devices, originally popularized for fitness tracking, show promise in clinical decision-making for HF. This study explores the application and potential for the broader integration of wearable technology in HF management, emphasizing remote monitoring and personalized care.

METHODS

A comprehensive literature review was performed to assess the role of wearables in HF management, focusing on functionalities like vital sign tracking, patient engagement, and clinical decision support. Clinical outcomes and barriers to adopting wearable technology in HF care were critically analyzed.

RESULTS

Wearable devices increasingly track physiological parameters relevant to HF, such as heart rate, physical activity, and sleep. They can identify at-risk patients, promote lifestyle changes, facilitate early diagnosis, and accurately detect arrhythmias that lead to decompensation. Additionally, wearables may assess fluid status, identifying early signs of decompensation to prevent hospitalization and supporting therapeutic adjustments. They also enhance physical activity and optimize cardiac rehabilitation programs, improving patient outcomes. Both wearable and implanted cardiac devices enable continuous, non-invasive monitoring through small devices. However, challenges like data integration, regulatory approval, and reimbursement impede their widespread adoption.

CONCLUSIONS

Wearable technology can transform HF management through continuous monitoring and early interventions. Collaboration among involved parties is essential to overcome integration challenges and validate most of these devices in clinical practice.

Wearable Devices for Supporting Chronic Disease Self-Management: Scoping Review

BACKGROUND

People with chronic diseases can benefit from wearable devices in managing their health and encouraging healthy lifestyle habits. Wearables such as activity trackers or blood glucose monitoring devices can lead to positive health impacts, including improved physical activity adherence or better management of type 2 diabetes. Few literature reviews have focused on the intersection of various chronic diseases, the wearable devices used, and the outcomes evaluated in intervention studies, particularly in the context of primary health care.

OBJECTIVE

This study aims to identify and describe (1) the chronic diseases represented in intervention studies, (2) the types or combinations of wearables used, and (3) the health or health care outcomes assessed and measured.

METHODS

We conducted a scoping review following the Joanna Briggs Institute guidelines, searching the MEDLINE and Web of Science databases for studies published between 2012 and 2022. Pairs of reviewers independently screened titles and abstracts, applied the selection criteria, and performed full-text screening. We included interventions using wearables that automatically collected and transmitted data to adult populations with at least one chronic disease. We excluded studies with participants with only a predisposition to develop a chronic disease, hospitalized patients, patients with acute diseases, patients with active cancer, and cancer survivors. We included randomized controlled trials and cohort, pretest-posttest, observational, mixed methods, and qualitative studies.

RESULTS

After the removal of 1987 duplicates, we screened 4540 titles and abstracts. Of the remaining 304 articles after exclusions, we excluded 215 (70.7%) full texts and included 89 (29.3%). Of these 89 texts, 10 (11%) were related to the same interventions as those in the included studies, resulting in 79 studies being included. We structured the results according to chronic disease clusters: (1) diabetes, (2) heart failure, (3) other cardiovascular conditions, (4) hypertension, (5) multimorbidity and other combinations of chronic conditions, (6) chronic obstructive pulmonary disease, (7) chronic pain, (8) musculoskeletal conditions, and (9) asthma. Diabetes was the most frequent health condition (18/79, 23% of the studies), and wearable activity trackers were the most used (42/79, 53% of the studies). In the 79 included studies, 74 clinical, 73 behavioral, 36 patient technology experience, 28 health care system, and 25 holistic or biopsychosocial outcomes were reported.

CONCLUSIONS

This scoping review provides an overview of the wearable devices used in chronic disease self-management intervention studies, revealing disparities in both the range of chronic diseases studied and the variety of wearable devices used. These findings offer researchers valuable insights to further explore health care outcomes, validate the impact of concomitant device use, and expand their use to other chronic diseases.

TRIAL REGISTRATION

Open Science Framework Registries (OSF) s4wfm; https://osf.io/s4wfm.

