​OSU Ross ​Center for Brain Health and Performance

The Social Brain

Beyond 10,000 Steps: The Future of Wearables

Human performance expert discusses wearables and emerging ethical issues.

Posted Jun 04, 2019

Many of us, even those who aren’t professional athletes or trained commandos, walk around with some sort of wearable technology, from the Apple Watch to the Fitbit, that measures everything from our heart rate to our steps to how we sleep. But the world of wearables is much vaster, and the future of the technologies involved much brighter. The Social Brain Blog interviewed James Onate, Ph.D., a researcher at The Ohio State University who discusses how wearables are being used and the emerging ethical dilemmas.  

A panel on the ethics of wearables, “Whose Data is It?” will be featured at the upcoming Fourth Annual Brain Health and Performance Summit, presented by the Ohio State University Wexner Medical Center Neurological Institute and the Stanley D. and Joan H. Ross Center for Brain Health and Performance.

Pixabay, used with permission.
Wearables and Ethics
Source: Pixabay, used with permission.

Social Brain Blog (SBB): What kinds of information are we able to collect through wearables today?

James Onate (JO): Pretty much everything that you could collect with any other type of system: heart rate, sweat, a variety of different levels of exertive movements — pretty much anything that you can think of you can track with a wearable sensor. The issue becomes accuracy because there is a decrease in accuracy for a wearable as compared to some other kinds of external monitoring systems.

SBB: What kinds of wearable sensors/monitoring devices are currently being used and who's using them?

JO: There's a variety. Let's think about the most basic use, which is an effort or exertion type of wearable — essentially a heartbeat monitor. Many types of athletes employ these. Cyclists and runners have been using those for years. Soccer and rugby are big into wearables, trying to look at how to keep their individuals in peak performance, but also tracking them during the live events and seeing what's happening to their system: Are they ready to meet the demands that they have going on? The military has been in that world for a while and you can see this in the regular population too. There's a variety of people who have a Fitbit, but that’s just a brand name, there are thousands of other sensors that do very similar things.

SBB: Why are these important for improving performance?

JO: They provide feedback. They provide information. For some individuals we’re talking about milliseconds differences in performance. You could look at the Boston marathon—a 26-plus mile race that can come down to the last few steps, a two-second difference. So people are trying to gain an edge in any way they can and wearables are part of that; it's actually the everyday norm for most individuals. The other part is, I think we're fascinated with measuring things. If you think about our cars, we've been measuring them for years — how far we've gone, what our fuel rate is, etc. We buy cars based on miles-per-gallon on the highway and the city and other metrics. Well, that's just now transferred over to the human.

SBB: How is all of this information changing sports, the military, and everyday life?

JO: It makes things more interactive in sports. From a fan perspective, the thought is that you measure your performance against others. For example, you could compare your 40-yard dash time to the most recent NFL combine numbers. You could also see if, for example, the top running back on your football team is fatigued, etc. From a military standpoint it's about optimizing sustained performance, not only in the short term but throughout the years and for a whole lifetime. Now, as far as the regular public, we’re trying to think about how wearables are going to change the landscape of healthcare and how they already are. We’re now able to provide external pieces that can measure something and be able to keep a medical team in the loop. We could measure blood pressure, heart rate, etc. Right now diabetics can get an evaluation of their blood glucose by simply wearing an external piece. This is information that can be instantaneously shared with a healthcare provider. This is similar to fashion and retail in the sense that we no longer go to the big box store or the mall to do all our shopping, we go online. In the same way, with wearables we're going to be having our systems’ information being fed back to the healthcare system and then, based on those pieces of information, it can be determined whether you need to go to see a provider at a central location or not. I think we're going to see that kind of thing, and the cultural change has already started. But we're going to see that culture change going to lead to a shift from enormous medical treatment environments to smaller, sleeker, local facilities.

SBB: Who owns and controls this data that is coming out of these performance devices? Is it the people who are wearing it? Is there potential for abuse? Are there different concerns for professional athletes? Weekend warriors? Parents with kids?

JO: A great article that came out last called “The legal and ethical implications of athletes’ biometric data collection in professional sport.” So we have to think about the different categories of sport. If your job is to be an astronaut you’re relegating yourself to being monitored on a regular basis; that's mission critical. If you're a professional athlete your job is to perform on the field, meaning that we have to monitor and evaluate the system, but who owns the data is a very tricky question. There are different perspectives. Does the fact that you agreed to wear that monitor or device mean that it’s the club/employer’s data and they can track you and monitor you during whatever event, game, practice, so on and so forth? That's a really key question that a variety of people are trying to look at from a legal and ethical standpoint. I don't think we have the exact answers yet. I do think one of the big things is when you start monetizing off of that data, when people want to be able to buy the information or subscribe for extra information from an athlete, and be able to look at their physical performance stats, then it raises the question of whose data is it from a financial standpoint. There are a lot of things to look at. You also have the question of, is this health information or is this performance information? Is heart rate a performance measure or a medical measure? These are questions that the NCAA and various professional sports teams are looking at. And it's not just teams—it’s leagues like the Premier League, MLB, the NBA, NFL, and I could keep going down the line. And it's not an easy answer.

SBB: Are there any protections in place right now?

JO: There are in some areas. From a collegiate standpoint or from a school/scholastic standpoint you have your FERPA aspects. That's the federal education piece. You also have HIPAA (The Health Insurance Portability and Accountability Act), which regulates health information protection and provides accountability, which applies across all medical fields. But does this count as medical? Also, a lot of player collective bargaining agreements are addressing these issues right now. And it's a constantly changing world because wearables are constantly changing. The market is getting flooded with a variety of different things—some good that can really help the system, and some that really are not very good.

