The Antisocial Doctors Podcast

Episode 15: Do Fitness Tracking Watches & Rings Actually Make Us Healthier?

• Sonia Singh

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0:00 | 58:15

In this episode, we explore the hype and reality behind wearables like Oura Rings, Apple Watches, Fitbits, and other fitness trackers, using real patient stories to frame the conversation. We share what the data can and can’t tell you, how accuracy varies across metrics, and why “more data” doesn’t always mean better health outcomes. We also discuss why these devices are so popular, the motivations and fears they tap into, and the potential downsides—like anxiety, perfectionism, and increased healthcare utilization. We close with how we think about these tools in clinic and how to decide whether a wearable is truly helping you.

00:00 Podcast mission

01:25 Patient stories

03:05 Wearables big claims

05:35 Why wearables took off

11:04 Nugget of truth

13:54 Accuracy and impact

14:58 Step counting science

18:24 Apple Heart Study

23:08 Heart rate variability

27:19 HRV Norms Myth

27:34 Wearables and Heart Health

30:34 Sleep Tracking Accuracy

32:30 Sleep Apnea Screening

34:40 Patient Case Sleep Apnea

37:21 Psychological Harms

40:04 Data Overload and OCD

43:27 Healthcare Utilization Risks

46:38 Trusting Symptoms Over Data

51:24 Costs and Hidden Tradeoffs

52:41 Talking to Patients

55:50 Wrap Up and Disclaimer

📖 Read the full episode summary, sources, and resources on our Substack:
 👉www.theantisocialdoctors.com

Sonia Singh MD

You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety

Rebecca Berens MD

and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.

Sonia Singh MD

We're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.

Rebecca Berens MD

This podcast is meant to be the antidote to your doom. Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion. That comes from social media's messaging around health. In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.

Sonia Singh MD

This is not your average debunking podcast. We wanna explore not just what is trending on social media, but why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.

Rebecca Berens MD

We're so glad you're here.

Sonia Singh MD

Hey, Rebecca.

Rebecca Berens MD

Hey, Sonya.

Sonia Singh MD

How's your day going?

Rebecca Berens MD

It's going,

Sonia Singh MD

that's us every week basically. Every

Rebecca Berens MD

week, yes.

Sonia Singh MD

I'm really eager to hear about this week's topic 'cause I have never looked into the data on this and I actually have had several patients ask me about it and I've just been assuming things about these. So I'm excited to actually know the facts and the science. So tell us about the patient story that inspired this episode.

Rebecca Berens MD

Yeah, so I'm gonna give you two because there's two there's two ways that I've seen this go. And so I'm gonna give you two stories and then we'll loop back to them at the end. Okay. Okay. So the first one, it was a patient who sent me aura ring data on their sleep. And they said Hey, my aura ring's been measuring significantly less deep sleep in the last few weeks, and I've been feeling less rested during the day. What does that mean? So we'll come back to that at the end. Okay. And then another patient who called me about 10 days after, they'd had a upper respiratory infection, had gotten a little bit better, and then about 10 days later they were getting worse again. And, having more coughing, blowing their nose, thick, green mucus coming up. And they were concerned they were getting a sinus infection because their aura ring was saying you have mild signs of stress after several days with no alerts. And at the beginning of the illness it said major signs of stress. It'd seen major signs of stress and then better, and then now mild signs of stress again. So these are some aura ring data that was sent to me for my patients that they felt was clinically relevant. And we can talk about how those played out at the end of this episode.

Sonia Singh MD

Yeah, I've had similar things happen to me in clinic where most of the time it's somebody's already in clinic because they're feeling sick and then they'll say, and also my AA ring told me that I'm stressed. So yes, I've definitely had similar experiences. So what do you think are the claims being made about AA rings or fitness trackers in general?

Rebecca Berens MD

Yeah in general, I think one of the biggest things is if we have enough data, we can use that data to optimize our health. And it's this whole obsession that we all have with optimizing, especially right now. In wellness culture optimize is a really commonly used word. And so the idea that the data doesn't lie, we can use this data to help us optimize our health. And the more that we track, we might be able to predict or catch a disease earlier and prevent it turning into something worse. I think there's also this move towards more personalized medicine. So not that one size fits all reactive sick care. That is the US healthcare system. Yes. But personalized, proactive precision medicine. Precision medicine based on my personal data.

Sonia Singh MD

Yes.

Rebecca Berens MD

And then I think the other piece to this is a moralization of health, which is these are all the things I have to do to be a good person. If I close all my rings, if I took 10,000 steps today, if I got x number of hours of sleep and, all these things, this is this means I did a good job. I got a, it's very cool. I got a gold star at the end of the day. Yeah. It came from my Apple watch because I closed all my rings, so that was, yeah.

Sonia Singh MD

And we are millennials that apparently need a trophy for everything. So maybe it feeds into our desire to get the sticker, the gold star or the good grade whatever.

Rebecca Berens MD

Yes. So a plus score at the end of the day for closing all your rings. So yeah, I think those are the claims that I see brought up in marketing and underlying a lot of the posts and ads for these devices. What are your thoughts about that?

Sonia Singh MD

Yeah, no, I've definitely heard the same. I feel like I've always been a data gal. So it's weird to me actually that I don't, I'm not that interested in these. I think if I was not a medical professional, I would be very interested in, in, in these. 'cause I just. I like tracking data. I just like seeing numbers. I guess that's why I am in a scientific field. It's I just, I like that concreteness of it. I like the elegance of seeing things change as you're, tinkering with different variables, so yeah. I can see why they would emphasize all of that in their marketing and why they would claim how can you make decisions or take actions or do interventions if you don't have this data?

Rebecca Berens MD

Yeah. And it's like giving that clarity and in the face of uncertainty. Here's some concrete information. This is facts, so you can rely on this. And you can make informed decisions based on this factual data, right?

Sonia Singh MD

Yes. Okay. So why do you think these are so popular? We talked about some of those right now, but at this moment, why do you think wearables have taken off?

Rebecca Berens MD

Yeah, I think obviously it's in this. Overlying narrative of wellness, culture and optimization that we've been talking about in pretty much every episode of this podcast. That is underlying a lot of these health tech developments. But then I think the virality comes from fomo. Someone gets one and then they're like, oh, my ring told me this about myself. And they're like, oh, I wonder what's going on with me. So it just like spreads really quickly. So it's something that I don't know about myself, maybe it could help me if I learned this about myself. And then I think it's also, as we've talked about before, a lot of this, fear of an unexpected health event. 'cause we are still all seeing the GoFundMe on social media, the horrible, disease that. Took out a celebrity or a young child or a or some person that's an influencer. And if only they had known earlier, they could have prevented it. And so maybe if I get some data about myself, I can prevent that happening to me. I think that also has fueled a lot of it.