A Hierarchical-Based Learning Approach for Multi-Action Intent Recognition

Recent applications of wearable inertial measurement units (IMUs) for predicting human movement have often entailed estimating action-level (e.g., walking, running, jumping) and joint-level (e.g., ankle plantarflexion angle) motion. Although action-level or joint-level information is frequently the focus of movement intent prediction, contextual information is necessary for a more thorough approach to intent recognition. Therefore, a combination of action-level and joint-level information may offer a more comprehensive approach to predicting movement intent. In this study, we devised a novel hierarchical-based method combining action-level classification and subsequent joint-level regression to predict joint angles 100 ms into the future. K-nearest neighbors (KNN), bidirectional long short-term memory (BiLSTM), and temporal convolutional network (TCN) models were employed for action-level classification, and a random forest model trained on action-specific IMU data was used for joint-level prediction. A joint-level action-generic model trained on multiple actions (e.g., backward walking, kneeling down, kneeling up, running, and walking) was also used for predicting the joint angle. Compared with a hierarchical-based approach, the action-generic model had lower prediction error for backward walking, kneeling down, and kneeling up. Although the TCN and BiLSTM classifiers achieved classification accuracies of 89.87% and 89.30%, respectively, they did not surpass the performance of the action-generic random forest model when used in combination with an action-specific random forest model. This may have been because the action-generic approach was trained on more data from multiple actions. This study demonstrates the advantage of leveraging large, disparate data sources over a hierarchical-based approach for joint-level prediction. Moreover, it demonstrates the efficacy of an IMU-driven, task-agnostic model in predicting future joint angles across multiple actions.

Associations between number of steps and health outcomes in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Today's public health discourse prioritizes the health and well-being of children and adolescents. As step counts include both light and moderate-to-vigorous physical activities, and monitoring steps has become a popular method for assessing daily physical activity, it is critical to gain a better understanding of how measuring daily steps may contribute to overall health in children and adolescents. The aim of this study was to thoroughly review the studies that investigated the associations between daily number of steps (DNoS) and health outcomes (HO) in children and adolescents.

METHODS

Electronic searches were conducted in PubMed, Google Scholar, Cochrane, MEDLINE, Web of Science, SPORTDiscus (2000 -January 2024.). Key terms such as number of steps, daily steps, average steps, physical activity, health outcomes were used. The primary outcomes were (1) body composition/obesity risk factors; (2) cardiorespiratory fitness (CRF); and (3) cardiovascular risk factors. Secondary outcomes were psychological/psychosocial parameters (sleep habits, i.e. quality of life). We assessed the methodological quality of each trial using AXIS quality assessment tool. In instances where continuous data emanated from two or more trials, a meta-analysis was undertaken.

RESULTS

The main findings of this systematic review and meta-analysis are that an increased number of DNoS is associated with better HO in children and adolescents, as evidenced by improvements in body mass index (BMI), body weight, waist circumference, body fat percentage, and cardiorespiratory fitness (i.e., VO2max). However, due to a dearth of studies and conflicting results from current studies, no inferences can be drawn about the correlations between DNoS and sleep quality, quality of life, or cardiovascular risk factors (i.e., blood pressure). Across most of the studies, the average correlation between the DNoS and HO reflected a small, but significant, association with a small effect size.

CONCLUSIONS

Our findings highlight the importance of daily physical activity, as evidenced by the association between the number of steps and health outcomes in children and adolescents.

TRIAL REGISTRATION

PROSPERO # CRD42024523729.

Current State of Connected Sensor Technologies Used During Rehabilitation Care: Protocol for a Scoping Review

BACKGROUND

Connected sensor technologies can capture raw data and analyze them using advanced statistical methods such as machine learning or artificial intelligence to generate interpretable behavioral or physiological outcomes. Previous research conducted on connected sensor technologies has focused on design, development, and validation. Published review studies have either summarized general technological solutions to address specific behaviors such as physical activity or focused on remote monitoring solutions in specific patient populations.

OBJECTIVE

This study aimed to map research that focused on using connected sensor technologies to augment rehabilitation services by informing care decisions.

METHODS

The Population, Concept, and Context framework will be used to define inclusion criteria. Relevant articles published between 2008 to the present will be included if (1) the study enrolled adults (population), (2) the intervention used at least one connected sensor technology and involved data transfer to a clinician so that the data could be used to inform the intervention (concept), and (3) the intervention was within the scope of rehabilitation (context). An initial search strategy will be built in Embase; peer reviewed; and then translated to Ovid MEDLINE ALL, Web of Science Core Collection, and CINAHL. Duplicates will be removed prior to screening articles for inclusion. Two independent reviewers will screen articles in 2 stages: title/abstract and full text. Discrepancies will be resolved through group discussion. Data from eligible articles relevant to population, concept, and context will be extracted. Descriptive statistics will be used to report findings, and relevant outcomes will include the type and frequency of connected sensor used and method of data sharing. Additional details will be narratively summarized and displayed in tables and figures. Key partners will review results to enhance interpretation and trustworthiness.

RESULTS

We conducted initial searches to refine the search strategy in February 2024. The results of this scoping review are expected in October 2024.

CONCLUSIONS

Results from the scoping review will identify critical areas of inquiry to advance the field of technology-augmented rehabilitation. Results will also support the development of a longitudinal model to support long-term health outcomes.

