By David Carfagno, DO, CAQSM, ACSM (EP-c), medical director | HonorHealth Medical Fitness and Mia Chorney, DNP, FNP-BC | HonorHealth Cardiovascular Genetics

The evolution of wearable technology represents a remarkable transformation in how we monitor and manage patient health. What began as simple tracking tools for steps and basic fitness metrics has evolved into sophisticated monitoring systems capable of detecting potential cardiac issues, analyzing sleep patterns and providing real-time health insights. Understanding these tools’ capabilities and limitations is crucial for their effective integration into clinical practice.

The paradox of play and technology

A paradox exists in our modern society. Just a generation ago, exercise was not a structured activity requiring formal equipment or technological validation. Communities and neighborhoods were vibrant places where children and adults alike engaged in spontaneous play. Games ended not when fitness goals were achieved or metrics were logged but when participants were out of breath, it became too dark to see the ball or it was time to eat dinner.

Today we see a stark contrast: the once-bustling streets and fields are often empty. Exercise has become quantified, with people tethered to wearable devices tracking every imaginable metric. Heart rate, VO2 percentage, calories burned and recovery times dictate our movements, telling us whether we are healthy or striving to be healthy. While this technological evolution has brought undeniable benefits in terms of health insights and motivation, it raises important questions about balancing the joy of spontaneous movement with the regimented pursuit of health through numbers.

Current state of wearable technology

The evolution of wearables has led to increasingly advanced devices that monitor various cardiovascular and health metrics. From a cardiovascular genetics perspective, these devices have revolutionized the monitoring of cardiac conditions. Continuous monitoring of heart rhythm patterns and heart rate variability provides invaluable data for identifying early manifestations of cardiac conditions, such atrial fibrillation (often not primarily genetic) and arrhythmogenic right ventricular cardiomyopathy (ARVC).

In sports medicine practice, wearables have been integral to patient management since their early adoption in the 2000s, with the emergence of brands such as Garmin, Polar, Fitbit and later Apple Watch. Studies show that wearable technologies, especially those with ECG capabilities, have been instrumental in detecting early arrhythmias in patients predisposed to ARVC (Buchanan et al., 2020). The accessibility of these devices promotes continuous monitoring outside clinical settings, improving diagnosis and guiding long-term management strategies for patients with inherited cardiac conditions.

Key monitoring capabilities include:

• Advanced cardiac monitoring (including ECG capabilities, heart rate variability and rhythm tracking)
• Blood oxygen levels and respiratory health assessment
• Sleep patterns and their impact on cardiovascular health and athletic recovery
• Stress levels and autonomic nervous system function
• Physical activity metrics across multiple activities
• Continuous glucose monitoring

Recent innovations have expanded beyond traditional smartwatches to include smart rings and wearable patches. Smart rings, in particular, have revolutionized continuous monitoring by being lightweight, unobtrusive and aesthetically pleasing. These devices deliver real-time health data while addressing key barriers like comfort and battery life that often discourage long-term use. Their simple interfaces and reliable data collection make them especially accessible to diverse populations, including older adults who might struggle with more complex devices.

Clinical applications in genetic cardiac conditions

Wearable devices have transformed the monitoring of genetic cardiac conditions, particularly for detecting early signs of ARVC. While they cannot provide a definitive diagnosis, they can identify patterns or anomalies that warrant further clinical evaluation, enabling timely interventions that may reduce morbidity and mortality.
Piwek et al. (2016) highlight that wearables enhance engagement by delivering real-time feedback and data visualization, encouraging proactive health management. Their continuous monitoring capabilities improve early detection, reducing the risk of severe complications.

Innovations such as smart rings, which track heart rate variability and sleep patterns, offer insights into stress-related cardiovascular risks. By addressing common barriers like discomfort and frequent charging, these devices improve long-term adherence, particularly among older adults who benefit from passive data collection and user-friendly interfaces.

By enhancing usability and accessibility, wearables empower patients to actively manage their health, leading to better adherence and improved outcomes in chronic disease management (Piwek et al., 2016).

Biometrics: Bridging medicine and sports medicine

Biometric data from wearables have become invaluable for both clinical care and athletic performance:

• Sports medicine integration: Enables precise monitoring of athletes’ recovery, early detection of overtraining and fine-tuning of training regimens.
• Exercise as medicine: Supports the prescription of exercise for chronic disease management through objective data.
• Gamification and patient engagement: Through gamification strategies like challenge boards and metrics tracking, friendly competition and accountability are created. By introducing these gamified elements and tracking metrics, entire communities can become more active and invested in their health. This approach has proven especially effective in maintaining long-term engagement and fostering a culture of movement and wellness.

Clinical implementation guidelines

When incorporating wearables into patient care, consider these recommendations:

1. Set realistic goals
   • Establish achievable health objectives aligned with each patient’s medical condition and fitness level.
   • Create individualized monitoring plans based on technology comfort.
   • Start with small, actionable goals that can be gradually increased.
2. Understand device limitations and alert management
   • Emphasize that wearables supplement, not replace, professional medical assessments.
   • Discuss the accuracy limitations of different devices.
   • Establish clear protocols for when to seek medical attention.
   • Create specific guidelines for not responding to device alerts, particularly for ECG readings and irregular heart rhythm notifications.
   • Educate patients on the difference between device-generated warnings and true medical emergencies.
3. Data integration in patient care
   • Use wearable data during regular check-ins to discuss trends in daily activity patterns, sleep quality and heart rate.
   • Guide patients in distinguishing between actionable alerts and false positives.
   • Leverage insights for personalized exercise and treatment protocols.

Benefits for patient care

Comprehensive monitoring and engagement

• Continuous monitoring with real-time feedback on cardiovascular metrics, enabling early detection of arrhythmias and irregular patterns
• Enhanced self-awareness and proactive management of heart health patterns
• Support for lifestyle modifications that impact cardiovascular health
• Improved adherence to treatment plans through data-driven motivation and accountability

When monitoring patients with inherited cardiac conditions, these devices provide invaluable longitudinal data. However, alerts should be calibrated to individual genetic risk factors. While device alerts can be helpful indicators, they are not always precise and should prompt patients to contact their provider if concerns arise. Clear guidelines can help patients understand when to act on alerts versus when to wait for their next appointment.

Future directions

The integration of AI and advanced sensors promises to make wearables even more valuable in healthcare settings. Emerging trends include:

• Improved accuracy in health monitoring through advanced sensor technology
• Enhanced predictive capabilities for health issues
• Better integration with telehealth platforms and EMRs
• More sophisticated data analysis for personalized care
• Dynamic treatment programs that evolve with patients’ daily lives (e.g., adjusting exercise recommendations based on sleep quality data or modifying heart rate thresholds based on training load)

Wearable technology represents a powerful tool in modern healthcare delivery, bridging the gap between visits and daily health management. While these devices cannot replace professional medical care, they provide valuable insights that can enhance patient care and support better health outcomes. As medical professionals, understanding both the capabilities and limitations of these tools is crucial for their effective integration into patient care protocols.

References

Buchanan, J. W., Weiss, R., & Gollob, M. H. (2020). Wearable technologies for inherited arrhythmia syndromes: New frontiers in arrhythmia detection and management. Circulation: Genomic and Precision Medicine, 13(6), e003226. https://doi.org/10.1161/CIRCGEN.120.003226

Piwek, L., Ellis, D. A., Andrews, S., & Joinson, A. (2016). The rise of consumer health wearables: Promises and barriers. PLoS Medicine, 13(2), e1001953. https://doi.org/10.1371/journal.pmed.1001953