Sonia Singh MD

Yeah, one thing that I have no studies or data to point to for this. This is just like a general feeling that I have is I think a lot of people are disconnected from their physical bodies or just don't for some reason we seem to be losing some sort of just connection and awareness about our physical beings in some way. Maybe because so much of our lives are digital and online and are not us moving our bodies through space and touching and feeling things. And I think there's some disconnection that's happening between mind and body and I think. These trackers the popularity of them is partially driven by people's deep desire to just understand what is happening in their bodies, and I think these very much give, to, I don't know, to me it's an illusion. I guess we'll find out if it's an illusion, but they give you the illusion that you are connected to your body and that you understand deeply what's going on with it. How my body is stressed. Like now my body is this, but I don't know. I get, I say it's an illusion 'cause I feel like every time a patient has been like, yeah I a or ring says I'm stressed, I'm like, yes. Like we both know that, I see it in your face,

Rebecca Berens MD

I so agree with you on that. And I actually think, I think part of the reason these have appeal is I think we are used to taking in information through notifications because we are so overwhelmed.

Sonia Singh MD

Yes. That's so

Rebecca Berens MD

with constant input.

Sonia Singh MD

Yes.

Rebecca Berens MD

There's so much stuff going on. It's so hard to keep track of everything. Life moves at a million miles a minute. There's just constant stuff. So it's like I need to be reminded of

Sonia Singh MD

Yeah,

Rebecca Berens MD

I need to go to the bathroom.

Sonia Singh MD

Your

Rebecca Berens MD

wife needs to tell

Sonia Singh MD

you that you are stressed right

Rebecca Berens MD

now, the number of people that I, we have to talk about setting alarms to eat meals. Setting alarms to go to the bathroom.

Sonia Singh MD

Yes.

Rebecca Berens MD

Setting alarms to drink water. We, we are so tied up in the constant input that we're getting that we need notifications. And so I think people want that data feedback of what's going on with me? 'cause I haven't felt anything in a while and we are disembodied in Yeah. In our culture. Because even even just think about like during the pandemic, that was literal disembodiment, all interaction was happening virtually. Yeah. There's no embodied interaction with other people. And so much of our lives has been moved virtually even post pandemic when we are reintegrated it. There's just a lot that happens virtually now. And it does really separate our brain life from our physical life. And I don't think we actually feel things anymore.

Sonia Singh MD

Yeah.

Rebecca Berens MD

And if we do feel them, we don't trust them. What does this mean? Is this true? Is this not true? Am I really feeling this? I don't know. I need some proof. Prove it to me, proof that I'm sick.

Sonia Singh MD

Yes. I think we can come back to that because I think there is an element of almost so there is that disembodiment that kind of disconnection from our physical bodies, but then I think there's also a lack of trust in ourselves and in our own knowing and in our own experience, so it's like there's times when somebody will be clearly totally stressed and overwhelmed and sleep deprived, and I'm like, yes, you do not feel well. Not slept more than four hours for three nights. And they're just like. Oh, I like it. It almost feels like they're not even allowing themselves to feel the feeling. And then even if they are feeling the feeling, they don't trust that they know why they're having that feeling. I don't know. There's just a lack of faith in our own, you, there's this desire to see everything as concrete data and objectify and objective. And not, not being able to trust your own experience of it, basically. Yeah, I don't know. I think there's some deeper roots here that, that are making these very popular.

Rebecca Berens MD

I think a lot of that comes from a societal shift that's happened too, because think of how many patients now who are grown adults who need a note to take a day off of work when they're sick. Yes,

Sonia Singh MD

that's true.

Rebecca Berens MD

Kids, like kids for school. It's if they're sick, when I was growing up, not that my parents ever kept me home when I was sick, but if they did I didn't need a note. They just were like, she's sick, she'll come back. And then I came back and it was fine. Now it's did they go to the doctor? What do they have When the can do, they come back we need a note, we need documents. And it's like that for adults too. Take a day off of work because you're sick. You need so many layers of bureaucracy to prove it, that a lot of people, a lot of my patients are just like, I'm just gonna go to work. It's not worth it.

Sonia Singh MD

Yeah.

Rebecca Berens MD

And I think that's, there, there's this cultural thing of we just keep going, hustle, culture, grind through it, it'll be fine. Yeah. And so people are ignoring a lot of these signs that they're feeling because it's I have to keep going. I have to keep going. Life keeps moving and I have to keep up.

Sonia Singh MD

Yeah. Yeah. I agree. Okay. So what do you think is the nugget of truth in some of those claims about fitness trackers and wearables?

Rebecca Berens MD

Yeah, so I think it's definitely true that there are several diseases that have symptoms that may go unnoticed or unrecognized, and earlier intervention is beneficial. Hypertension for example, there's been a really good public health campaign around hypertension as the silent killer. 'cause hypertension or high blood pressure often does not have symptoms until a later stage of disease, right? So people who have high blood pressure often don't feel necessarily anything different. Yeah. Or if they do feel anything, they attribute it to other things like, oh, I have a headache. It could be lots of things. They're not necessarily thinking it's their blood pressure. And so I think that there's been successful public health campaigns around the idea of screening in general and the fact that there are conditions that can be intervened on before there are symptoms. And so that is true. And I think, so people are looking for ways of what else can I screen for earlier? Because now I know we have all of this data of these other things that I can screen for I like cancer screenings, blood pressure screenings. Diabetes screening, how, what else could I screen for that I could catch earlier? And then I think the other piece is I think a skill that we are all taught as children and that we learn in school is you can't improve what you don't measure. So you have to, there is this idea of tracking is a helpful tool we can use to improve or like to make a habit stick or to improve a behavior that we wanna work on. There's good evidence for that. And also just practice of that in our lives. It's talked to us I think from childhood. And so I think that's that underlies the idea of tracking. But then I think there's also the truth that this can become unhelpful when it's taken to extremes.

Sonia Singh MD

Yeah. I guess examples that I'm thinking of are of like. Let's say you embark on a new fitness regimen, and a lot of times you may not see anything happen on the scale. You may feel a little bit better, but you may not really know if you're making any difference. And then, maybe you see on your wearable that your resting heart rate has gone down over a certain period of time and you might think, oh okay, that is something, and that might be motivating and encouraging for you to continue. I, I don't know if there's any research on this. My dad is a cardiologist and he's told me that a couple of times. He's had patients come in saying that their Apple watch told them that they had an abnormal heart rhythm and they actually did, and it was asymptomatic and so they wouldn't have known otherwise. And I, again, this is, I don't know if this is a slightly different category than just an aura ring or fitness tracker, but I've also heard of cases where somebody had a bike accident and their fitness tracker alerted, their emergency contact that, they seem to be in distress or something along those lines. And they know they were able to send help very quickly. I don't know. I can think of a few examples and even the case you presented at the top of the episode, where potentially, there can be some benefits or some positive outcomes from 'em.