TRIAL REGISTRATION

Open Science Framework jys53; https://osf.io/jys53.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60496.

Development of a Theoretical Continuous Glucose Monitoring Module for Pharmacy Students: Preparing Pharmacists for the Future

To enhance the digital competencies of pharmacy students, the Institute of Clinical Pharmacy and Pharmacotherapy at Heinrich-Heine University Duesseldorf developed and evaluated a theoretical module on digital health and data analysis. This innovative module integrated a continuous glucose-monitoring (CGM) wearable device into teaching, providing students with in-depth practical experience and a 2.5 h seminar on digital health and CGM systems. Students' knowledge of CGM and self-assessment of their CGM competencies were assessed in a pre-post manner. Additionally, students' satisfaction with the module and their perceptions of the future integration of digital health training and the role of wearables in pharmacy practice were also assessed after the module. A total of 39 final-year pharmacy students completed the module conducted in June 2024 as part of the clinical pharmacy seminar. In total, 32 students completed the pre- and post-knowledge tests and self-assessment questionnaires. Both the knowledge and the students' self-assessment of CGM-related skills after the module increased significantly (p < 0.05). Students expanded their knowledge regarding digital health solutions, in particular the CGM systems, and increased their self-reported competence in CGM-related skills. With this module, an important foundation was laid, as this is the first theoretical module including the essentials of CGM digital health tools for pharmacy students in Germany.

Personalized and predictive strategies for diabetic foot ulcer prevention and therapeutic management: potential improvements through introducing Artificial Intelligence and wearable technology

Diabetic foot ulcers represent a serious and costly complication of diabetes, with significant morbidity and mortality. The purpose of this study was to explore advancements in Artificial Intelligence, and wearable technologies for the prevention and management of diabetic foot ulcers. Key findings indicate that Artificial Intelligence-driven predictive analytics can identify early signs of diabetic foot ulcers, enabling timely interventions. Wearable technologies, such as continuous glucose monitors, smart insoles, and temperature sensors, provide real-time monitoring and early warnings. These technologies promise to revolutionize diabetic foot ulcer prevention by offering personalized care plans and fostering a participatory healthcare model. However, the review also highlights challenges such as patient adherence, socioeconomic barriers, and the need for further research to validate these technologies' effectiveness. The integration of artificial intelligence and wearable technologies holds the potential to significantly improve diabetic foot ulcer outcomes, reduce healthcare costs, and provide a more proactive and personalized approach to diabetic care. Further investments in digital infrastructure, healthcare provider training, and addressing ethical considerations are essential for successful implementation.

Integrating Heart Rate Monitoring Into a Camp for Children With Neuromotor Disorders: A Case Series

PURPOSE

This case series investigated the implementation fidelity, feasibility, and effectiveness of integrating continuous heart rate monitoring with visual feedback into an established, intensive physical therapy camp for children with neuromotor disorders.

SUMMARY OF KEY POINTS

The provision of continuous visual feedback through color-coded, individually calculated heart rate zones was a feasible and effective intervention, encouraging pediatric gait camp participants to exercise at intensities that produced aerobic and functional gains. The use of technology facilitated participation with peers, an outcome equally as important as their endurance and functional improvements.

CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE

Pediatric physical therapists play a crucial role in enhancing the well-being and physical fitness of children with disabilities. Encouraging regular exercise in a social environment fosters enjoyable, inclusive experiences while promoting overall health. It is important for clinicians in various pediatric rehabilitation settings to establish programs that offer such opportunities for children with neuromotor disorders.

The Impact of Digital Health Solutions on Bridging the Health Care Gap in Rural Areas: A Scoping Review

Digital health tools can improve health care access and outcomes for individuals with limited access to health care, particularly those residing in rural areas. This scoping review examines the existing literature on using digital tools in patients with limited access to health care in rural areas. It assesses their effectiveness in improving health outcomes. The review adopts a comprehensive search strategy to identify relevant studies from electronic databases, and the selected studies are analyzed descriptively. The findings highlight the advantages and barriers of digital health interventions in rural populations. The advantages include increased access to health care practitioners through teleconsultations, improved health care outcomes through remote monitoring, better disease management through mobile health applications and wearable devices, and enhanced access to specialized care and preventive programs. However, limited internet connectivity and a lack of familiarity with digital tools are barriers that must be addressed to ensure equitable access to digital health interventions in rural areas. Overall, digital tools improve health outcomes for individuals with limited health care access in rural areas.

