Digital Health: Wearables, Exergaming and Connected Fitness

There is an accelerating convergence taking place between the digital revolution, the medical cocoon, healthcare, and consumer health-wellness-fitness (i.e., preventative medicine). Remote patient monitoring is a nascent advance in healthcare for disease management in the hospital, at home, and elsewhere. Innovative sensors will enable the transformation of our healthcare systems to a more consumer-centric model, where medicine moves away from episodic treatment delivered in centralized hospitals, to a patient-centered medical home where prevention, early intervention, and better chronic disease and acute medical condition management are the norms, not the exceptions.  This new paradigm is reliant upon the ability to monitor and measure biometric data using wearable sensors that provide individuals with information on their own health status as well as feeding this important health data to their care delivery team.

While wearables and their medical and fitness applications are vast and expand to all populations in many settings, research must parallel this expanding frontier to ensure appropriate validation studies and understanding of each device’s limitations in order to maximize the utility of physiological monitoring. Validation studies are often costly and time-consuming processes. Unfortunately, the pace of research studies seems to be lagging behind the pace of advertising and marketing in the digital health arena. Moreover, peer-reviewed studies remain the gold standard in the biomedical community, yet the claims of both clinical- and consumer-related health and wellness devices have not been universally held to similar standards. In effect, it has become part of the ‘wild, wild west’ of marketing and advertising often with unsubstantial claims. The AEPRL leverages extensive experience in the meticulous validation and reliability of wearable biosensors for clinical and health-fitness applications. Moreover, our research process is a disease, device, and outcome-agnostic, specifically one that can handle the vast number of devices available in the marketplace today.

In 2015 we developed the AEPRL Digital Health Network (DHN); the offspring of ongoing research collaboration between the Department of Homeland Security, emergency responders, and our laboratory. The goal of this collaboration, known as PHASER (Physiological Health Assessment System for Emergency Responders), was to bring together researchers from engineering, medicine, exercise physiology, industry, and the emergency responder community to create state-of-the-art technology solutions for ensuring the health and safety of emergency responders by leveraging economies of scale and expediting opportunities for system deployment and national roll-out. The DHN system architecture mimics much of the PHASER-Net platform; it is low-cost, secure and private, scalable, supportive of standardization, robust, reliable, and amenable to future modifications. The DHN system employed existing state-of-the-art wireless wearable physiological status monitors and standalone instruments. Durable smartphone platforms were integrated via a novel DHN Mobile Application (App) for sensor data acquisition, processing, and interaction with users. The data from the App was then securely uploaded to the DHN, implemented with dedicated secure servers at UCLA for archival, processing, and development of individualized feedback available to each user via password-protected web pages. Access to the data on DHN was restricted to the participants and authorized personnel to perform an additional over-read of the data and provide further feedback and guidance.

Recently exergaming – digital games that require bodily movements to play, stimulate an active gaming experience to function as a form of physical activity – has emerged as a popular fitness movement. The goal of exergaming is to merge interactive fitness programs with high-tech equipment to make getting healthy more enjoyable. It provides a new way to engage people in interactive fitness through gamification and technology. By doing this, it creates socially engaged, supportive, and inviting fitness communities worldwide.

Nascent technological advances have emerged in the home-based fitness landscape with new products and applications incorporating virtual training via connected fitness equipment. Such systems have become known as ‘smart home gyms’ or ‘AI-powered home gym equipment and will
herein be referred to as home-based digital exercise training systems. These modalities seek to improve the user’s physical performance (fitness) and cardiometabolic health from the comfort of their own home. Studies have found that home-based exercise training interventions (in populations ranging from youth-to-older adults, healthy-to-clinical patients, and beyond) utilizing remote, ‘virtual trainers’ are just as efficacious and economically viable compared to face-to-face training. A recent research study conducted on virtual-reality training in an elderly population showed a significant increase in health and balance. The relative convenience and constant access to virtually guided workouts have also resulted in increased adherence to a myriad of these exercise regimens.