Rebecca Berens MD

Yeah. Yeah. We will come to the Apple Heart study shortly.

Sonia Singh MD

Oh, okay.

Rebecca Berens MD

But so when we get into the facts with context and nuance I wanted to point out I just covered some of the common things that people use these trackers for.

Sonia Singh MD

Okay.

Rebecca Berens MD

And for each one I want us to consider. Is the data we are getting accurate from the tracker. Okay. Because that's the first piece. Is it even accurate? And then why does it matter? Because you can have lots of accurate data. That means nothing,

Sonia Singh MD

right?

Rebecca Berens MD

Doesn't change anything for you. So both have to be true for this to be a worthwhile endeavor, right? It has to be accurate and it has to have some sort of meaningful health outcome. So just wanna preface it with that.

Sonia Singh MD

Are we covering continuous glucose monitors in this or that's

Rebecca Berens MD

No, that's gonna have to be its own

Sonia Singh MD

episode. A whole episode?

Rebecca Berens MD

Yes. I did not get into that. I was like, that's a whole episode. That's a whole episode. But this one is just gonna be trackers. So Ora Ring, apple watch, Fitbit, strap all the various track trackers.

Sonia Singh MD

Man, I forgot about Fitbit. It's been a minute since I fit Fitbit. There was a year I gave everyone a Fitbit for Christmas.

Rebecca Berens MD

Oh, I remember my Fitbit days very well. Okay. Anyway. The early OTTs were a fun time. Alright okay. So for first thing I'm gonna say, I think this is the most basic type of tracker that everyone knows of, which is the step counter pedometer. And this is like we said, this is the earliest thing that we think of. And there there was a study that I found is comparison of consumer grade wearable devices with a research grade instrument for measuring physical activity in a free living setting. So this is basically taking a medical grade actograph, which is a thing that measures how much you move and is medical grade and making that the gold standard, and then comparing various other types of trackers to it. Now this is a pretty small study. It was only 36 office workers. But they wore an actograph and then, an Apple Watch, Fitbit and Aura ring over a three week period. And they measured step count, physical activity, energy expenditure, and moderate to vigorous physical activity data from all of the devices. And then they analyzed them and compared them. And so the step counts were actually pretty consistent across all of the devices. So the Apple Watch and Ora Ring were within 10% of the actograph, although I have to mention the Oura ring was only five of these people. Apple Watch was 21 and the Fitbit was 22. I don't really understand why that was the case. It seems like more people could have worn Ora rings, but anyway so this is minimal data that we have here, but they were pretty accurate. While the Fitbit overestimated step count by about 18%.

Sonia Singh MD

Ooh, 18 percent's kind of a lot.

Rebecca Berens MD

Yeah. So Fitbit's out on step counting, it's not as accurate. But the AA ring and the Apple watch are actually pretty good. The, moderate to vigorous physical activity measurement was, has more variability between them. So Apple and AA ring both underestimated Apple watch by 46% and AA ring by 11%. Whereas the Fitbit actually showed mean minimal difference.

Sonia Singh MD

Okay.

Rebecca Berens MD

So that was interesting. And then the largest descriptions, these were with physical activity, energy expenditure, which I mean this is like when it tells you how many calories you burned, which there's actually no way that this thing could possibly tell you that there's so many variables that is not accounted for by your movement. So I don't even know why they bother reporting it. But anyway based on. Even the ACTO graph can't accurately provide you with that information. But

Sonia Singh MD

I don't, they ask you questions about yourself. I'm pretty sure the Apple Watch and the Fitbit, have you put your, height and

Rebecca Berens MD

weight. Yeah, but even that is, but even with your height and weight and stuff there's still other variables involved. Are you sick right now? Or, what are the things that there's just a lot of variables that are not being considered. So anyway, the largest discrepancies were with that calorie counting. So Apple Watch and Fitbit overestimated apple by 25% and Fitbit by 139%.

Sonia Singh MD

Fitbit was lying to us in the early on

Rebecca Berens MD

And Aura ring underestimating by 16%. So point being the step counter, probably pretty accurate. The other stuff less

Sonia Singh MD

okay.

Rebecca Berens MD

So yeah, so there's that. Now does any of that matter? So there is some data from the consumer wearable health and fitness technology in cardiovascular medicine, A-J-A-C-C-J-A-C-C, state-of-the-art review, where they reviewed several studies on on wearables. And we'll go back to this review several times in this episode. But there actually is evidence that step counting helps people be more physically active, particularly people who have been recommended to engage in physical activity to manage a health condition like a cardiovascular condition or diabetes or something like that. So there is actually evidence that step counting does help improve your activity. So not so bad. Now when we get into the harms, we'll talk more about this. But is it accurate and does it matter? I would say for step counting, yes. We met those criteria. So the next one is for cardiovascular health and this is where we come to the Apple Heart study that you alluded to earlier on. So there was a study funded by Apple which is a large scale assessment of a smartwatch to identify atrial fibrillation. And this had over 400,000 participants.

Sonia Singh MD

Wow.

Rebecca Berens MD

Yes. This was a really interesting study. Participants who self-reported no personal history of atrial fibrillation used a smartphone Apple iPhone app to consent to monitoring. And then they used the apple watch irregular pulse notification algorithm. And if so they're wearing the watch and it had this algorithm enabled that would notify them of a possible atrial fibrillation. And if that notification flagged a telemedicine visit was initiated and an EECG patch was mailed to the patient to be worn for up to seven days. Surveys were administered 90 days after the notification of the irregular pulse, and again, at the end of the study. And the main objectives were to estimate the proportion of people who received a notification of an irregular heart rate, who did have atrial fibrillation shown on an ECG patch, and the positive predictive value of irregular pulse intervals with a target confidence interval with, of 0.1. So how predictive was it of actually having an irregular pulse, essentially? Okay. So over 400,000 per participants. And there was 117 days of monitoring, 2,161 participants received a notification. 450 of those people returned ECG patches, so not a great rate of return containing the data that could be analyzed which had been applied on average 13 days after the notification. And, atrial fibrillation was present in 34% of those overall, and in 35% of those participants who were 65 or older. So the positive predictive value of a irregular pulse notification resulting in a diagnosis of atrial fibrillation was 0.84. So decent.

Sonia Singh MD

Yeah.

Rebecca Berens MD

But the interesting thing which we will come back to is of so of 1,376 participants who were notified, and again, not all of these people actually then followed through with the ECG patch for the study.

Sonia Singh MD

Yeah.

Rebecca Berens MD

They, when they did the 90 day follow up survey, 57% of them had contacted healthcare providers outside of the study.

