Tag: wearables

Wearable technology in the management of complex chronic illness: preliminary survey results on self-reported outcomes

Abstract:

Introduction: Complex chronic illnesses like Long Covid (LC) and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) are marked by fluctuating symptoms, often exacerbated by physical, cognitive, or emotional exertion in a phenomenon known as post-exertional malaise (PEM). Home monitoring technologies offer potential benefits by enabling individuals to track symptoms and biometrics, aiding in disease self-management. However, the general effectiveness of such tools is still unknown.

Methods: A random sample of users of the Visible mobile application (Visible Plus; requires both the armband and paid subscription), aged 18 or older and with self-identified complex chronic illnesses such as LC or ME/CFS, were invited to complete an online survey regarding the impact of the app on their chronic disease self-management. Descriptive statistics related to the responses were analyzed and reported.

Results: The survey was distributed to 2,636 people, with 1,301 participants responding (49.3% response rate). The average age was 46 years. 82% of respondents were female, 8% were male, 8% were non-binary, and 2% preferred not to say or preferred to self-describe. Participants self-identified as having ME/CFS only (n = 534, 42%), LC only (n = 396, 31%), ME/CFS and LC (n = 236, 18%), or another illness (n = 122, 10%). Of the n = 2,636 randomly selected subscribers, the mostly commonly listed “other illnesses” were Postural Orthostatic Tachycardia Syndrome (POTS, 6%), fibromyalgia (5.2%), Ehlers Danlos Syndrome (EDS; 1.7%) and Mast Cell Activation Syndrome (MCAS, 1.2%). Of those with at least 30 days of data, 77% reported seeing an improvements associated with app use, corresponding to 23% of all invited users, 85% (corresponding to 29% of all invited users) reported feeling somewhat (53%) or significantly (32%), and 94% (corresponding to 33% of all invited users) reported a better understanding of their energy budget.

Discussion: Home-monitoring based mobile applications are feasible and acceptable for a motivated subgroup of people with energy-limiting complex chronic illnesses, and are associated with self-reported benefits in energy management and participation in daily activities. The findings of this study should be interpreted as descriptive and hypothesis-generating and do not represent clinically significant effects, underscoring the need for randomized controlled trials to formally evaluate efficacy. Future studies should incorporate a comparison group to better differentiate intervention effects from improvements gained through lived experience.

Source: Sawyer Abbey , Preston Rory , Leeming Harry , Martin-Fuller Luke , Proal Amy , Putrino David. Wearable technology in the management of complex chronic illness: preliminary survey results on self-reported outcomes. Frontiers in Digital Health, Volume 7 – 2025. DOI=10.3389/fdgth.2025.1662255. ISSN=2673-253X https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2025.1662255/full (Full text)

Wearable heart rate variability monitoring identifies autonomic dysfunction and thresholds for post-exertional malaise in Long COVID

Abstract:

Objectives Patients with Long COVID experience disabling fatigue, autonomic dysfunction, reduced exercise capacity, and post-exertional malaise (PEM). Heart rate variability (HRV) can evaluate autonomic function and monitor overexertion, potentially helping to mitigate PEM. This study aimed to use continuous multi-day HRV recordings to monitor overexertion and study autonomic function in Long COVID.

Method Heart rate and HRV were continuously measured in 127 patients with long COVID (43±11 years, 32% male) and 21 healthy controls (42±13 years, 48% male), and daily life activities tracked in a logbook. Participants underwent a (sub)maximal cardiopulmonary exercise test to determine heart rate at the first ventilatory threshold (VT1) to study HRV responses to exercise at different intensities.

Results HRV was lower in patients with long COVID compared to healthy controls during various daily activities and sleep (p<0.027). HRV remained lower for 24 hours after exercise below, at or above VT1 in patients, but not in healthy controls (p=0.010). Nighttime HRV decreased with intense exercise and longer durations in patients with long COVID (p=0.018), indicative of exercise-induced diurnal disturbances of the autonomic nervous system in long COVID.

Conclusion Heart rate variability, assessed by wearables, confirms autonomic dysfunction in patients with long COVID. The delayed recovery of the sympathovagal balance after exercise close and above to VT1 suggests that VT1 can be practically interpreted as a PEM threshold.

Application These results confirm the applicability of wearables to assess autonomic function and manage overexertion in long COVID patients.

What is already known on this topic Patients with long COVID often experience fatigue, autonomic dysfunction, and post-exertional malaise (PEM). HRV can be used as a non-invasive tool to measure autonomic function and recovery. Anecdotal evidence suggests lower HRV in patients with long COVID, but measurements are usually very short.