Digital health in pharmacy education: Elective practical course integrating wearable devices and their generated health data

The widespread adoption of wearable devices (wearables) for monitoring vital signs, including blood pressure and glucose levels, has experienced a considerable surge in recent times. This surge has led to the generation of a substantial amount of health data, accessible to pharmacists during patient consultations as the healthcare sector advances in digitalization. To enhance the digital competencies of future pharmacists required by the rapidly changing digital health landscape, the Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University (HHU) Duesseldorf has developed an innovative elective practical course aimed to bolster pharmacy students' competencies in handling wearables and the health data generated. The three-week practical elective course employed wearables FreeStyle Libre® 3 (Continuous Glucose Monitoring, CGM) and Aktiia (Cuffless Blood Pressure Monitoring). The hands-on activities allowed participants to obtain and interpret wearable-generated health-related data and acquainted them with simulated patient cases. Final-year pharmacy students' subjective assessments before and after the course depicted the increased knowledge and competence regarding analysing wearables data.

Identifying Future Study Designs and Indicators for Somatic Health Associated with Diets of Cohorts Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets, but also overall food environments, comprise a variety of significant factors with direct and indirect impacts on human health. Eco-Regions are geographical areas with a territorial approach to rural development, utilizing organic food and farming practices, and principles and promoting sustainable communities and food systems. However, so far, little attention has been given to quantifying aspects of the health of citizens living in these sustainable transition territories. The project "Indicators for Assessment of Health Effects of Consumption of Sustainable, Organic School Meals in Eco-Regions" (INSUM) aims to identify and discuss research approaches and indicators that could be applied to effectively measure the somatic, mental, and social health dimensions of citizens in Eco-Regions, linked to the intake of organic foods in their diets. In this paper, we focus on the somatic (physical) health dimension. A two-day workshop was held to discuss suitable methodology with an interdisciplinary, international group of experts. The results showed the limitations of commonly used tools for measuring dietary intake (e.g., relying on the memory of participants), and nutritional biomarkers (e.g., variations in correlations with specific intakes) for research understanding dietary intake and the health effects of diets. To investigate the complexity of this issue, the most suitable approach seems to be the combination of traditional markers of physical and mental health alongside emerging indicators such as the microbiome, nutrigenomics, metabolomics, or inflammatory biomarkers. Using new, digital, non-invasive, and wearable technologies to monitor indicators could complement future research. We conclude that future studies should adopt systemic, multidisciplinary approaches by combining not only indicators of somatic and mental health and social wellbeing (MHSW) but also considering the potential benefits of organic diets for health as well as aspects of sustainability connected to food environments.

Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas

INTRODUCTION

Common, consumer-grade biosensors mounted on fitness trackers and smartwatches can measure an array of biometrics that have potential utility in post-discharge medical monitoring, especially in remote/rural communities. The feasibility characteristics for wrist-worn biosensors are poorly described for post-COVID conditions and rural populations.

METHODS

We prospectively recruited patients in rural communities who were enrolled in an at-home rehabilitation program for post-COVID conditions. They were asked to wear a FitBit Charge 2 device and biosensor parameters were analyzed [e.g. heart rate, sleep, and activity]. Electronic patient reported outcome measures [E-PROMS] for mental [bi-weekly] and physical [daily] symptoms were collected using SMS text or email [per patient preference]. Exit surveys and interviews evaluated the patient experience.

RESULTS

Ten patients were observed for an average of 58 days and half [N = 5] were monitored for 8 weeks or more. Five patients [50%] had been hospitalized with COVID [mean stay = 41 days] and 4 [36%] had required mechanical ventilation. As baseline, patients had moderate to severe levels of anxiety, depression, and stress; fatigue and shortness of breath were the most prevalent physical symptoms. Four patients [40%] already owned a smartwatch. In total, 575 patient days of patient monitoring occurred across 10 patients. Biosensor data was usable for 91.3% of study hours and surveys were completed 82.1% and 78.7% of the time for physical and mental symptoms, respectively. Positive correlations were observed between stress and resting heart rate [r = 0.360, p<0.01], stress and daily steps [r = 0.335, p<0.01], and anxiety and daily steps [r = 0.289, p<0.01]. There was a trend toward negative correlation between sleep time and physical symptom burden [r = -0.211, p = 0.05]. Patients reported an overall positive experience and identified the potential for wearable devices to improve medical safety and access to care. Concerns around data privacy/security were infrequent.

CONCLUSIONS

We report excellent feasibility characteristics for wrist-worn biosensors and e-PROMS as a possible substrate for multi-modal disease tracking in post-COVID conditions. Adapting consumer-grade wearables for medical use and scalable remote patient monitoring holds great potential.