Sonia Singh MD

Okay.

Rebecca Berens MD

Yeah. So we'll come back to that later. But there were no reports of serious app related adverse events. So serious adverse events, there's none. But again we could argue that. Increased healthcare contact may be considered an adverse event of this app potentially. So the probability overall of receiving an irregular pulse notification was pretty low. But then those who those who did have an irregular pulse, 34% had atrial fibrillation. And so 84% of the notifications were concordant with atrial fibrillation. So positive predict value of 80 84%. Okay. And so yeah, so decent study large study and seems that it's a fairly good way of picking up atrial fibrillation. Now what I'm missing here is the negative predictive value. I don't actually see that reported. But, and I don't know how much of that was just based on obviously they weren't doing. The ECG patches on people who didn't get notifications.

Sonia Singh MD

I think they just probably had no way to follow up. Yeah. They could have just asked those people at the people who did not have any notifications at a certain time point. Have you been diagnosed with atrial fibrillation? Yeah. Since

Rebecca Berens MD

the

Sonia Singh MD

start of the study.

Rebecca Berens MD

Yeah. But I guess if the, in theory if what we're looking for is does it miss unrecognized cases? We don't know that. Because we don't know what happened with the other people who didn't get the notifications. So that was interesting. So yeah, I think again, looking at the smartwatch in terms of the irregular heartbeat notifications, is it accurate? It's decent, I would say. Again, I don't know how much it's missing, but at least if it picks something up, it's probably worth getting it checked out if it picks something up. 'Cause it seems like a decent percentage of the time.

Sonia Singh MD

I wonder

Rebecca Berens MD

you may be maybe

something,

Sonia Singh MD

I wonder if their positive predictive value is a little bit inflated because if. Over 2000 participants did have an abnormal rhythm. That's true. And got a notification. And even the 57% contacted healthcare providers, even though they might not have all done the follow-up patch that was sent to them. It's probably self-selecting for people who maybe were symptomatic or like some other concern that where they were like, that does happen to me sometimes. Like I've been meaning to get this checked out. And so that is very true. Maybe a lot of the people who ignored the notification or who did not do the follow-up or did not contact a healthcare provider did so because it was like a healthy 25-year-old who was like, I have no reason to have this. This is just, this is nonsense. Yeah. So I don't know. I don't know if we can totally trust the numbers they came up with at the end of this, 'cause it

Rebecca Berens MD

Yeah, very

Sonia Singh MD

true caveats there. But anyway. Okay. Okay. So what's the next study you wanted to talk about?

Rebecca Berens MD

So the next thing I wanted share, and this is just coming again from that JA. A CC review is about heart rate variability. So this is something that patients have asked me before. Because they'll get all these notifications about their heart rate variability and they're like, what does this mean? And I'm like, I don't know.

Sonia Singh MD

I know this is another example where a patient said it to me the first time and I was like, I don't know what you're talking about. And I just felt so dumb. But even then after I read about it briefly, I was like, I still don't really know what you're talking about, so I'm glad you're gonna tell me about.

Rebecca Berens MD

Yeah. So this I just took from the review because it's, again, it's not a clinical measure that we really use. It's not something that is super relevant to me. So what I took away from it is it's something that is used to indicate how well you're recovering from stress. So if you have lower heart rate variability, it's an indicator that you are more stressed because your autonomic nervous system regulation is being affected.

Sonia Singh MD

Okay, so low heart rate variability is bad and high heart rate variability is good? Yes. Okay.

Rebecca Berens MD

Yes. So basically, so high baseline heart rate, vari heart rate variability or increased heart rate variability over time indicates cardio, respiratory, fitness, sleep quality decreased stress, being younger and then being male also. It was on that list. And then low heart rate variability is associated with less cardio, respiratory, fitness, lower sleep quality, inadequate exercise recovery, chronic exercise over training, increased stress, systemic illness or infection, aging and being female. Which, oh yeah, that

Sonia Singh MD

all sounds

Rebecca Berens MD

bad. That was fascinating to me. I don't know, I don't know why the male and female thing, if that's actually hormonally related or if it's just stress related. I don't know. But but they were different for some reason. And so that's essentially the meaning behind it. But again, this is not something that we have clinical norms for this is something that, it's like a, in an individual's trend over time is maybe relevant for how that person, how, like how stressed are you relative to how stressed you were yesterday. But there's not a, there's not a like good number and a bad number, if that makes sense. It's not like a, it's not like you your heart rate availability should be this and it's not. So now you're sick basically.

Sonia Singh MD

Yeah. I'm also curious what interval they use to calculate this number. Is it minutes or hours or days or

Rebecca Berens MD

So that is actually very interesting. There's a number, there's actually multiple different ways it can be calculated. And I didn't get all into the weeds of this because frankly it was very confusing. And the upshot of what I got from it was They have variable accuracy, and the point is that there's not a clinical norm for a given person. And these these monitors the wearables compared to like medical grade, like ECG monitoring of the same thing. There were absolute errors ranging from 29 to 31%. And they were less accurate during waking activities when you're moving around, which makes sense. Okay. Versus when you're sleeping when you're not moving around, which again makes sense to me. So they're not super accurate when you're awake. They're not absolutely accurate either. But the trend for one person over time likely has some relevance. But again, like in terms of. What does this mean that we don't already know? As you alluded to, if someone comes in and they're like, yeah, I've been sleeping terribly and I feel sick and blah yeah, they're probably gonna get a flag on their ring or their watch that you're stressed. It's okay, we know. I believe you. But it's going back to what you said I think people they don't believe that they feel sick until it's proven to them. It gives them validation because they're like, I shouldn't feel this way, but now that my watch or ring has validated it, I'm allowed to feel this way.

Sonia Singh MD

Yeah, that's an interesting concept. Like it almost gives you permission. Yeah. You're like no. But my watch says that I slept very poorly. Yeah. So I can be cranky and tired today. I slept.

Rebecca Berens MD

And it's or you could just be allowed to be cranky and

Sonia Singh MD

tired. You're allowed to be cranky. Yes.

Rebecca Berens MD

Like, why do you need permission from a, from an electronic device to be crank?

Sonia Singh MD

So if people ask what, 'cause I think I've had somebody ask me before what is the ideal heart rate variability? And I was like, I don't know what that is. And I feel very, we don't have

Rebecca Berens MD

norms for that. We do not have norms for that.

Sonia Singh MD

I feel very validated that you said you were confused by it. 'cause every time I've tried to read about this topic, I get a little bit in and then I'm like, I, my head is spinning and I'm like, I don't know. I'm not, I don't think this is that helpful.

