Cardiac care to go

Wearables in cardiology: from activity monitoring to research support

Activity monitors on phones and bracelets are helping assess exercise performance but experts say it remains unclear which are most suitable for research or best at motivating cardiovascular patients to keep active. The ESC Preventive Cardiology 2021 online congress heard that devices can also vary in their accuracy and usefulness for different activities.

The session, “Activity-monitoring devices: what to use in research and patient care”, discussed technologies available for use in cardiovascular patients, with speakers examining which devices are most appropriate for research. They also looked at the suitability of the devices in different areas of application, as well as comparing performance of commercially-available products.

portrait of leonie Klompstra
Dr Leonie Klompstra
Source: Linköping University

Dr Leonie Klompstra from the Faculty of Health Sciences in the Department of Social & Welfare Studies at Linköping University, Norrköping, Sweden, spoke about “Which type of activity-monitoring device to use in heart failure patients?”, with a particular emphasis on heart failure. She said some measures of physical activity such a diaries and questionnaires are easy to use and cost-effective but rely on patient participation and honesty in readings, while other approaches such as heart rate telemetry, pedometers and activity monitors can record energy expenditure with low patient participation burden, but also have limitations.

Heart rate telemetry is restricted to aerobic activities and influenced by factors such as age, stress and disease, while a pedometer is easy to administer and inexpensive but only assesses walking.

There are three types of activity monitors – uniaxial, which measure acceleration in one plan; biaxial and triaxial, which measure acceleration in two or three planes; and multisensory activity monitors, which measure acceleration in three plans together, plus heart rate. Activity monitors can be validated by field validation, which is preferred for research purposes, or laboratory validation, but while they are small, lightweight, non-invasive and record in real time, they are expensive and are not accurate for all activities.

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Choosing the right tool for the task

Dr Klompstra said: “When choosing an activity monitor for research, it is important is to decide on the aim; whether to motivate a patient or to measure physical activity over time.” Factors to consider include data storage and data access, and the length of time of activity, which she suggests should be a minimum of 540 minutes a day, and for a whole week for patients with heart failure. She warned that devices designed for commercial usage may store patient data in a cloud, which could pose ethical issues. Cost is also a factor as devices can range from 60 to 2200 euros.

Current consumer grade devices are reasonably accurate for heart rate, steps and sleep, however for other measures such as moderate to vigorous activity, they are not so accurate yet

Khung Keong Yeo

Dr Khung Keong Yeo from the National Heart Centre, Singapore, discussed which consumer-grade wearable fitness tracking devices to integrate into clinical research, with devices on the market now able to measure heart rate stats, sleep, oxygen saturation, and ECG. He said: “When we consider which consumer grade wearables we use for clinical research, important considerations are what we might measure, device accuracy, battery life, whether software upgrades are available, whether the researchers have access to raw data, what is sample size and purpose of the study, the cost of each device and, user accessibility.” Comparing device performance of consumer wearables in individuals and accuracy of commercially-available heart rate monitors in athletes, he said there are areas where consumer wearables are not as accurate as research-grade devices.

In summary, Dr Yeo said: “Current consumer grade devices are reasonably accurate for heart rate, steps and sleep, however for other measures such as moderate to vigorous activity, they are not so accurate yet. The key question is what type of research to use it for and if we know what the accuracies and corelations are, we might be able to choose the right and appropriate research to deploy these devices.”

During the session, Dr Tomas Vetrovsky from the Faculty of Physical Education and Sport at Charles University of looked at which technologies might best motivate patients to be active, while Dr Martijn Scherrenberg from Hasselt University in Belgium explored the challenges of using exercise apps in older adults. (MN)


Dr Leonie Klompstra is a Principal Research Engineer in the Faculty of Health Sciences in the Department of Social & Welfare Studies at Linköping University, Norrköping, Sweden, with a research interest in enhancing the self-care of heart failure patients through new technologies.


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