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Remote health technologies, including wearable biometric and activity tracking devices, increase connectivity between patient and practitioner, help engage patients in their therapeutic treatments, and provide clinicians a contextual understanding of each patient’s functioning. They may also hold promise for disease detection and prevention.

Continuous glucose monitors, wearable heart monitoring devices, and biosensor technology that records vital signs such as temperature, respiration, and sleep are all examples of telemonitoring technologies used to remotely observe a patient’s health and record pertinent data in the context of daily life. Additional remote monitoring devices include smart devices (phones, watches, pedometers, etc.) used to acquire, transmit, process, and store health data for either communication between a patient and practitioner or for an individual’s personal health monitoring. Studies suggest that data points from these devices may identify the onset of an acute viral illness,¹ and they may also help to monitor chronic illness development and progression.^2,3

Remote Health Monitoring & Chronic Disease

Research suggests that remote health monitoring helps to increase the effectiveness of chronic disease home care and may reduce acute hospital use for patients. A recent systematic review of 91 studies that included a range of populations and disease conditions found that remote patient monitoring detected disease exacerbations, facilitated proactive disease management, and reduced hospital admissions, length of stay, and emergency department presentations, especially for patients with cardiovascular disease and COPD.⁴ In addition, a 2020 meta-analysis of 26 randomized controlled trials (n=11,450) found that those remote health monitoring approaches that involved medication support and mobile health (i.e., software apps for smartphones, personal digital assistants, and tablet computers) were associated with improvements in all-cause mortality and hospitalization outcomes for patients with chronic heart failure.⁵ Further, a 2021 systematic review suggested that the use of smartphone applications in chronic disease monitoring and management, specifically app-based weight management programs, favorably influences lifestyle factors such as healthy eating behaviors, dietary patterns, physical activity, and stress levels and decreases mean body weight and waist circumference.²

Health Tracking Devices & Clinical Applications

Wearable health devices provide a clinician with a patient’s real-time health information and may enhance the effectiveness of some lifestyle interventions.^6,7 This technology also increases an individual’s access to their personal health information and patterns. Does this increased access encourage individuals to make healthier lifestyle choices for potential prevention of chronic disease? Conclusions from current research studies are mixed but encouraging overall.

A 2022 umbrella review of 39 systematic reviews and meta-analyses (n=193,992 participants) found that overall, activity trackers used in healthy and clinical populations improved physical activity, body composition, and fitness.⁸ In some included reviews, the benefit was sustained up to one to two years.⁸ However, a 2021 systematic review found that while the use of wearable activity trackers improved conscious exercise behavior, including daily steps and weekly moderate-to-vigorous physical activity, their use did not effectively change habitual behavior, such as light physical activity and sedentary behavior.⁹ And while a 2021 meta-analysis of 28 studies (n=7,454 healthy adults) suggested that health approaches using apps or trackers showed a small-to-moderate positive effect on physical activity measures,¹⁰ a 2020 systematic review of 58 randomized controlled trials (n=10,071) highlighted the concern that the effectiveness of interventions that use biometric monitoring devices, while promising, was dependent on the individual’s uptake and adherence.¹¹

With the consumer popularity of smart devices, some patients may have a comfortable working knowledge of their health data from wearable technology. However, some patients may have encountered frustrations when using the devices or may not have easy access. These considerations may be helpful when tailoring the most appropriate personalized therapeutic intervention for a patient’s treatment or prevention strategy.

Summary

Wearable devices and trackers may provide an opportunity for increasing patient empowerment and engagement in treatments. The technologies are potential tools for discovery that provide a dynamic perspective of an individual’s health patterns and a deeper understanding of a patient’s condition. Data points from devices can be used to show patients measured changes in their health journey, increasing transparency and trust in the patient-practitioner therapeutic partnership, a cornerstone of the functional medicine approach.

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References

1. Radin JM, Wineinger NE, Topol EJ, Steinhubl SR. Harnessing wearable device data to improve state-level real-time surveillance of influenza-like illness in the USA: a population-based study. Lancet Digit Health. 2020;2(2):E85-E93. doi:1016/S2589-7500(19)30222-5
2. Moses JC, Adibi S, Shariful Islam SM, Wickramasinghe N, Nguyen L. Application of smartphone technologies in disease monitoring: a systematic review. Healthcare (Basel). 2021;9(7):889. doi:3390/healthcare9070889
3. Mattison G, Canfell O, Forrester D, et al. The influence of wearables on health care outcomes in chronic disease: systematic review. J Med Internet Res. 2022;24(7):e36690. doi:2196/36690
4. Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open. 2021;11(3):E40232. doi:1136/bmjopen-2020-040232
5. Ding H, Chen SH, Edwards I, et al. Effects of different telemonitoring strategies on chronic heart failure care: systematic review and subgroup meta-analysis. J Med Internet Res. 2020;22(11):E20032. doi:2196/20032
6. Dehghan Ghahfarokhi A, Vosadi E, Barzegar H, Saatchian V. The effect of wearable and smartphone applications on physical activity, quality of life, and cardiovascular health outcomes in overweight/obese adults: a systematic review and meta-analysis of randomized controlled trials. Biol Res Nurs. 2022;24(4):503-518. doi:1177/10998004221099556
7. Wong SH, Tan ZYA, Cheng LJ, Lau ST. Wearable technology-delivered lifestyle intervention amongst adults with overweight and obese: a systematic review and meta-regression. Int J Nurs Stud. 2022;127:104163. doi:1016/j.ijnurstu.2021.104163
8. Ferguson T, Olds T, Curtis R, et al. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. Lancet Digit Health. 2022;4(8):e615-e626. doi:1016/S2589-7500(22)00111-X
9. Li C, Chen X, Bi X. Wearable activity trackers for promoting physical activity: a systematic meta-analytic review. Int J Med Inform. 2021;152:104487. doi:1016/j.ijmedinf.2021.104487
10.  Laranjo L, Ding D, Heleno B, et al. Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregression. Br J Sports Med. 2021;55(8):422-432. doi:1136/bjsports-2020-102892
11.  Perlmutter A, Benchoufi M, Ravaud P, Tran V-T. Identification of patient perceptions that can affect the uptake of interventions using biometric monitoring devices: systematic review of randomized controlled trials. J Med Internet Res. 2020;22(9):E18986. doi:2196/18986