Rebecca Berens MD

It's not. It's not. Okay. Okay. Alright. And then big picture for cardiovascular health in general, do these things actually help? Like I said. There are benefits in increasing physical activity and increasing key health metrics associated with cardiometabolic conditions. So blood pressure, waist circumference, LDL cholesterol, but there are also significant disparities. So people who actually use these devices are often not the people who would actually benefit most from using these devices. Which, surprising to no one, I'm sure. So it says about 30% of US adults use wearable devices, and this is again from the JCC review. Adoption is concentrated among younger and wealthier and more educated individuals who are already healthier at baseline and already are engaged in exercise. So the people who would most benefit maybe from having some additional tracking to help them with motivation to be physically active and to monitor for things like atrial fibrillation, if they're maybe someone who's at risk are not probably wearing these things. And the other key thing that they said was that the face-to-face delivery of wearable interventions, so like using the wearable and then discussing it with your doctor in a visit was much more effective than just doing it on your own. And I think that's because, as we could expect having a synchronous conversation about this is what matters, this is what doesn't, this is, the things I care about would allow someone to focus on what's important and understand the nuances.

Sonia Singh MD

Yeah. It's interesting that's what the data shows. 'cause when I think about, I've had two or three patients that ask me about heart rate variability and they're among the healthiest patients in my practice, like people who are exercising regularly and really conscious of what they're eating. And especially for them, I was just like, I don't think this adds anything for you. Like I, there, there's nothing that I think you should be doing differently. Yeah. But I think their frustration was I feel like I'm doing everything right. So like why is this thing still telling me that my heart rate variability is too low? Too low? Yeah. So yeah. Okay.

Rebecca Berens MD

Yeah, and so that's the thing, like I, I think my answer to that would be the absolute number does not matter. Your trend personally over time may indicate increased or decreased stress for you.

Sonia Singh MD

Yeah.

Rebecca Berens MD

But the absolute number is not accurate and there's no actual norm for it anyway, because we don't use that number clinically so

Sonia Singh MD

That's helpful. I gotta keep that explanation in my back pocket.

Rebecca Berens MD

Yeah. Yeah, so I think when it comes to cardiovascular health, there are some benefits in terms of increasing physical activity. Again, that sort of like accountability piece maybe. And maybe if you're someone who's at risk for atrial fibrillation, maybe wearing this watch is a reasonable thing to consider doing. I don't know that everyone should just be wearing one, because I don't think it's likely that every random person's gonna be at risk for atrial fibrillation. But I think that the piece of 57% of people who got notifications reaching out to a healthcare provider is very relevant because how helpful was it to get that notification and then have to reach out to a healthcare provider? Did it actually add anything to you, or did it just add more anxiety to your day? All right. So the next thing I wanna cover is sleep. So for sleep disorders this is another common reason that people use these devices. So this study was called The Accuracy of three Commercial Wearable Devices for Sleep Tracking in Healthy Adults. So in this one, they compared the AA ring Gen three, the Fitbit Sense two and the Apple Watch Series eight to a gold standard sleep assessment with polysomnography. Again, very small study, 35 participants.

Sonia Singh MD

Yeah.

Rebecca Berens MD

And they wore these devices and were monitored with a polysomnography. And the sensitivity for detecting a sleep versus a awake was greater than 95% for all of the devices. And so that's in, in comparison to the polysomnography for discriminating between sleep changes. The sensitivity varied so aura Ring was better able to distinguish between different stages of sleep and be correct versus the Fitbit and Apple. And aura Ring was not different from Polysomnography in terms of wake, like light sleep or deep sleep or REM sleep. Fitbit overestimated light sleep and underestimated deep sleep. Apple underestimated the duration of wake and deep sleep and overestimated light sleep. So in, in all of them, the devices were similar to polysomnography in the estimate estimation of total sleep duration. So basically they're okay, or a ring seems to be a little bit better than the others. None of them are perfect but they're okay. But again, this is just light sleep. Deep sleep, awake, asleep.

Sonia Singh MD

Not,

Rebecca Berens MD

this is not anything to do with sleep apnea in terms of like your. Oxygen level is dipping. Now it is also measuring heart rate, which again, we may see a person who has sleep apnea may experience an apnic episode and have a big heart rate fluctuation associated with that. But but that is not what this study was looking for. They were just looking for concordance in terms of estimating the types of sleep.

Sonia Singh MD

Okay.

Rebecca Berens MD

But interestingly, there is actually a the Samsung smartwatch feature was FDA authorized in 2023 for detecting signs of moderate to severe sleep apnea. And so they, it detected that this device it's an app on the Samsung. Phone, I guess that syncs with the Samsung smartwatch and you can opt into this feature to detect signs of sleep apnea. And it's doing similar things to what these other trackers are doing in terms of monitoring sleep, but it, the patterns that it was able to identify compared with polysomnography, they determined were accurate enough to pick up moderate to severe sleep apnea. Now, not for diagnosis right, it's enough just to say, you may have this

Sonia Singh MD

like a screening tool for

Rebecca Berens MD

Yeah. But but it cannot it cannot give you a diagnosis. It does not diagnose or treat anything. It is not to be used as an apnea monitor. It's just, using a software algorithm to analyze the sensor input and give an overall risk assessment for sleep apnea. And it can show only in cases of moderate to severe sleep apnea, not for mild sleep apnea.

Sonia Singh MD

But do we know how good it is at that?

Rebecca Berens MD

The Samsung sleep apnea sensitivity was 82.7%. And specificity was 91%.

Sonia Singh MD

Oh, that's not bad. If we apply your two questions, is it accurate and does it matter? So is it accurate? It sounds like it's decent, it's not perfect, but it's decent. And then does it matter? Like it certainly matters if you have sleep apnea or not, but I guess the part to remember is this does not make the diagnosis. Yes. So now you still have to go to an actual doctor and get a referral for a sleep study, go do the sleep study, get your cpep titrated if you have it. And I guess what I would imagine for people who are in the moderate to severe category, if they had just gone to the doctor and said. I think I'm concerned that I have sleep apnea. If you snore, if are above a certain BMI, if you are tired during the day, I mean there's a zillion ways to get to a sleep study. I guess my question would really be to put this in clinical context and say was this thing even necessary or was there a much more direct route to getting diagnosed with sleep apnea if that was, a concern?

Rebecca Berens MD

Yeah. So I'm gonna go back to my patient case because Okay. I think it's very relevant. So this patient that I talked about at the beginning, again, this was a patient who sent me oring data, but they were worried about lack of deep sleep and they were feeling less rested during the day, so had a symptom. They did snore and had done so for years and their wife had told them that they should get a sleep study. They denied any witnessed apnea or waking up in the middle of the night coughing, gasping for air. They denied morning headaches. They'd had a recent blood pressure check that was normal. They had some symptoms of sleep apnea, but not all of them. I think it's very possible that this person, especially if they had not had the AA ring data, would not have brought this up to their doctor.