What this study adds This study demonstrates that continuous HRV monitoring through wearables can effectively identify overexertion and autonomic dysfunction during daily activities in patients with long COVID. Patients with long COVID have a lower heart rate variability during sleep and HRV remained significantly lower for a longer period after moderate-to-heavy exercise, that is generally associated with the induction of post-exertional malaise.

How this study might affect research, practice, or policy This study supports the use of wearables for assessing autonomic function and overexertion in daily life, helping patients with long COVID in pacing daily activities to mitigate symptoms of post-exertional malaise. HRV tracking after exercise shows that VT1 is a potential threshold for PEM. Sports physicians and physiotherapists can incorporate HRV biofeedback measures into pacing advice to patients. Additional research is needed to further investigate the effect of such an intervention.

Source: Twan Ruijgt, Anouk Slaghekke, Anneke Ellens, Kasper W. Janssen, Rob C.I. Wüst.. Wearable heart rate variability monitoring identifies autonomic dysfunction and thresholds for post-exertional malaise in Long COVID. medRxiv 2025.03.18.25320115; doi: https://doi.org/10.1101/2025.03.18.25320115 https://www.medrxiv.org/content/10.1101/2025.03.18.25320115v1.full-text (Full text)

‘A gift and a curse’: the benefits and limitations of self-tracking Long COVID

Abstract:

People living with Long COVID are dealing with significant challenges related to limited understanding of this novel condition, social stigma, and lack of support from medical professionals and others in their lives. This article discusses findings from a qualitative study about how people with Long COVID have spontaneously engaged in self-tracking for the purposes of understanding and managing their illness. It draws on 30 semi-structured interviews with study participants in the USA, UK, Australia, Germany, Denmark and Canada.

The study’s findings reveal that the personal health data generated by people with Long COVID through practices of self-tracking create new forms of knowledge about a novel post-viral condition and to some extent challenge the power differentials and fraught sociopolitical climate of the pandemic. The benefits provided by self-tracking data reflect the often psychologised and understudied position of post-viral conditions such as Long COVID.

All participants described self-tracking as a valuable tool to gain insight into symptoms and evaluate interventions. It provided them with a sense of empowerment, control, encouragement, and very importantly, validation. However, for some participants, self-tracking their Long COVID symptoms was also sometimes experienced as overwhelming, anxiety-inducing, and frustrating. The study findings are interpreted with references to the broader contexts of novel chronic illness, medical power, lay expertise, COVID politics and digitised information and care work.

Source: Jayadeva, S., & Lupton, D. (2025). ‘A gift and a curse’: the benefits and limitations of self-tracking Long COVID. Information, Communication & Society, 1–17. https://doi.org/10.1080/1369118X.2025.2483834 https://www.tandfonline.com/doi/full/10.1080/1369118X.2025.2483834 (Full text)

Wearable Devices Enable Long COVID Patients to Decrease Symptom Severity: A Case Series From Pilot User Testing

Abstract:

Purpose: Long COVID is a debilitating condition that is estimated to affect over 65M individuals across the world after a Coronavirus Disease 2019 (COVID-19) infection and has no broadly effective treatments. People with Long COVID have reported that pacing helps manage their symptoms, but it is difficult to implement. Based on experiences in the Long COVID community, we hypothesized that wearable devices can help individuals pace and reduce their Long COVID symptom severity.

Methods: To inform the design of a larger study, we performed user testing by distributing Garmin® devices, the study surveys and pacing educational materials to 11 individuals with Long COVID, and conducting interviews to learn about their experience.

Results: Eight of the 9 (89%) individuals reported that the information provided was helpful for their symptom management, and 2 testers did not complete the final survey. Four (44%) users had not used a wearable device before and none had trouble setting up their device. Due to the limited sample size and lack of control group, generalizability is unknown.

Conclusions: The most user testers reported that the study materials were helpful for their symptom management. These results are a promising indication of the potential for wearable devices and educational materials to help individuals with Long COVID, and potentially other chronic conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), decrease symptom severity.

Source: Goosen A, Foster-Bonds R, Vogel JM. Wearable Devices Enable Long COVID Patients to Decrease Symptom Severity: A Case Series From Pilot User Testing. Cardiopulm Phys Ther J. 2024 Dec 3;36(2):99-104. doi: 10.1097/CPT.0000000000000268. PMID: 40190996; PMCID: PMC11970588. https://pmc.ncbi.nlm.nih.gov/articles/PMC11970588/ (Full text)

Web-based telemedicine approach for treatment of post-COVID-19 in Thuringia (WATCH)

Abstract:

Objective: After infection with SARS-CoV-2, a substantial proportion of patients develop long-lasting sequelae. These sequelae include fatigue (potentially as severe as that seen in ME/CFS cases), cognitive dysfunction, and psychiatric symptoms. Because the pathophysiology of these sequelae remains unclear, existing therapeutic concepts address the symptoms through pacing strategies, cognitive training, and psychological therapy.

