Wearables in Health, Performance, and Medicine: Promise, Pitfalls, and the Path Ahead

In recent years, wearable biometric devices have moved far beyond the realm of step counters and calorie trackers. Rings, wristbands, and smartwatches such as the Oura Ring, Whoop, Apple Watch, Garmin, and Polar monitors now promise far more sophisticated insights like continuous heart rate monitoring, heart rate variability (HRV) measurement, sleep staging, respiratory rate, body temperature, and even predictive health alerts. For both clinicians at the front line and health-conscious consumers, the potential is exciting. But as with any rapidly evolving technology, the evidence must be carefully considered and evaluated before we can fully embrace these devices as tools of modern medicine and for disease prevention. In this week’s newsletter I want to discuss some of the applications of wearable technology, some of the potential pros and cons and finally the future directions in the healthcare and performance spaces.

The Current Landscape of Wearables

At their core, wearables like the Oura Ring, Whoop, Garmin and Apple watches are consumer products. They collect physiological data through sensors such as photoplethysmography (PPG), accelerometers, and temperature probes to provide us insights into our health status. They have become increasingly adept at offering real-time insights into the body’s autonomic nervous system balance, recovery status, and sleep quality. For athletes and health-conscious individuals committed to performance and longevity, these insights may help guide training intensity, recovery days, and lifestyle choices that can have meaningful change. The Oura Ring and Whoop, specifically emphasize HRV and sleep staging as proxies for recovery and readiness, while more fitness-oriented wearables from Garmin and Polar prioritize training load, VO₂ max, and performance metrics to determine training readiness, fitness level and recovery.

Yet while the data is plentiful, questions remain about its validity and reliability. We know that HRV measured by wrist or ring devices can differ from gold-standard electrocardiogram (ECG) readings, particularly during movement or exercise, although it’s getting better and better as new software and hardware emerges. Sleep staging is similarly imperfect, with wearables often overestimating deep sleep compared to the gold-standard of polysomnography (PSG).

While not yet diagnostic, it’s important to consider that these devices increasingly demonstrate value for trend detection rather than absolute precision in measurement. They can really be an asset in helping consumers, and as we're seeing more recently, clinicians notice changes over time rather than relying on single daily numbers. Having personally used the Oura Ring for over 5 years I can honestly say that I continue to find value in this trend detection when it comes to health monitoring, signs of overtraining, disrupted sleep or even early detection of illness (more on this later, but for me it's been pretty spot on).

I’ve also begun using this technology clinically for select patients in my practice which has been showing some meaningful change. I'm findings that it's really helping people recognize the relationship between what we eat, how we think and how we recover and how this all impacts performance. But is it time that we use these technologies more broadly in healthcare?

Wearables in Healthcare: Evidence and Applications for Cardiovascular Health

The most compelling evidence for medical use of wearables lies in cardiovascular health. Several studies have shown that wearable devices can detect irregular heart rhythms suggestive of atrial fibrillation, often before patients present with symptoms, and there have been publications analyzing the pros and cons of potential integration into healthcare. Although such alerts are not diagnostic on their own, they can act as gateways to formal clinical evaluation. Additionally, moderate-to-vigorous physical activity, as detected by an activity tracker has been shown to reduce the risk of aortic valve stenosis. Not that the activity tracker did the work here, but if patient compliance to exercise is increased by the feedback of a wearable, there's something important we must consider here.

Beyond arrhythmia detection, ongoing research is investigating how wearables might assist in monitoring patients with hypertension, heart failure, or post-operative recovery. As per Hughes et al. (2023): “[the use of wearables has the] potential to broadly impact cardiovascular medicine through lifestyle modifications for primary prevention, arrhythmia screening of at-risk individuals, and remote management of patients with established heart failure (HF) or peripheral artery disease (PAD), among other chronic cardiovascular conditions.” Unfortunately, the clinical use of wearables seems to be constrained by concerns about data privacy, lack of dedicated clinical teams to extract and monitor data, device measurement accuracy, and the lack regulatory and reimbursement policies.

Wearables in Healthcare: COVID-19 and Illness Detection

Now, perhaps the most headline-grabbing application came during the COVID-19 pandemic, when studies and reviews began to demonstrate that devices like the Oura Ring and Whoop band may detect subtle changes in body temperature, resting heart rate, respiratory rate, and HRV up to two days before a positive test or the onset of symptoms. These findings suggested that wearable devices may act as early warning systems for viral infections which in 2020 was obviously top of mind.

Shortly after some of these preliminary studies, the NBA actually partnered with Oura as their season resumed in the “bubble” to monitor the health of players and coaching staff. This was one of the first major partnerships that brought wearables to the forefront as a paired medical and performance device during the pandemic.