Sonia Singh MD

Yeah.

Rebecca Berens MD

Without the data. Now their wife might have.

Sonia Singh MD

The evidence was there.

Rebecca Berens MD

The evidence was there, like to, to your point, there was evidence it could have been brought up, but I don't know that it would've been, and again, this is, this comes to the question of do we not take our symptoms seriously until we have some sort of data proving it? And so I think if this is something that helps someone take their symptoms more seriously and actually bring them up to their doctor,

Sonia Singh MD

yeah,

Rebecca Berens MD

that is potentially beneficial. Could this person have been diagnosed with a sleep apnea without it? Yes, absolutely. But they were not.

Sonia Singh MD

I can understand why maybe when you're just hearing it from your spouse who's complaining about your snoring, you discount that. And when you're tired during the day, there's a million other explanations for it. I can see how this thing still would have therapeutic value for somebody, even though you know it like you, and I said, this is not the most direct path to getting this diagnosis is not required to make this diagnosis. But in the same vein as like us talking about doing a few additional labs in certain cases that are maybe not indicated from a medical perspective, but help the patient, understand what's happening in their body. Yeah. And get to the point of accepting a certain diagnosis or not having a diagnosis. So yeah, I think it falls into that category, so that's interesting.

Rebecca Berens MD

Yeah. Yeah. I think this is the one area where I'm like, if I have a patient who I'm concerned about this, they're at high risk, they don't wanna go get a sleep study. Maybe this would be a way To convince them to get a sleep study

Sonia Singh MD

that it's worth the time. Yeah.

Rebecca Berens MD

But yeah, I think I, to your point, like I think that they may not be taking their own symptoms seriously, or the concerns of their spouse seriously

Sonia Singh MD

but if, or the concerns of their doctor, yeah. Or the

Rebecca Berens MD

concerns

Sonia Singh MD

of their doctor. Doctor just wants to make some money off of the sleep study. So

Rebecca Berens MD

but if the, unbiased third party

Sonia Singh MD

device

Rebecca Berens MD

Yeah. Device that is, when I say unbiased, it is still a for-profit company making this device. But there's, it, there's some useful data there potentially.

Sonia Singh MD

Yeah.

Rebecca Berens MD

So I think it's interesting.

Sonia Singh MD

Okay. Let's move on so we've reviewed all of these potential benefits. So let's talk a little bit about potential harms.

Rebecca Berens MD

Yeah. So I think the biggest one as we have alluded to is just the impact psychologically that this information has on a person. And unsurprisingly, this has not been studied very much so in that JACC scientific statement article about consumer wearables. They said inadvertent psychological effects from the use or prescription of consumer wearables are under-recognized. Some individuals may be incentivized to adopt healthy behaviors and enhance their cardiovascular self-management. This desirable effect, contrast with others who may react negatively. Eg. Obsessive symptom control monitoring by the worried well negative reactions to notifications, serving as reminders of disease or inclu inclusive results. And these responses may undermine relations with healthcare providers satisfaction with care and mutual trust. These factors are important, but a little studied, so there's just not been a lot of study on this.

Sonia Singh MD

Okay. Can I also just get on my soapbox about worried well I hate the phrase worried well doctors use it all of the time, and it just makes me cringe because really most of these people have some health anxiety. Maybe it's mild, but they have some health anxiety, and that is pathology. Just like any other pathology, they're anxious about their health, they're concerned about something. And I think when it's phrased as worried well it just sounds like they're just. Annoying, yes. It's oh, these people are just coming and asking you stuff and taking up resources and filling up appointments and they're fine. And it's if they are worried they are not fine, by definition they're not fine, so anyway, I really hate that phrase of worried. And just the treating of it as oh yes. People can become obsessive or they can get worried about these numbers. It's no, they can develop true pathology. Yes. Related to this data, so I and I just think. This also shifts as time goes on because we already take in so much data all the time. Everybody is constantly being flooded with data. So I guess one of my biggest gut, repulsions to this whole category of things is just I don't want more data. I have too much, I had a fellow physician ask me the other day like, oh, are there any medical record systems that interface with Aura so that you can get that data from patients? And I was like, I don't know how you're gonna deal with that. 'cause that is so much data for every person that you're then trying to process and review. And again, you just have to ask yourself how much is this adding to versus me sitting down and really talking to this patient, so anyway, yeah, I don't think those psychological side effects can be. I'm sure they are minimized in a lot of these studies and

Rebecca Berens MD

They're just not even asked about. I think that's the problem. And I totally agree with you. I hate the words worried well as well. And I think, you know what the, what I see happening is, the idea of oh yeah. How all this data can help people, be more proactive and make changes about their health. I see it going the opposite direction where it's like a gamification gone too far. Yes. And it becomes a competition with yourself to get more and more steps every day and to close your rings every day, even if you're sick. And I see patients who have OCD or have eating disorders and it becomes so distressing if they can't. If they can't do that day, they're like, they're outside febrile with the flu and they're still getting their steps in because they have to get it in that day, it's just, it's it's not helpful. And it is actually harmful and I think that's the problem. These things are framed as really benign and no problem at all. And that's clearly not the case. There are clearly people who this really negatively affects them. And I'm not sure that it always outweighs the potential benefits, especially as we said. 'cause most of the people who are using these are not the people who would benefit from them the most potentially in terms of metabolic health.

Sonia Singh MD

I think that people who are drawn to these things are people who are already very achievement driven, accomplishment driven, productivity driven, already a little bit obsessional about data and numbers. And those are the people who I think are attracted to these devices. And then they get them and they just lean further and further into that. And I always try to tell people okay, so let's zoom out. What was even the goal of getting this thing? It's probably to improve your overall quality of life by helping you be healthier and more fit, and maybe live longer and be healthier and all. But if on a day-to-day basis it is draining you of mental energy and you are becoming emotionally tied to what is happening with your data isn't really doing that, and I think there's very few patients that I can think of that I've interacted with, in which I think. Any of these wearables have made. A really positive difference in the big picture of their health. I'm certainly not anti I'm not like, no, you should not have, actually, in a couple of cases, I have told patients that they should not. I have a few patients that are already extremely anxious and hypervigilant about every physical symptom in their body, and I had one of them reach out to me and say. My husband's thinking about getting me an AA ring for my birthday, but I was thinking about it and I talked to my therapist and I wanted to talk to you, and I was like, I'm not sure if this is the right move for me. And I was just so grateful that she asked me and she asked the therapist and we were both on the same page of no. You were already so aware of everything in your body. You already have so much data coming in from so many different specialists and so many different people. This is just going to add to the pile of things that need to do. I was actually thinking about this and I think it's relevant to a few of our episodes. The full body MRIs, like the blood tests for cancer. Several of the other ones, but there's a certain amount of healthcare that I think is preventive and proactive and helps people live healthier lives and live longer. And then there's like a point after which more healthcare, begets more healthcare, where like the more stuff you're doing, the more stuff it ends up leading you to. And I think these fitness trackers are beyond what I would consider the high return on investment, necessary for you healthcare and like into the realm of more healthcare begets more healthcare. Where like you, you'll do it and then you'll find something and then you'll do more and then, and it just goes on and on. Yeah.

