Smartwatches have emerged as a remarkable outcome of the information technology revolution, offering benefits that extend beyond health monitoring to early detection of sub-clinical conditions, potentially preventing serious health complications like stroke. In collaboration with other Lithuanian universities, Prof. Marozas and the team from Kaunas University of Technology (KTU) have developed a prototype smartwatch known as the TeltoHeart multifunctional smart wristband system, a creation of the Lithuanian company Teltonika.
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Nowadays, smartwatches have become much more than physical activity monitoring devices – they have acquired the function of a personal health consultant.
Vaidotas Marozas, Professor and Director, Biomedical Engineering Institute, Kaunas University of Technology
Monitoring abnormal heart rhythms, such as atrial fibrillation (AF), is a critical area where wearable devices are proving invaluable. According to KTU researcher Prof. Vaidotas Marozas, the latest Clinical Practice Guidelines for AF diagnosis and management, published in Circulation, reference wearable devices no fewer than ten times. These guidelines reflect the significant progress in arrhythmia monitoring and recognition, prompting medical experts to consider retiring the term “clinical AF” altogether.
“In the future, it is hoped that wearable devices will not only be used for early diagnosis and warning, but also for assessing the effectiveness of treatment. Large global research studies show that wearable devices have a 92-97 % reliability in detecting arrhythmias. Early diagnosis and treatment can reduce the risk of stroke by as much as 70%,” noted the KTU researcher.
Several countries are already incorporating digital health monitoring into their healthcare systems. In Germany, for instance, the digital health device initiative DiGA (Digitale Gesundheitsanwendungen) is advancing rapidly. This program certifies devices and applications designed to diagnose, monitor, or treat a range of diseases and conditions.
“Patients can buy these devices with a doctor’s prescription and the cost is reimbursed by insurance companies. A similar initiative is being developed in France, according to recent reports. These programs are a testament to the growing confidence in the ability of smart technologies to improve healthcare and people’s quality of life,” said Prof. Marozas.
Can Prevent Disease
The KTU researcher outlines that smartwatches can monitor key health indicators, including physical activity (measured by step count), pulse rate (in beats per minute), blood oxygen saturation (as a percentage), and sleep quality (covering duration and stages such as REM, light, and deep sleep).
“Smartwatches allow for detailed analysis that helps identify potential health problems. For example, the heart rate monitoring function can help detect arrhythmias and other heart rhythm problems. Analyzing sleep quality can help detect sleep apnea or other forms of sleep disorders,” Prof. Marozas adds.
These devices also offer insights into metabolic disorders, such as weight issues or diabetes, by evaluating physical activity and calorie intake. Beyond physical health, they assess emotional and psychological well-being. Some smartwatches monitor stress levels by analyzing breathing rates and autonomic nervous system balance, enabling users to take timely actions, like deep breathing, to alleviate stress.
Marozas highlights that commercially available wearables now evaluate various health metrics, including body composition (fat, fluid, and muscle mass), stress, blood pressure, heart arrhythmias, and sleep apnea.
“The number of functions is growing as this is a very active area of research. For example, research is being carried out in Lithuania and the Netherlands on how to use a smartwatch to recognize and encourage a patient to seek immediate medical attention if a myocardial infarction is suspected,” said Prof. Marozas.
According to Prof. Marozas, the wearer determines which smartwatch features are most beneficial. These may involve keeping an eye on vascular stiffness, cardiac arrhythmias, physical activity, or a woman's fertility cycle: “For example, currently in Lithuania, if you suspect that your breathing stops intermittently at night, you could have to wait up to three years for a test at a clinic. The latest wearable devices can not only warn of suspected apnea but also assess its intensity index.”
Particularly Useful in Dementia
Smartwatches can be particularly valuable for older adults dealing with chronic conditions, especially neurodegenerative diseases like Alzheimer’s or advanced dementia, according to the KTU researcher. These devices, equipped with GPS tracking, help buttons, and two-way communication, provide critical support in such cases.
“This is borne out by personal experience: a close relative with symptoms of dementia found a mobile phone impractical and had to call the emergency services several times because of disappearances and searches. Now, the relative wears a smartwatch with GPS, cellular and some vital signs monitoring functions all the time. This allows us to always know where our relative is, to monitor their vital signs, and if they get lost, to contact them and, if necessary, to help return home,” adds Prof. Marozas.
Preventing dementia, he explains, involves adopting a healthy lifestyle and mitigating risk factors. Regular physical activity, a balanced diet, managing blood pressure and weight, stress reduction, and quality sleep are essential. With age, the risk of conditions like sleep apnea, arrhythmias, and hypertension increases, but modern technological solutions can help monitor these parameters effectively.