SBB: Is this performance data coming into the workplace? What prevents a company from monitoring everything about the performance of its workers through wearables?

JO: It is coming into the workplace. Labor unions are going to become involved in those things, but it already is in the workplace. There's a variety of different things that happen where you could capture statistics in the workplace. For wellness programs, prevention is a big concept. So we want to try to prevent any onsets of disease. Let's take diabetes as an example. If we could prevent the onset of diabetes we would have a tremendous amount of financial gain for a variety of different individuals. Let's take somebody who's potentially at risk in a workplace and let's track them with a step counter. So we give them a step counter and we say, "We want you to do that general notion of 10,000 steps.” Well, that's biometric data. That's providing information on how much you're moving on a regular basis. Is that something that’s allowable? Is that something that's encouraged? Is that something that's crossing the line? Those are all questions that are out there right now and people are utilizing those things in the workplace now. So how much do we go on to utilizing information that's tracking your heart rate? That's tracking your sweat? That's tracking your cortisol levels? That's tracking your blood pressure? And so on and so forth, and now start creating these types of environments where the employer is from a financial standpoint making its employees wear are these devices and tracking where they are. Those are interesting debates right now and we look forward to continuing to try to solve these pieces because we're trying to use the tech in a positive manner, but it can have a big brother kind of look and feel to it. There is definitely potential for abuse, but that will be judged differently depending on the eyes of the employer and the employee.

SBB: It sounds like as the technology gets better, as these wearable devices proliferate, become more comfortable, can measure more things etc., it presents greater and greater ethical dilemmas. When and how do you anticipate that these dilemmas are going to be settled, and where are they going to be settled?

JO: I think the dilemmas are going to be settled in the legal battles looking at the interplay between individuals’ rights and the interests of team and business structures under the guidance of these privacy acts. I think professional sports understands that they have a little bit more to look at under the hood. I think theirs is going to be largely a financial side, but I think the employer workspace is going to be an entirely different thing more focused on the implications of prevention and cost savings. And then I think the one that's really interesting is the NCAA and the collegiate sports world where you have to consider whether the student-athlete constitutes an employee-employer relationship. Currently, this is not the case. Student-athletes are not allowed to unionize. A similar debate can be had down to the high school setting and so on and so forth. The high school setting right now does not have a major implication of wearables. Most high schoolers are not allowed to use wearables except for safety purposes. Things like a diabetic monitoring system have a safety purpose so those are a different story. So most of the time the National Federation of High School Athletic Associations (NFHS) rules that that is a safety concern. But that discussion has changed over the years. I think that wearables are going to continually be at the forefront of discussions and I think it's really going to be very interesting at each level.

SBB: What do you see 10 years down the road?

JO: I see implantable wearables. I think individuals will have implantables or tattoo type of pieces— things that are very simple and are not obtrusive anymore. I think the whole world of tissue bioengineering is going to see changes. We already can introduce a pacemaker for years to electrically stimulate the heart. Why couldn't we also insert some things that are able to track and monitor different metrics? I think the other part is going to be that it's going to become an everyday system. People are going to get used to monitoring their weight, their blood pressure—all their levels—on a regular basis. And we're going to be able to have those pieces of information sent to their medical healthcare system and create different types of red flags systems that can alert individuals when it's time to really be concerned. So I think the future is going to change the whole hospital-based and healthcare system and really flip it on its head. We’re really going to have to consider a combination of the sociological and ethical ramifications. We’re also going to have to employ computer science, artificial intelligence, machine learning information, and we’re going to have to change how we train physicians and clinicians in healthcare. We have already seen some of this. Maybe it's not 10 years, but I definitely think down the road we will have clothes with completely different monitoring systems with which we'll be able to check on individuals on a regular basis as a part of everyday life. When I was going to graduate school in the nineties I did not think that one day I'd be connected to a computer on my phone and walk around with it all day long.

SBB: So it's a race for the ethical side to keep up with the technology, which is moving very, very quickly.

JO: Yeah. The technology is moving at a much faster pace than the ethical side—its considerations and the legal considerations—and I think that's a space that's going to need filling. This will require a lot of very interesting conversations about employee-employer relationships and financial gain from information. It’s also important to consider what the accuracy of these pieces of information is, and how can they provide benefits, while also understanding the risks.

SBB: It sounds like what started out focused on the elite, whether it's professional athletes or the military, is now something that is affecting everybody.

JO: One-hundred percent. We can look to the automotive industry for a lot of things that are comparable to wearables in the sense that you're able to take a tremendous amount of information about things like car engines and tires from eye-level auto racing teams. They provide a lot of information and a lot of technology that then trickles its way “down," or, more accurately, it moves into different levels and layers. So you'd take information from professional athletes and that trickles down to the collegiate athlete, and then to the high school athlete before youth sports. Subsequently and simultaneously this information makes its way to the public. We see this in rockets and planes where information trickles its way down into tech for the planes that we fly on a weekly basis. I see wearables as being exactly the same.

James Onate is Associate Professor in the College of Medicine School of Health and Rehabilitation Sciences at The Ohio State University, Director of the Human Performance Collaborative, Director of the MOvES Research Lab, Co-Director of OSU Sports Medicine's Movement Analysis & Performance (MAP) research program, a Research Consultant to Naval Special Warfare groups, and Director of Sports Performance at Bo Jackson Elite Sports.