Rebecca Berens MD

Yeah. And I totally agree with you. And that was my next risk that I thought up was the. Associated increase in healthcare usage and follow up testing and the associated risks and costs that come with that, because like I said, so 57% of the participants who got notified of the Apple heart study did reach out to their healthcare provider. Outside of the study. And I am sure every PCP who is listening to this podcast has received a portal message with a screenshot of a health tracker.

Sonia Singh MD

Yeah.

Rebecca Berens MD

Something. And they're like, what does this mean? And, you and I have time to look at that. And generally I know what I do is I'm like, let's talk about this in a visit so we can like, really, I can look at everything and we can really talk about it. Most PCPs do not have time for that.

Sonia Singh MD

Yeah.

Rebecca Berens MD

They're already getting so many portal messages in a day. And so

Sonia Singh MD

many lab results and so many imaging results and so many cons. So many things like real data that needs to be acted upon and Yeah.

Rebecca Berens MD

And it's be

Sonia Singh MD

urgent.

Rebecca Berens MD

You're getting this. And you can't dismiss it, because you don't wanna miss something. And what if it is something serious? But it's, it requires an appointment really to like really assess what's going on and is it necessary to have that appointment? Or are we taking that appointment from someone else who needs it? There's limited healthcare resources, and so I think it, there's a lot of both personal risk and population risk of increased uptake of this because it increases healthcare usage in a way that is not necessarily likely helping anyone. Yeah. And is creating more anxiety, is creating more cost and more testing. And another thing that I just wanted to plug in here was for all the PCPs who are listening, 'cause we understand you I'm sure you've heard of that study where they they estimated the time it would take for A-P-C-T-P to provide Yep. Adult primary care. I know it was estimated as 26.7 hours per day.

Sonia Singh MD

27 hours. Yeah.

Rebecca Berens MD

Okay. So we don't have time

Yeah.

Rebecca Berens MD

To review more data. And that was assuming a panel of 2,500 patients. Yeah. I don't know how many patients were on your panel when you were employed, but I had over 3000

Sonia Singh MD

No, I never got there.

Quit.

Rebecca Berens MD

Oh that's that was nice of them. Yeah. I started and I got, so someone else who just left panel transferred to me and then they just kept adding new patients and I was like, what?

Sonia Singh MD

Yeah. There are not enough hours in the day to provide high quality, adequate care to a typical primary care panel. So to add more data to that for them to review is presenting a challenge?

Rebecca Berens MD

Yes. Yes. And I think the other flip side of that is, if you have a person, which I mean is unlikely a person who's wearing a health tracker, but say a person who really does have something going on and is ignoring it and the device is maybe not picking it up. 'cause again, we don't know the negative predictive value, for example of of the devices picking up atrial fibrillation. Or if it's, or if there is sleep apnea that's not picked up some for some reason by the device, they're thinking they're fine And they're being falsely reassured and therefore not going for needed healthcare to the healthcare system. 'Cause they're replacing healthcare with this system. Again, we've talked about this many times where the more direct to consumer health tech that has become available and the more people who are losing healthcare coverage. They're just taking it into their own hands of I can't do it that way. That's too expensive and complicated and I'm just gonna handle it myself. I'll do these things, these tests, and now I'm, I know I'm good. But are you really good? You might not be. And so that's another flip side from that. And I think the big thing too is the as we both have mentioned several times in this episode the disconnection of our mind from our body and not actually experiencing our physical sensations and relying more on data to tell us how we feel than how the symptoms we're having. For example, if we go back to my sinus infection patient at the beginning of the episode so that patient had classic symptoms of a sinus infection. Yeah. The classic

Sonia Singh MD

sinus symptom, sinus. Sinus.

Rebecca Berens MD

I don't know if they would've reached out to me if. The heart rate thing hadn't triggered. And I'm like, why don't you trust that you feel sick?

Sonia Singh MD

Yes. Maybe we're part of that problem, is that we make it hard to get in. We can be dismissive. I think people have been trained to do this whole grin and bear it or deal with it. Suck it up or deal with it myself. And maybe sometimes they need the ding of a notification to push them to take the next step of messaging the doctor and saying, I'm not better, so yeah. I think there's a lot of factors that play in that.

Rebecca Berens MD

I think it's an interesting concept to think about and I think it is just something we all should be thinking about if we're going to be interacting with these devices is if we wanna talk about what we can learn from this as doctors and humans How are we integrating this into our life and our care? How is it benefiting us? How might it be harming us? How can we ba balance those things? And I think there, there are some clinical situations like my patient with sleep apnea. I really don't think that person would've come to me about that. Sleep apnea.

Sonia Singh MD

Yeah.

Rebecca Berens MD

Any other way. And they got diagnosed and it was, and they're, now they're treated and I'm, I fully believe that was very beneficial for that patient. But I think there's a larger number of people who are getting a lot of information and data overload and a lot of anxiety coming from that. And it's really difficult to balance those things.

Sonia Singh MD

Yeah, I think I would just say the same thing that we have said for social media generally in one of the early episodes, which is just frequently check in with yourself about how this thing is making you feel. If this thing is adding to your life in some way or benefiting you in some way, then great, continue using it. But if you're noticing that it's not adding anything and all it does is like it's another thing for you to look at, another app for you to check, or it's becoming obsessive or it's. Leading to I can imagine looking at my watch or my, I don't have an Oura ring, but I can imagine looking at my Oura Ring app and it's saying I didn't sleep well and then just being annoyed and feeling like, yeah, I know I should have gone to bed earlier. I have that talk with myself even without the ordering, but it would be worse. It's like an app was also shaming me for how I did not sleep enough. I think you just have to this is such an individual thing. You have to really look at what it's adding and what it's taking from you and make the decision from that. One thing that you didn't mention, because I'm sure there's no data on it, but I had a patient who was wearing all of the wearables and he was just like, sometimes I worry about like the I'm gonna use the wrong physics term, like the electromagnetic radiation or like the wi the fact

that

Rebecca Berens MD

all of these, yes, I did not look at that, but that

is

Sonia Singh MD

good. The fact that all of these things are pinging wifi, what's gonna happen years from now from us wearing all of these things, and I was like, I don't know. I told him I don't know the data on that. I have not looked it up. I still have not looked it up. But my question to you would be there are some things in our life that are just like necessary parts of modern life, and there may be some really low level risk associated with them, but if it's a necessary thing that you have to do or something that's an integral to your functioning, then you just gotta swallow it and do it, and keep an eye out for any actual data that tells you one way or another. And so for him, I was just like, I want you to really think about whether all those things you're wearing is really doing anything for you. Because if you at all have that fear in your mind, if that is an anxiety that he's walking around with of oh, putting in this thing on every day what might it be doing to me? Then get rid of it if it's not adding anything to your life, because I'm certainly not telling you it's necessary. I don't need any of that data. Yeah, I don't know if I, I don't know if there's any