Wearable in Healthcare: Other Applications

Post-surgical monitoring is another emerging area. A recent 2025 study used Fitbits to track children recovering from appendectomies. By analyzing activity, sleep, and heart rate data, researchers developed a machine learning model that detected complications with 91% sensitivity and 74% specificity, identifying all cases that required hospital readmission post-surgery. While still preliminary, such studies highlight how passive, continuous data collection might one day complement or even replace episodic follow-ups in outpatient care, potentially reducing the load on global healthcare systems.

The Behavioural Power of Wearables

While the medical applications are compelling and exciting, the primary benefit that I see in wearables today lies in their ability to influence behaviour change. Simply putting on a device creates a heightened awareness of one’s own actions. Daily step counts, sleep scores, or recovery indexes may not always be perfectly accurate, but they provide tangible feedback that can nudge users toward healthier habits based on a motivational-reward feedback loop. Pair this with someone who understands the nuance and limitations of the data that is being spit out at them, and I honestly don’t see much of a downfall.

Behavioural science suggests that accountability is a key driver of sustained lifestyle change, and the data-driven insights help provide grounds for this. A wearable that displays a nightly sleep score or a weekly HRV trend acts as both coach and reflection of your health habits, reminding the wearer of the potential impact of late nights, alcohol consumption, or high levels of stress. For my patients, this can translate into better adherence to exercise prescriptions, nutritional strategies, sleep hygiene and recovery protocols.

And the literature supports the benefits of reaching those daily goals. A large study using UK Biobank data of over 93,000 fitness tracker users demonstrated that those who consistently met recommended physical activity targets had significantly lower risks of atrial fibrillation and stroke over five years. Simply put, having a target goal (whatever that is) and having real-time feedback may help hold you accountable and keep motivation high as you begin to change your behaviours.

Limitations and Cautions

Despite their obvious promise, wearables should not yet be considered medical devices in most circumstances, and should be considered an adjunct to typical means of health monitoring. Heart rate variability (HRV) measurement for example, while widely used as a marker of autonomic nervous system function, is highly sensitive to artifacts, device placement and fitting, and even software algorithms used to calculate it. Within HRV, there are both frequency and time domains of measurement and over-the-counter consumer wearables typically simplify the measurement to one metric: the root mean squared of successive differences (RMSSD) between heart beats. Although valuable to monitor for trends of autonomic nervous system status and recovery, this does not paint a complete picture of the complexity of HRV measurement when comparing to the medical gold-standard of a 12-lead ECG. I provide an extensive description of HRV measurement for autonomic nervous system monitoring here, in my published systematic review on sport-related concussion.

Similarly, sleep staging algorithms vary across devices, and while useful for detecting general patterns, they lack the diagnostic fidelity of gold-standard polysomnography (PSG).

Regulatory approval is another hurdle. This creates a grey zone where consumers may over-interpret results or clinicians may face uncertainty about how to act on the data. Integration with healthcare systems remains patchy at best, and without standardized thresholds or validated clinical algorithms that we can all reference, continuous streams of wearable data can overwhelm rather than assist practitioners. This is where the integration of AI assistants and machine learning within healthcare operations may be beneficial.  

Lastly, there are also broader issues of equity and ethics. Access to premium wearables is often limited to more affluent populations, raising questions about further amplifying existing health disparities between different socioeconomic groups. Moreover, as data becomes more granular, concerns around privacy, security, and ownership of health information must be addressed.

The Road Ahead

Looking forward, the future of wearables in healthcare appears bright but complicated. I already see them as an asset to individuals who are generally healthy and looking to optimize performance through actionable data-driven insights to drive behaviour change to improve their health. But I think the jury is still out with respect to where consumer wearables fit when it comes to full implementation into our healthcare systems.

Advances in sensor technology, AI-driven analytics, and integration with electronic health records will likely improve accuracy and usability while reducing cognitive and time burdens for providers. Before we can do this, however, we need to more rigorous validation studies while also trying to figure out an efficient way to implement wearables within the existing healthcare frameworks. This may be the biggest challenge.

Conclusion

Wearable technology is reshaping how we think about health, performance, and disease prevention. From detecting early signs of disease or illness to optimizing sleep and recovery to improve daily performance, these devices are beginning to move from the consumer fitness market into mainstream healthcare. While their measurements are not always perfectly aligned with gold-standard methods, their ability to track trends, foster accountability, and encourage behaviour change is undeniable.

I am admittedly a long-time Oura Ring user, and continue to find personal benefit in it. I also have begun to use them with a select number of patients/clients, however this selection process is highly nuanced and based on accessibility, goals, and psychological readiness.

For other clinicians working in multidisciplinary settings, wearables offer a new dimension of patient engagement—allowing us to integrate objective, continuous data into personalized care. For consumers and aspiring high-performers, they provide a window into the effects of lifestyle on health and recovery. The challenge ahead lies in harnessing their strengths while acknowledging their limitations, ensuring that as the technology evolves, it remains both evidence-based and accessible. If this can be done, there's no question that wearables will play a big role in our future healthcare ecosystem, bridging the gap between prevention, performance and personalized medicine.

Yours in good health,

Andrew

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