A Comprehensive Review on Harnessing Wearable Technology for Enhanced Depression Treatment

Depression is a prevalent and debilitating mental health disorder that significantly impacts individuals, families, and societies worldwide. Despite advancements in treatment, challenges remain in effectively managing and monitoring depressive symptoms. Wearable technology, which encompasses devices that can monitor physiological and behavioral parameters in real time, offers promising new avenues for enhancing depression treatment. This comprehensive review explores the potential of wearable technology in managing and treating depression. It examines how wearables can monitor depressive symptoms, improve patient engagement and adherence to treatment plans, and provide valuable data for personalized treatment strategies. The review covers the integration of wearable technology in clinical settings, the role of wearables in remote monitoring and telemedicine, and the ethical and privacy considerations associated with their use. Additionally, it highlights case studies and pilot programs demonstrating the practical applications and outcomes of wearable technology interventions. Future directions and innovations are discussed, identifying potential advancements and challenges in this emerging field. This review aims to inform healthcare professionals, researchers, and policymakers about the opportunities and challenges of integrating wearable technology into depression treatment, ultimately contributing to improved mental healthcare outcomes.

Flexible self-powered bioelectronics enables personalized health management from diagnosis to therapy

Flexible self-powered bioelectronics (FSPBs), incorporating flexible electronic features in biomedical applications, have revolutionized the human-machine interface since they hold the potential to offer natural and seamless human interactions while overcoming the limitations of battery-dependent power sources. Furthermore, as biosensors or actuators, FSPBs can dynamically monitor physiological signals to reveal real-time health abnormalities and provide timely and precise treatments. Therefore, FSPBs are increasingly shaping the landscape of health monitoring and disease treatment, weaving a sophisticated and personalized bond between humans and health management. Here, we examine the recent advanced progress of FSPBs in developing working mechanisms, design strategies, and structural configurations toward personalized health management, emphasizing its role in clinical medical scenarios from biophysical/biochemical sensors for sensing diagnosis to robust/biodegradable actuators for intervention therapy. Future perspectives on the challenges and opportunities in emerging multifunctional FSPBs for the next-generation health management systems are also forecasted.

Integrating Artificial Intelligence-Driven Wearable Technology in Oncology Decision-Making: A Narrative Review

BACKGROUND

Clinical decision-making in oncology is a complex process influenced by numerous disease-related factors, patient demographics, and logistical considerations. With the advent of artificial intelligence (AI), precision medicine is undergoing a shift toward more precise and personalized care. Wearable device technology complements this paradigm shift by offering continuous monitoring of patient vitals, facilitating early intervention, and improving treatment adherence. The integration of these technologies promises to enhance the quality of oncological care, making it more responsive and tailored to individual patient needs, thereby enabling wider implementation of such applications in the clinical setting.

SUMMARY

This review article addresses the integration of wearable devices and AI in oncology, exploring their role in patient monitoring, treatment optimization, and research advancement along with an overview of completed clinical trials and utility in different aspects. The vast applications have been exemplified using several studies, and all the clinical trials completed till date have been summarized in Table 2. Additionally, we discuss challenges in implementation, regulatory considerations, and future perspectives for leveraging these technologies to enhance cancer care and radically changing the global health sector.

KEY MESSAGES

AI is transforming cancer care by enhancing diagnostic, prognostic, and treatment planning tools, thus making precision medicine more effective. Wearable technology facilitates continuous, noninvasive monitoring, improving patient engagement and adherence to treatment protocols. The combined use of AI and wearables aids in monitoring patient activity, assessing frailty, predicting chemotherapy tolerance, detecting biomarkers, and managing treatment adherence. Despite these advancements, challenges such as data security, privacy, and the need for standardized devices persist. In the foreseeable future, wearable technology can hold significant potential to revolutionize personalized oncology care, empowering clinicians to deliver comprehensive and tailored treatments alongside standard therapy.

Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks

United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.

florio® HAEMO: A Longitudinal Survey of Patient Preference, Adherence and Wearable Functionality in Central Europe

INTRODUCTION

florio® HAEMO is a hemophilia treatment monitoring application (app) offering activity tracking and wearable device connectivity. Its use might support everyday activities for people with hemophilia. The aim of this study was to evaluate user satisfaction, long-term usage and the impact on data entry when pairing a wearable with a hemophilia monitoring app.

METHODS

This is a follow-up of a two-part user survey conducted in Central Europe. People with hemophilia and parents/caregivers of children with hemophilia using florio HAEMO and who completed part one were invited to complete a second online questionnaire at least 4 months later.