Rebecca Berens MD

Yeah. I didn't look that up, but that's a really good point. Maybe we can do that for a future episode because actually I've heard concerns about that from patients before. And I have looked it up a handful of times, but I didn't look it up as it relates to, these trackers specifically. When I looked at that before, it's mostly been around wifi routers is what people have been concerned about. Yes. And it seems like you said, very low level, if any risk and distance from it and all of that matters. And so yeah, I mean if there is any coming from these things, they are touching you. Yeah. If you're wearing multiple of them, then yeah. I think it's a cumulative effect. Probably. We talked about this in clean beauty. It's the same sort of thing. Yes. It's like

Sonia Singh MD

same

Rebecca Berens MD

concept, low level environmental risk. Yes. You are not gonna be able to avoid wifi routers. You're just not, those are gonna be in your life everywhere you go. But you could avoid,

Sonia Singh MD

Easily avoid an aura ring. Yes.

Rebecca Berens MD

So if it's a concern and we don't really maybe know how much of a concern, do you actually need that thing? Probably not. I think the other thing is at the end of the day, these are all for-profit businesses, and they are gonna come out with the next big model. The next new thing you're gonna be replacing this device. Regularly if you wanna have the most up-to-date data, which is what they're selling to you. Yeah. So is the cost of that worth the benefit? Because they're not cheap. A lot of them also have with subscriptions associated with them. So you pay for the actual device and then you also have the monthly subscription. And I've had a couple patients who, again, they, I'm a little bit worried about sleep apnea and I'm like, maybe we should do a sleep study. And they're like, ah, I don't wanna do that. And I'm like but they'll get an NOA ring. And I'm like okay, maybe it's something. It won't, I don't know if they'll tell us everything we need to know, but, but maybe if it flags, then you'll go get the actual sleep study done. But then I'm like, did you save yourself any money by doing that?

Sonia Singh MD

I can see the argument for sure, like the convenience of it, yeah. And just the ease of it. I can actually imagine my husband making that decision. Yeah. And just being like, I'm just gonna get this thing. And then if it says that I'm not sleeping well I will go get it. And I don't necessarily think there's anything wrong with that as long as you have the resources to do that. But if you're using your limited resources for this and for going something else, that is where the real harm I think

Rebecca Berens MD

happens.

Sonia Singh MD

Yeah. Okay. So how do you talk about wearables and trackers to your patients? What are some tips you would have for that?

Rebecca Berens MD

Yeah, so most of the time people already have them.

Sonia Singh MD

That's

Rebecca Berens MD

true. I have rarely, I've rarely had anyone ask me if they should get one, but most of the time they already have them. And it comes up as this is what this thing said. What I generally will ask is what we talked about, what, how are you using this device? What are, what is it helping you with and how disruptive is it to your life in terms of notifications? Notification burden we all have at baseline.

Sonia Singh MD

Yeah.

Rebecca Berens MD

But particularly for my patients who have, eating disorder history, OCD, perfectionistic traits, they're compulsive about closing rings. I have a much more serious conversation about the harms of this are maybe outweighing the benefits for you Versus someone else who's maybe, yeah, maybe it's helping me, meet my exercise goals for the day. And I'm not, but I'm not compulsive about it. I'm not gonna go exercise when I'm sick. Yeah. And, I'm not gonna worry about it if I didn't close my rings one day. It's a balance. So I think that's the thing is how is it helping you? How much is it disrupting you? Is the, is it affordable to you? Yeah. Or are you foregoing, like you said, something more necessary to pay for this device. And particularly when it comes to getting a real sleep study done. You're still gonna have to get the real sleep study done if it flags. So you're not really saving any money and it could falsely reassure you. So I think there's there's that piece as well.

Sonia Singh MD

Yeah, no, I totally agree. And like you said most people are not gonna come to us to have a conversation about whether to get one of these, which is a shame because I do think that you should do a little bit of a screening before deciding if one of these is right for you.

Rebecca Berens MD

But I think for the doctors who are listening I think it's very important for us to be having these conversations with patients. And not to be dismissive of the data that is produced. Because I can imagine if I'm someone who has 10 minute visits back to back and someone's scrolling through pages of data in my office, like I don't have time to review it. I think it's important to have a conversation with them about it doesn't mean you have to look at every single piece of data in there. Some of this stuff that we've talked about in this episode people are gonna be using this stuff, it's going to affect their health one way or another. So it's good for us to be having an open conversation with them about it.

Sonia Singh MD

Yeah. Or just to be able to say these are some of the evidence backed benefits of it. If you were trying to reach a certain steps goal if you were, trying to increase your physical activity. If you're trying to establish a habit, it's understandable. I can pick up some cases of sleep apnea, I can pick up some cases of atrial. But, a lot of the metrics it's giving you are probably not actionable or anything that, is super relevant for our work together. And I would just keep checking in with yourself about how this data is making you feel and how much it's really benefiting you. And the vast majority of patients that will come in with these trackers are already very proactive about their health. So it, it typically, it's not adding a ton.

Rebecca Berens MD

Yeah. It's, and it, the people who it would add more to are usually the people that don't have them.

Sonia Singh MD

And a lot of the benefits you talked about could be achieved from a simple pedometer I bought my son one for $10 on Amazon,

Rebecca Berens MD

yeah.

Sonia Singh MD

So those things can often be achieved without a fancy aura ring and a subscription and all of those other, bells and whistles.

Rebecca Berens MD

Yeah, absolutely.

Sonia Singh MD

All right. This was a great episode. So we will have additional resources. All of our references for this episode. Other experts you can potentially follow on our substack. The substack also has our antidote, which is for patients. We have little affirmations and reminders you can tell yourself, and you're maybe tempted to by a wearable or you're trying to interpret data from your invariable, or you're getting anxious from something that your wearable is telling you. And then we also have scripting for clinicians that they can, tweak or borrow and use in clinic to talk to patients about some of these devices. So hope that's helpful for you, and we'll see you next time. Bye, Rebecca.

Rebecca Berens MD

Bye, Sonya.

Sonia Singh MD

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