Wearable health tech

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Wearable health technology refers to technology that consumers wear to track various aspects of their health. The advancement of ubiquitous computing health metric collection has resulted in the popularity of wearable accessories which collect health data. Examples of Wearable health tech include Fitbit devices and the Apple Watch. Wearable health tech fits under the umbrella of the Internet of Things (IoT), where everyday devices are sending and receiving data simultaneously to generate new insights. Because Wearable health tech is often utilized in a data-driven setting, ethical concerns regarding it surround the issue of data utilization and the security of collected data.

A stock photo of a user looking at their phone which captures physical activity data collected by the user's Apple Watch.


Wearable Health Technologies started in 1938 when the first hearing aid was developed in Chicago.[1] In 2003, the first digital pacemaker was on the market and doctors could download the information within 18 seconds. Wearable technologies became more of a trend in 2006 when Nike and Apple created footwear to connect your iPod and sneakers for a personal running experience.[2]

Today, many of the current smartwatch devices, such as Fitbit and Apple Watches, are referred to as “activity trackers” to reference their capability to capture and analyze movement. The Apple Watch sold more watches in the fourth quarter of 2016 than Rolex, Omega, and Swatch combined [3]. It has also represented almost half of all smartwatch units, with Fitbit following, and nearly 80% of smartwatch revenue, amounting to USD $2.6 billion[4].

What do Typical Wearable Technology Users Look like?

  • 68% of owners of smart watches are between the ages 18 and 34, and the majority are males [5].
  • Individuals earning $45k or less per year are more likely to own smart watches [5]
  • Females are more likely to own fitness trackers suck as FitBit and FuelBand by Nike. [5].
  • Fitness tracker devices are usually owned by individuals between the ages of 35 and 54. The majority of individuals who own fitness trackers have an income of $100k per year [5].

Popular Features

Types of Wearable Health Technology [6]

Wearable technology range from wrist trackers to smart garments and body sensors used to track vital signs and responses to environment and stress. These devices fall into six categories - monitoring hydration status and metabolism, monitoring physical and psychological stress, devices that provide physical biofeedback, cognitive feedback and training, monitoring and promoting sleep, and evaluating concussion [7].

Smartwatches come with a variety of features such as messaging, alarms, calendar, and other application connection while some smartwatches have elected to focus mainly or solely on health tracking abilities. These devices can capture comprehensive data (such as altitude in addition to distance), analyze the data, and comparatively display the data to allow for activity tracking. Devices are gaining capabilities to motivate users as well to be mindful of their health in the form of encouraging visualizations of data and reminders to be active. For example, the Apple Watch has default reminders to stand at certain time intervals and has the capability to evaluate whether the user has stood or not[8]. Smartwatches may also provide the framework for 3rd-party developers to create apps to further expand the technological capabilities of health-related initiatives[9].

Heart-rate monitor

The heart-rate monitor is one popular feature of wearable tech. Devices such as the Apple Watch and Fitbit's use photoplethysmography to measure the user’s heart rate[10]. These devices have the capabilities to record rates at different intervals throughout the day and adapt to the interval of collection when detecting activity, such as running.

Users have used such wearable tech devices to monitor their heart rate for issues. Cases have occurred when users were able to detector early signs of a heart attack using a Fitbit[11] and the Apple Watch even provides the capability to alert the user if the device records an unusually high spike in heart rate during leisurely activity[12].

Calories burned

Smartwatches and wearable health technology are often able to calculate calories burned in some form for the purpose of evaluating a workout or cardio activity. The Apple Watch used the motion and heart monitoring data it collects to determine calories burned[13]. The Fitbit estimates using the heart rate tracker and BMR data[14] A user can make use of the caloric data to evaluate their activity and calories burned against the caloric intake they have manually logged for the day.

Sleep monitoring

Smartwatch devices and wearable tech may also offer services for sleep monitoring. These services use movement and heart rate monitoring to calculate time of sleep, time of waking up, duration of sleep, and movement between cycles and depth of sleep[15].


Wearable Health Technology offers many benefits to help the user stay healthy and feel responsible for their health.


In addition to physical health, these Wearable devices provide help with a user's mental health and mindfulness. The Apple Watch by default offers a “Breathe” function which prompts the user throughout the day to pause and monitor their breathing. The Watch signals the user to inhale and exhale at calculated moments. The Apple Watch App Store also has a comprehensive section for health-related apps which includes multiple apps focused on guided meditation and mindfulness[16]


Researchers have found benefit for patients when an activity tracker is used to motivate physical activity for patients with depression. Activity tracking devices were used to complement behavioral activation therapy; patients cited “positive experiences included self-awareness, peer motivation and goal-setting opportunities” as well as “[n]egative themes included inconvenience, inaccuracies and disinterest"[17]. Some wearable health technology also allows users to compete with each other, creating an environment that fosters competition, values fitness, and rewards healthy behavior.


Wearable health technology urges users to take an active role in their healthcare through exercising and nutrition by seeing real-time health data. Wearable health technology helps users feel responsible for staying healthy by creating an awareness of the user's daily activity (or lack thereof).