Methods: Here, we present a protocol for a digital multimodal structured intervention addressing common symptoms through three intervention modules: BRAIN, BODY, and SOUL. This intervention includes an assessment conducted via a mobile “post-COVID-19 bus” near the patient’s home, as well as the use of wearable devices and mobile applications to support pacing strategies and collection of data, including ecological momentary assessment.

Results: We will focus on physical component subscore of the SF36 as Quality of Life parameter as the primary outcome parameter for WATCH to take into account the holistic approach that is necessary for care of post-COVID patients.

Conclusion: In the current project, we present a protocol for a holistic and multimodal structured therapeutic concept which is easily accessible, and scalable for post-COVID patients.

Source: Reuken PA, Besteher B, Bleidorn J, Brockmann D, Finke K, Freytag A, Lehmann-Pohl K, Lemhöfer C, Mikolajczyk R, Puta C, Scherag A, Wiedermann M, Zippel-Schultz B, Stallmach A. Web-based telemedicine approach for treatment of post-COVID-19 in Thuringia (WATCH). Digit Health. 2024 Oct 14;10:20552076241291748. doi: 10.1177/20552076241291748. PMID: 39493638; PMCID: PMC11528766. https://pmc.ncbi.nlm.nih.gov/articles/PMC11528766/ (Full text)

An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome

Abstract:

Background: Myalgic encephalomyelitis (ME) is a complex, multi-system neurological condition. The defining feature of ME is post-exertional malaise (PEM) with over 30 symptoms triggered by physical, cognitive, emotional and social activity.

The cause of PEM is unclear but one area of research using cardio-pulmonary exercise tests show a reduced ventilatory anaerobic threshold (VAT) with repeated tests leading to PEM.

Pacing with heart rate monitoring (HRM) provides feedback to maintain activity intensity below the VAT. There is only one piece of research investigating the use of HRM although a number of guidelines recommend it.

Objective: To identify the experiences and attitudes of people with ME towards HRM.

Methods: A 40 question online survey was devised and released on ME websites, Twitter and Facebook pages. People with ME read the information sheet and followed an online link to the survey. The survey was open for three weeks and all answers were anonymous.

Results: 488 people with ME completed the survey. Most participants were female, 35-50 years and with a reported illness of greater than 5 years. Over 100 types of HR monitor used. Over 30 benefits and over 30 negatives identified. HRM reduced severity of ME and severity and duration of PEM.

Conclusion: Although there are limitations, HRM has many benefits including helping PwME to understand and manage their PEM and support them to increase their activities, including work. There is a need for more research and education of healthcare professionals in the safe use of HRM.

Source: Clague-Baker N, Davenport TE, Madi M, Dickinson K, Leslie K, Bull M, Hilliard N. An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome. Work. 2023 Mar 13. doi: 10.3233/WOR-220512. Epub ahead of print. PMID: 36938766. https://content.iospress.com/articles/work/wor220512 (Full text)

Compliance challenges in a longitudinal COVID-19 cohort using wearables for continuous monitoring

Abstract:

Background: Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19 (WEAICOR) study is a prospective observational study using continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results.

Objective: The aim of this study is to evaluate patients’ compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort.

Methods: Biostrap wearable device was used to monitor participants’ biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days in the study. Univariate correlation was performed between compliance, days in the study and age, BMI, sex, symptom severity, and number of complications/comorbidites as independent variables. Also, multivariate linear regression was then performed with days in the study as a dependent variable to assess the power of different parameters in determining days in the study.

Results: On hundred twenty-two patients were included in the study. Patients were on average 43 years old and 32% were female. Age was found to be correlated with compliance (r=0.23, P=0.01). In addition, age (r=0.30, P=0.001), BMI (r=0.19, P=0.03) and severity of symptoms (r=0.19, P=0.03) were found to be correlated with days spent in the study. On multivariate analysis with days spent in the study as a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2 = 0.1, β = 1.6, P= 0.01).

Conclusions: Compliance is a major obstacle in remote monitoring studies and the reasons for a lack thereof are multifactorial. Patient factors such as age, in addition to environmental factors can affect compliance to wearables.

Source: Mekhael M, Ho C, Noujaim C, Assaf A, Younes H, El Hajjar AH, Chaudhry HA, Lanier B, Chouman N, Makan N, Shan B, Zhang Y, Dagher L, Kreidieh O, Marrouche N, Donnellan E. Compliance challenges in a longitudinal COVID-19 cohort using wearables for continuous monitoring. J Med Internet Res. 2023 Jan 6. doi: 10.2196/43134. Epub ahead of print. PMID: 36763647. https://preprints.jmir.org/preprint/43134/accepted (Full text available as PDF file)