“Elderly parents can be helped by giving them smart devices, by offering active support in adopting new health monitoring technologies, and by remotely monitoring and discussing their health data – just as their parents once analyzed their grade books,” said Prof. Marozas.
The Evolution of Precision in Smart Devices
The accuracy and reliability of health data monitored by smart devices are critical for informed decision-making, according to the KTU researcher.
“Back in 2015 as part of an international project, we were conducting the accuracy of smart devices research. We investigated their measuring of physical activity, body composition, and blood pressure, and observed a wide variation in accuracy. Some step-counting devices counted 48 % more steps, while others counted 32% fewer steps,” noted Prof. Marozas.
For systolic blood pressure, some blood pressure monitors consistently read 4 mm Hg too high, while others read 7 mmHg too low. He claimed that even the most precise devices had an error of up to 30 % when it came to calorie monitoring, making it the most challenging.
Prof. Marozas points out that using the major advancements in instrumentation, the situation has now changed. For instance, when driving on a road with potholes, steps will no longer be counted. Additionally, pulse monitoring errors during sleep and rest are reduced.
To offer devices with blood oxygenation, ECG, and cardiac arrhythmia monitoring capabilities, device manufacturers must go through a clinical validation and certification process. New standards for blood pressure and oxygenation monitoring have also been developed.
“In Europe, these functions are certified as Class IIa medical devices that patients and doctors can trust. Unfortunately, standards for monitoring stress, pain, and sleep quality have not yet been developed, so we can expect a wide variation of results between different devices,” said Prof. Marozas.
Smart Devices for Analyzing Sweat
The creation of new sensors and non-invasive diagnostic techniques, like sweat analysis and long-term monitoring of blood pressure, blood temperature, and blood glucose levels, are among the most significant technological advancements, according to the KTU professor.
“New methods for analyzing long-term data will allow us to offer digital biomarkers that will, for example, help us to identify individual arrhythmia triggers or to tailor drugs to treat hypertension. Although these features are still in development, their potential is undeniable, especially for patients with chronic diseases,” noted the KTU professor.
Smartwatches should not be used as a last resort for medical diagnosis but rather as an additional tool.
The application of artificial intelligence is heavily emphasized since algorithms are able to analyze data, identify health abnormalities, and offer insights into potential risk factors. This highlights the value of preventive medicine by enabling proactive disease prevention in addition to real-time health monitoring.
“In the future, smartwatches could become an important link between patients and doctors, enabling remote monitoring of patient’s condition, their response to treatment, and rapid response to potential health problems. In addition, the integration of smartwatches and genetic information could provide even more accurate personalized health recommendations,” said Prof. Marozas.
Prof. Marozas claims that the improvement of both public and individual health will be greatly impacted by this blending of technology and medicine. Currently, underrepresented groups, such as older adults, people with disabilities, and people with rare chronic or genetic diseases, will be able to use wearable technology.
How Do I Choose a Smartwatch?
Selecting the right smartwatch depends on understanding your personal needs, according to a KTU researcher. He suggests several key considerations when making your decision. The first step is to evaluate the health monitoring functions offered by the smartwatch. While more features can provide greater benefits, it’s equally important to ensure the accuracy and reliability of these features.
“Another important aspect is the battery life, which depends on the intensity of use and the functions of the watch. Longer battery life allows the device to be used without frequent charging, which is particularly important for everyday use. It is also important to consider how the watch integrates with a mobile phone and other technologies, such as smart scales, to monitor and analyze the data collected,” said the KTU researcher.
Additionally, the availability of alerts and reminders can be a significant advantage. These features not only assist in maintaining health goals but also prompt timely action by notifying users of changes in health indicators.
Apple and Samsung watches have the most features, but shorter battery life. One possible solution is to charge your watch every morning, for example during your morning shower.
Vaidotas Marozas, Professor and Director, Biomedical Engineering Institute, Kaunas University of Technology
For specific use cases, Garmin and Polar devices cater to athletes seeking to optimize their training and performance. On the other hand, Fitbit and Withings emphasize health monitoring with longer battery life, with some Withings models lasting up to 30 days on a single charge.
“However, while these devices can provide many useful insights and help identify health problems early, they are not a substitute for professional medical advice. It is important that people use smartwatches as a complementary tool rather than a final solution for health diagnosis,” stressed Prof. Marozas.
Journal Reference:
Joglar, A, J., et al. (2024) 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. doi/10.1161/CIR.0000000000001193