Apple Watch Series 3
Nina Raja | CNBC
Apple introduced a slew of new features for its Apple Watch this week, ranging from sleep tracking to hand-washing reminders, most of which were targeted to all consumers.
All except for one: An update to its motion sensors that is designed to help the clinicians monitor patients’ remotely as they age. Apple shared in a news release that the watch can now track low-range cardio fitness, walking speed, double support time, step length and six-minute walk distance, among other metrics. The data will be available in the Health app in the fall.
Apple has described the metrics as “validated” because it compares them in internal studies to the gold standard for measurement.
The company said that, because of these updates, it now has a way to track “functional (aerobic) capacity” through the Apple Watch. That means it can start to assess a patients’ mobility in a standardized way.
Most of what Apple does is intended for consumers at large, but these new features are most relevant to those who are aging or experiencing events that impact their ability to move freely because of an injury or procedure.
Measuring recovery from medical procedures
Apple said it is currently working with Zimmer Biomet, an orthopedics products company, on a service called mymobility, which uses Apple Watch’s gait metrics to collect a user’s walking speed and double support time — a measurement of when both feet are on the ground — on flat surfaces without GPS. This could be useful data for physicians after a procedure, like a knee or hip replacement, to assess their patients’ rate of recovery between clinic visits.
Many doctors focused on heart health will use a “six minute walk test” in their clinics to measure how well someone is walking or recovering. Historically, patients have needed to go into a clinic to measure how far they’ve walked between set of cones or markers, while a supervisor wears a stopwatch.
“The goal isn’t just to see how you walked in six minutes,” explained Dr. Paul Friedman, a Professor of Medicine and Chair of the Department of Cardiovascular Medicine at Mayo Clinic. “But to see how you compared to others your age and sex – and to look at that as an overall marker of health.”
Dr. Friedman thinks that wearables can certainly play a role when it comes to measuring functional capacity, particularly in how it’s changing over time. It’s also a window into patients’ everyday lives, where they might move differently than in the lab or the clinic. But it’s still early days, and it’s too soon to say whether health developers will flock to incorporate the new metrics into their apps.
But some studies are currently underway to assess the role of wearables in monitoring patients’ mobility. The Palo Alto Veterans Institute for Research is testing whether a mobile medical app called VascTrac that monitors movement using Apple devices can predict endovascular failure of patients with peripheral artery disease, which refers to a narrowing of peripheral arteries serving the legs, stomach, arms and head.
“Think of it as a clinically validated way for us to know how you’re doing in the real world,” said Dr. Oliver Aalami, a vascular surgeon at Stanford University and a researcher behind the study.
It can help doctors check in on declines in physical activities over time
Where he sees Apple Watch or the iPhone playing a role is by providing doctors with an activity index of sorts, so they can check in on general declines in physical activity over periods of time. Wearables can play a particularly important role during the pandemic, he notes, because patients might prefer to perform such tests or exercises at home. Ideally, he’d like for the data generated from wearables to be used as part of a structured program, which is supervised by a doctor or exercise specialist.
Dr. Jeffrey Wessler, a cardiologist based in New York, said he could see Apple Watch being particularly useful for monitoring how patients are faring during clinical trials. That’s because it could allow for researchers to measure participants asynchronously, and without extra resources to track how they’re responding to an intervention over time.
There’s also the potential for health systems to team up with Apple and strike deals with health plans willing to pay for exercise interventions down the road. There are even cases where patients can enroll in physical therapy in lieu of needing a surgical procedure.
In the Netherlands, for instance, exercise therapy programs are covered for vascular patients with peripheral artery disease. Vascular surgeon Joep Teijink told CNBC by phone say that patients after six weeks of physical therapy are seeing promising results, and many do not require a procedure. Teijink said he’s still determining how wearables can play a role in helping these patients.
In the United States, Dr. Aalami said that integrated health systems are most likely to be investing in exercise therapy programs using wearable devices because they get paid based on patient outcomes. At fee-for-service hospitals, there’s less of a financial incentive to do so as they typically get paid for performing the procedures.
Most doctors agree that it’s an area that needs more investment and resources in using wearables to monitor patients.
For Dr. Aalami, there’s even potential down the road to “make physical activity a vital sign”.
Some say Apple needs to do more
Still, not every doctor said they’re blown away by the update. Some say that Apple needs to do a lot more for the medical community, and focus less on wellness features. They note that there are other ways of tracking movement, which are good enough for their purposes, but that Apple should focus on more sophisticated medical monitoring.
“Very few physicians use walking speed or stair ascent speed in everyday practice and can easily assess them if truly needed,” said Christopher Kelly, a cardiologist in Raleigh at North Carolina Heart and Vascular. “We need more creative innovation from Apple that really offers medical value.”