RESULTS

Fifty participants (83.3%) who completed part one of the survey continued to use the florio HAEMO app and completed part two. Of 14 participants who chose to use the app with a wearable, more than half (57.1%) were aged between 13 and 25 years. Overall, the results demonstrated that florio HAEMO is very easy or rather easy to use, especially for individuals pairing the app with a wearable. Most people using a wearable indicated that florio HAEMO was very or rather important in bringing certainty to daily activities (85.7%). Notably, 14 of 36 (38.9%) non-wearable users indicated that they would prefer to pair the app with a wearable in the future.

CONCLUSIONS

Adherence to the florio HAEMO app is maintained over an extended period of use. Pairing the app with a wearable might enable easier access to app features, increase data entry motivation and provide more certainty about daily activities for people with hemophilia.

Continuous heart monitoring in patients with pulmonary hypertension smartwatches and direct transmission to their electronic health records: A trial design

BACKGROUND

Pulmonary hypertension is a progressive disease for which early treatment interventions are essential. Traditionally, patients undergo periodic clinical assessments. However, recent advances in wearable technology could improve the quality and efficiency of follow-up monitoring in patients with pulmonary hypertension.

TRIAL DESIGN

To our knowledge, this is the first study describing direct data transmission from a smartwatch to patients' electronic health records. It implements a novel update and customised program to continuously and automatically transmit data from a smartwatch to the patient's electronic healthcare records. It will evaluate continuous monitoring in patients with pulmonary hypertension and monitor their physical activity time, heart rate variability, and heart rate at rest and during physical activity via a smartwatch. It will also evaluate the data transmission method, and its data will be assessed by the treating physicians supplemental to clinical practice. Smartwatch integration promises numerous advantages: comprehensive cardiovascular monitoring and improved patient experience. Our continuous smartwatch monitoring approach offers a solution for earlier detection of clinical worsening and could be included as a combined endpoint in future clinical trials. It could improve patient empowerment, enhance precision medicine, and reduce hospitalisations. The user-friendly smartwatch is designed to minimise disruption in daily life.

CONCLUSION

The ability to transfer real-time data from wearable devices to electronic health records could help to transform the treatment of patients with pulmonary hypertension and their follow-up monitoring outside a clinical setting, enhancing the efficiency of healthcare delivery.

A comprehensive review of navigation systems for visually impaired individuals

Background

This review explores the evolutionary trajectory of navigation assistance tools tailored for the visually impaired, spanning from traditional aids like white canes to contemporary electronic devices. It underlines their pivotal role in fostering safe mobility for visually impaired individuals.

Objectives

The primary aim is to categorize and assess the plethora of navigation assistance solutions available. Emphasis is placed on technological advancements, particularly in electronic systems employing sensors, AI, and feedback mechanisms. Furthermore, the review underscores the emerging influence of smartphone-based solutions and navigation satellite systems in augmenting independence and quality of life for the visually impaired.

Methods

Navigation assistance solutions are segmented into four key categories: Visual Imagery Systems, Non-Visual Data Systems, Map-Based Solutions, and 3D Sound Systems. The integration of diverse sensors like Ultrasonic Sensors and LiDAR for obstacle detection and real-time feedback is scrutinized. Additionally, the fusion of smartphone technology with sensors to deliver location-based assistance is explored. The review also evaluates the functionality, efficacy, and cost-efficiency of navigation satellite systems.

Results

Results indicate a significant evolution in navigation aids, with modern electronic systems proving highly effective in aiding obstacle detection and safe navigation. The convenience and portability of smartphone-based solutions are underscored, along with the potential of navigation satellite systems to enhance navigation assistance.

Conclusions

In conclusion, the review advocates for continued innovation and technological integration in navigation tools to empower visually impaired individuals with increased independence and safe access to their surroundings. It accentuates the imperative of ongoing efforts to enhance the quality of life for those with visual impairments through futuristic technological solutions.

A Comprehensive Review on Advancements in Wearable Technologies: Revolutionizing Cardiovascular Medicine

Wearable technologies have emerged as powerful tools in healthcare, offering continuous monitoring and personalized insights outside traditional clinical settings. These devices have garnered significant attention in cardiovascular medicine for their potential to transform patient care and improve outcomes. This comprehensive review provides an overview of wearable technologies' evolution, advancements, and applications in cardiovascular medicine. We examine the miniaturization of sensors, integration of artificial intelligence (AI), and proliferation of remote patient monitoring solutions. Key findings include the role of wearables in the early detection of cardiovascular conditions, personalized health tracking, and remote patient management. Challenges such as data privacy concerns and regulatory hurdles are also addressed. The adoption of wearable technologies holds promise for shifting healthcare from reactive to proactive, enabling precision diagnostics, treatment optimization, and preventive strategies. Collaboration among healthcare stakeholders is essential to harnessing the full potential of wearables in cardiovascular medicine and ushering in a new era of personalized, proactive healthcare.

