The Role of Wearables in Unlocking a 24-Hour Activity Cycle for Seniors

A good amount of activity can help keep seniors healthy and fit, but many are worried they are not meeting activity guidelines. With wearables becoming more popular each day, however, creating a better picture of wellness for those in their golden years could be easier than ever.

In April of 2016, the Stanford Center on Longevity hosted a workshop sponsored by CDW titled “Wearable Devices & the 24-hour Activity Cycle: A Framework for Developing Daily Activity Recommendations” that brought together top researchers and leaders from academia and industry to examine a new hypothesis; namely that health recommendations would be more effective if they could include all health-related activity domains (exercise, sleep, sedentary behavior, and light activity) experienced in a daily cycle. This is a shift in paradigm from traditional recommendations, which have been created separately by individual medical research fields.

What researchers uncovered is the 24 Hour Activity Cycle (24HAC), which calls on wearable data to create comprehensive recommendations for how people, especially seniors, should structure physical activity and sleep that are aligned with how they actually spend their day and that incorporate how one activity affects another.

Wearables Make Daily Wellness Possible

Reasonably priced consumer wearable devices that can accurately measure activity hold the promise of “unlocking” the 24 HAC as a useful tool for helping individuals structure their day to promote better wellness.

This is especially true for devices that can both measure movement through the use of accelerometers and monitor heart rate as a way of gauging the intensity of activities at a personal level. A recent study attempting to record individuals’ time spent in exercise, sleep, and sedentary behavior using self- reported time illustrated why objective measurement so critical.

In the study, each individual was asked to estimate the time spent in each domain. When added together, the total significantly exceeded 24 hours per day. Given this tendency to misreport how we spend our time, it becomes clear that it is nearly impossible to develop accurate interventions without objective data.

New wearables are being developed rapidly. This wearables database website works to catalog this development and currently lists over 420 available devices. A number of these can already measure physical activity, sleep, and even provide useable indicators of sedentary behavior. More devices with these capabilities are in development and companies are looking to add measurement of biomarkers such as glucose level, blood pressure, and lactose that “report” on the status of the body as well as including additional sensors that can measure things like light, sound, and location in ways that provide more context for the activity.

The integration of these wearables with previously established health recommendations is a challenge, however, as technology development and medical research often do not intersect.

The highly competitive and proprietary nature of the wearables business has slowed progress in developing validated 24 HAC data. Most consumer devices only output activity readings after applying proprietary algorithms, resulting in appealing user interfaces, but making it difficult for researchers to evaluate the quality of measurements or to compare data from different devices. Research devices have better validation and transparency into the signal processing algorithms, but are often expensive and more cumbersome for the user. At the time of this writing, there is no accepted “standard” device that researchers can use to conduct studies and compare results.

The creation of 24HAC recommendations is stalled largely because of these challenges.

Wearables Deliver Value Now and Offer Future Potential

Even with current issues, it is possible to start developing 24 HAC cycle-based interventions. Wearables have reached a stage where they can reliably create 24-hour “clocks” for individuals. Though it is difficult to measure objective data quality, readings from a single device for a single individual can be used to spot trends and measure adherence to recommendations. For example, an individual could wear a device for a month-long “baseline” period and establish a pattern of activity. These patterns could be monitored on a week-to-week basis and trends could indicate potential problems or areas for improvement.

A normally active person becoming sedentary could alert a caretaker to investigate possible changes in health or socialization status. More proactively, a doctor or trainer could look at wearable data and make general recommendations such as “you are not sleeping well — add a20-minutee walk to your day” and check back to see if the person has improved behavior. Another potential benefit of the 24 HAC involves prescription medication. Knowing how activity and sleep patterns change as a result of new medications and dosage changes provides valuable and most importantly objective feedback on side effects such as drowsiness, lethargy, and dizziness (which may lead individuals to be more sedentary).

If the issue of data sharing and validity could be overcome, very large data sets could be created and machine learning algorithms applied to identify patterns in the data, linking them to health outcomes. This would begin a beneficial feedback loop in which interventions could be much more rapidly tested and evaluated. Of special value to older adults, these interventions could be tailored to individual health status and physical capability, meaning that we could advise individuals on the best level of activity for their particular situation.

While technology will likely never completely replace a human caretaker, these types of systems would also allow providers to leverage their caregiver resources better. With data in hand and advice from expert systems, caretakers could identify individuals who might need timely attention while simultaneously keeping tabs on a larger group of customers. Such feedback also serves as a guide to motivated seniors who do not understand how their activity patterns are affecting their quality of life.

Learn more about how large amounts of health data from wearables are unlocking the potential of the 24-hour activity cycle in the free white paper "Keeping Seniors Active: A 24 Hour Approach."