Wearable health technology automatically tracks different aspects of the user's health and fitness without any effort from the user. This allows users to easily keep track of their exercise or sleep in one accessible location.

Apple Watch

The Apple Watch is a smartwatch that syncs up to a user's iPhone. The Apple Watch displays a user's notifications, steps, distance traveled, and minutes of activity. All 3 models of the Apple Watch have a heart rate monitor. The monitor tracks users' resting heart rate and how it fluctuates during a fixed amount of time. Series 1 watches are splash resistant and Series 3 watches are water resistant up to 50 meters [18]. All watches can operate over wifi. The Series 3 has cellular and LTE capabilities and allows users to receive notifications as well as makes calls and send text messages.


There are 8 Fitbit trackers available on the market, each offering different features at their price points.


The Fitbit Zip is modeled more after the traditional pedometer. It clips onto the user's clothing, such as their waistband, pocket, or undergarments. At $59.95, this model tracks steps, distance, and calories burned. It sends the data it collects to a user's smartphone or laptop and allows them to compare their statistics to others around them. The battery lasts up to 6 months and it comes in 2 colors, black and pink. [19]

Flex 2

This piece of technology is wearable. Securing itself to the wrists of users, it tracks steps, distance, calories burned, minutes of exercise completed, and active hours. It also tracks sleep, is water-proof, and alerts users to notifications they receive on their cell phones, which means users never have to take it off. The battery lasts up to 5 days and the device syncs with smartphones and laptops so that users can track their progress. [20]


The Alta comes in two different versions: one with a heart rate monitor and one without. Tracking sleep, steps, active minutes, and heart rate (if applicable), the device also alerts wearers to notifications on their smartphones. With many different features, the device also has lots of different accessory bands available for users to purchase aftermarket. There are different colored options as well as designer options for a more professional look. [21]


This model is one of Fitbit's newest models designed specifically for children. Available for preorder as of April 2018, the model is designed around children. The bands are smaller, the watch face is better geared towards engaging the child, and parents can track their child's activity through a special family account through the FitBit website. In addition to tracking steps and active hours, this FitBit also encourages health sleeping habits for children by allowing parents to set silent alarms and reminders for their children to fall asleep and wake up. [22]

Charge 2

The Charge 2 has a larger face and different comfort levels of wristbands in comparison to the Charge HR. This version can track multiple fitness activities at the same time.


This is one of FitBit's two smartwatches. In addition to tracking everything that the other devices track, it also offers GPS tracking, women's health tracking, and a personal coaching feature to get users active. With a multi-day battery and a variety of bands and accessories, this smart watch is more than its previously mentioned counterparts. [23]


As FitBit's newest model on the market, the Versa is a less expensive alternative to the Ionic. The other difference between the two devices is that the Versa is swim-proof, while the Ionic is not. It features a personal coach that can set up workouts for the user and display them on the watch. There are more than fifteen modes for exercise, ranging from running to swimming to climbing, and the watch adapts its tracking style to the exercise that a user is doing. [24]

Controversy and Concerns

The criticism has occurred on whether the collection, storage, and analysis of this data is ethical.

5 Ethical Issues of Wearable Technology

  • Disclosure of Data - Privacy agreements that are signed when an individual signs up for an app connected to the wearable do no effectively explain how the data is used and who is using the data [25].
  • Selling of Data - Concerns over informed consent leads to the ethical issue of whether or not the data from wearables will be sold to health analytics companies, or used for health advertisements [25].
  • Insurance Premiums - Insurance companies may use the data accumulated by users to increase charges depending if the individual is in suboptimal health or not [25].
  • Data Interpretation - Wearables are sometimes criticized for giving out inaccurate information, leading to misguided interpretation of the data [25].
  • Cybersecurity - Concerns that wearables do not have enough cybersecurity protocols and protection, which may lead to a breach of sensitive information [25].

Continuous Tracking Controversy

In 2018, a heat map by fitness app Strava was released that highlighted the routes of all their users – including running and bike riding paths [26]. This caused controversy as military personnel was using this app as well. While military bases had been identified before using other mapping services, this capability of wearable devices to track both running and riding locations in addition to the frequency of use made it possible to see transpiration routes as well[27]. This could cause a threat to military personnel as anyone could see how what paths Strava app users are moving on and also with what speed and frequency. The military is currently looking into any implications of the map[28].

What Companies do with Sensitive Information

In 2009, David Shoemaker wrote a paper regarding self-exposure and informational privacy. He explores if there’s a way to come to terms whether it is ethically incorrect to share “innocent” personal data. In his exploration, he cites another author, Helen Nissenbaum, who has created a framework to justify the issue. First, just because data is offered, does not mean it can be ethically right for a party to gather and analyze it in a different context. For example, though the Strava location information was meant for an individual’s use to track their exercise, it is ethically wrong for someone to gather that data and use it to attack military personnel. Because – according to Nissenbaum – while bits of data may not be impactful, the collection of data could expose people. Users can feel be justified in feeling uncomfortable if their location data is being gathered and profiled[29]. User’s now must be mindful about the collection, storage, and privacy setting of location services for their wearable technology. It is critical that they understand its implications and whether they are comfortable with what someone can do with a mass amount of such information.