Addressing 6 challenges in generative AI for digital health: A scoping review

Generative artificial intelligence (AI) can exhibit biases, compromise data privacy, misinterpret prompts that are adversarial attacks, and produce hallucinations. Despite the potential of generative AI for many applications in digital health, practitioners must understand these tools and their limitations. This scoping review pays particular attention to the challenges with generative AI technologies in medical settings and surveys potential solutions. Using PubMed, we identified a total of 120 articles published by March 2024, which reference and evaluate generative AI in medicine, from which we synthesized themes and suggestions for future work. After first discussing general background on generative AI, we focus on collecting and presenting 6 challenges key for digital health practitioners and specific measures that can be taken to mitigate these challenges. Overall, bias, privacy, hallucination, and regulatory compliance were frequently considered, while other concerns around generative AI, such as overreliance on text models, adversarial misprompting, and jailbreaking, are not commonly evaluated in the current literature.

Recent Advances in Two-Dimensional Nanomaterials for Healthcare Monitoring

The development of advanced technologies for the fabrication of functional nanomaterials, nanostructures, and devices has facilitated the development of biosensors for analyses. Two-dimensional (2D) nanomaterials, with unique hierarchical structures, a high surface area, and the ability to be functionalized for target detection at the surface, exhibit high potential for biosensing applications. The electronic properties, mechanical flexibility, and optical, electrochemical, and physical properties of 2D nanomaterials can be easily modulated, enabling the construction of biosensing platforms for the detection of various analytes with targeted recognition, sensitivity, and selectivity. This review provides an overview of the recent advances in 2D nanomaterials and nanostructures used for biosensor and wearable-sensor development for healthcare and health-monitoring applications. Finally, the advantages of 2D-nanomaterial-based devices and several challenges in their optimal operation have been discussed to facilitate the development of smart high-performance biosensors in the future.

Revolutionizing Oncology: A Comprehensive Review of Digital Health Applications

Digital health is poised to revolutionize the field of oncology, offering innovative solutions that enhance diagnostics, treatment, and patient care. This comprehensive review delves into the multifaceted landscape of digital health in oncology, encompassing its definition, significance, applications, benefits, challenges, ethical considerations, and future trends. Key findings highlight the potential for early detection, personalized treatment, enhanced care coordination, patient empowerment, accelerated research, and cost efficiency. Ethical concerns surrounding privacy, equitable access, and responsible data use are discussed. Looking ahead, the future of digital health in oncology is bright, driven by advancements in artificial intelligence, virtual and augmented reality, predictive analytics, global collaboration, and evolving regulations. This review underscores the need for collaboration among stakeholders and a patient-centered approach to harness the transformative power of digital health, promising a future where the burden of cancer is lessened through innovation and compassionate care.

Continuously monitoring the human machine? - A cross-sectional study to assess the acceptance of wearables in Germany

Background: Wearables have the potential to transform healthcare by enabling early detection and monitoring of chronic diseases. This study aimed to assess wearables' acceptance, usage, and reasons for non-use. Methods: Anonymous questionnaires were used to collect data in Germany on wearable ownership, usage behaviour, acceptance of health monitoring, and willingness to share data. Results: Out of 643 respondents, 550 participants provided wearable acceptance data. The average age was 36.6 years, with 51.3% female and 39.6% residing in rural areas. Overall, 33.8% reported wearing a wearable, primarily smartwatches or fitness wristbands. Men (63.3%) and women (57.8%) expressed willingness to wear a sensor for health monitoring, and 61.5% were open to sharing data with healthcare providers. Concerns included data security, privacy, and perceived lack of need. Conclusion: The study highlights the acceptance and potential of wearables, particularly for health monitoring and data sharing with healthcare providers. Addressing data security and privacy concerns could enhance the adoption of innovative wearables, such as implants, for early detection and monitoring of chronic diseases.

Use of wearables among Multiple Sclerosis patients and healthcare Professionals: A scoping review

INTRODUCTION

Multiple sclerosis (MS) is an increasingly prevalent chronic, autoimmune, and inflammatory central nervous system illness, whose common symptoms undermine the quality of life of patients and their families. Recent technical breakthroughs potentially offer continuous, reliable, sensitive, and objective remote monitoring solutions for healthcare. Wearables can be useful for evaluating falls, fatigue, sedentary behavior, exercise, and sleep quality in people with MS (PwMS).

OBJECTIVE

This scoping review of relevant literature explores studies investigating the perceptions of patients and healthcare professionals (HCPs) about the use of wearable technologies in the management of MS.

METHODS

The Joanna Briggs Institute methodology for scoping reviews was used. The search strategy was applied to the databases, MEDLINE via Ovid, Embase, APA PsycInfo, and CINAHL. Further searches were performed in IEEE, Scopus, and Web of Science. The review considered studies reporting quantitative or qualitative data on perceptions and experiences of PwMS and HCPs concerning wearables' usability, satisfaction, barriers, and facilitators.

RESULTS

10 studies were included in this review. Wearables' usefulness and accessibility, ease of use, awareness, and motivational tool potential were patient-perceived facilitators of use. Barriers related to anxiety and frustration, complexity, and the design of wearables. Perceived usefulness and system requirements are identified as facilitators of using wearables by HCPs, while data security concerns and fears of increased workload and limited effectiveness in the care plan are identified as barriers to use wearables.

CONCLUSIONS

This review contributes to our understanding of the benefits of wearable technologies in MS by exploring perceptions of both PwMS and HCPs. The scoping review provided a broad overview of facilitators and barriers to wearable use in MS. There is a need for further studies underlined with sound theoretical frameworks to provide a robust evidence-base for the optimal use of wearables to empower healthcare users and providers.

Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study

BACKGROUND

Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance.

OBJECTIVE

This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease.

METHODS

We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data.

RESULTS

In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants' feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided.

CONCLUSIONS

Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR.

Sex-specific factors associated with acceptance of smartwatches among urban older adults: the Itabashi longitudinal study on aging

Smartwatches (SW) are wearable devices that support daily life and monitor an individual's health and activity status. This information is utilized to promote behavior modification, which could help prevent chronic diseases and manage the health of older adults. Despite being interested in SWs, older adults tend to decrease their SW usage as they age. Therefore, understanding the acceptance of SWs among older individuals can facilitate individual health management through digital health technology. This study investigated the factors associated with the acceptance of SWs among older adults in Japan and the variations in the factors by sex. This study utilized data from the 2022 Itabashi Longitudinal Study on Aging, an ongoing cohort study conducted by the Tokyo Metropolitan Institute for Geriatrics and Gerontology. We included 899 eligible individuals aged ≥65 years. Participants were classified into three groups: possessing SW (possessor group), not possessing SW but interested in possession in the future (interest group), and not interested in possession in the future (non-interest group) using a self-administered questionnaire. The level of SW acceptance was operationally defined as follows: low (non-interest group), medium (interest group), and high (possessor group). Further, we evaluated the association of acceptance and purchase intentions of SWs with sociodemographic variables, technology literacy, and health variables. Among the participants, 4.2% possessed SWs, with no significant sex difference (men, 4.2%; women, 4.3%). Among men, age < 75 years, obesity, diabetes, and dyslipidemia were significantly associated with SW acceptance level. Contrastingly, among women, age < 75 years, living alone, higher household income, and a high score for new device use in the technology literacy category were significantly associated with SW acceptance level. Health-related factors were associated with SW acceptance in men, while technology literacy and sociodemographic factors were associated with SW acceptance in women. Our findings may inform the development of sex-specific interventions and policies for increasing SW utilization among older adults in Japan.

Experiences with Wearable Sensors in Oncology during Treatment: Lessons Learned from Feasibility Research Projects in Denmark

BACKGROUND

The fraction of elderly people in the population is growing, the incidence of some cancers is increasing, and the number of available cancer treatments is evolving, causing a challenge to healthcare systems. New healthcare tools are needed, and wearable sensors could partly be potential solutions. The aim of this case report is to describe the Danish research experience with wearable sensors in oncology reporting from three oncological wearable research projects.

CASE STUDIES

Three planned case studies investigating the feasibility of different wearable sensor solutions during cancer treatment are presented, focusing on study design, population, device, aim, and planned outcomes. Further, two actual case studies performed are reported, focusing on patients included, data collected, results achieved, further activities planned, and strengths and limitations.

RESULTS

Only two of the three planned studies were performed. In general, patients found the technical issues of wearable sensors too challenging to deal with during cancer treatment. However, at the same time it was demonstrated that a large amount of data could be collected if the framework worked efficiently.

CONCLUSION

Wearable sensors have the potential to help solve challenges in clinical oncology, but for successful research projects and implementation, a setup with minimal effort on the part of patients is requested.