Security Risk

Wearable health technology is constantly gathering data about the user. It is continuously connected to the internet in order to upload this data and save it. Being connected to the internet poses a security threat to this data because most companies handling this sensitive health information does not encrypt this data appropriately. This allows hackers to gain access to this protected information. Many times, the user's data can be compromised without the user even knowing. The lack of encryption has become an embedded value in this wearable health technology. Because the corporation failed to preemptively address this issue through encryption, they have put customers at risk.


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  2. https://www.theguardian.com/technology/2014/oct/23/nike-apple-wearable-technology
  3. "Fortune Article on Apple Watch Sales" http://fortune.com/2018/02/20/apple-watch-sales-smartwatch/
  4. "Canalys's article on Apple Watch Revenue Analysis" https://www.canalys.com/newsroom/media-alert-apple-watch-has-its-best-quarter-and-takes-nearly-80-total-smartwatch-revenue-q
  5. 5.0 5.1 5.2 5.3 History of Wearable Technology
  6. Guk, Kyeonghye et al. Nanomaterials (Basel, Switzerland) vol. 9,6 813. 29 May. 2019, [Guk, Kyeonghye et al. “Evolution of Wearable Devices with Real-Time Disease Monitoring for Personalized Healthcare.” Nanomaterials (Basel, Switzerland) vol. 9,6 813. 29 May. 2019, doi:10.3390/nano9060813 Evolution of Wearable Devices with Real-Time Disease Monitoring for Personalized Healthcare
  7. Peake, Jonathan M, et al. Frontiers in Physiology, 28 May 2018, https://www.frontiersin.org/articles/10.3389/fphys.2018.00743/full?utm_source=FWEB&utm_medium=NBLOG&utm_campaign=ECO_FPHYS_wearable-devices A Critical Review of Consumer Wearables, Mobile Applications, and Equipment for Providing Biofeedback, Monitoring Stress, and Sleep in Physically Active Populations]
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  10. "Techadvisor article on Photoplethysmography" https://www.techadvisor.co.uk/feature/wearable-tech/fitbit-vs-apple-watch-2018-3612954/
  11. "Yahoo News Article on Heart Attack Instance" https://au.news.yahoo.com/a/30839939/life-saving-fitbit-detects-grandfathers-heart-attack-before-it-happened/
  12. "Apple Website's news on Heart Track"https://www.apple.com/newsroom/2017/11/apple-heart-study-launches-to-identify-irregular-heart-rhythms/
  13. "TechAdvisor Article on Calories Tracking"https://www.techadvisor.co.uk/feature/wearable-tech/fitbit-vs-apple-watch-2018-3612954/
  14. TechAdvisor Article on Fitbit Heart Rate Track and BMR Data"https://www.techadvisor.co.uk/feature/wearable-tech/fitbit-vs-apple-watch-2018-3612954/
  15. TechAdvisor Article on Sleep Monitoring" https://www.techadvisor.co.uk/feature/wearable-tech/fitbit-vs-apple-watch-2018-3612954/
  16. "Imore Article on Apple Watch Meditation App" https://www.imore.com/best-meditation-apps-apple-watch
  17. Chum J, Kim MS, Zielinski L, et al Acceptability of the Fitbit in behavioral activation therapy for depression: a qualitative study Evidence-Based Mental Health 2017;20:128-133. http://ebmh.bmj.com/content/20/4/128
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  20. “FitBit Flex 2.” Fitbit, Fitbit, Inc., www.fitbit.com/flex2.
  21. https://www.fitbit.com/alta
  22. https://www.fitbit.com/ace
  23. https://www.fitbit.com/ionic
  24. https://www.fitbit.com/versa
  25. 25.0 25.1 25.2 25.3 25.4 UIC Online Health Informatics, University of Illinois Chicago , 9 Dec. 2020, Ethics of Wearables: Health Data and Wellness Technology
  26. "Strava Heatmap Article" https://www.strava.com/heatmap#2.95/59.86091/47.61165/hot/all
  27. "The Verge Article on Tracking Locations" https://www.theverge.com/2018/1/28/16942626/strava-fitness-tracker-heat-map-military-base-internet-of-things-geolocation
  28. "Washington Post Article on Location Controversy for Wearable Tech" https://www.washingtonpost.com/world/a-map-showing-the-users-of-fitness-devices-lets-the-world-see-where-us-soldiers-are-and-what-they-are-doing/2018/01/28/86915662-0441-11e8-aa61-f3391373867e_story.html?utm_term=.db3c0da67fee
  29. Shoemaker, D. W. (2009). Self-exposure and exposure of the self: Informational privacy and the presentation of identity. Ethics and Information Technology, 12(1), 3-15. doi:10.1007/s10676-009-9186-x