Get Fit with Apple Watch: Using the Apple Watch for Health and Fitness (2015)
Part II. The Apple Watch in Health & Fitness
Chapter 8. The ResearchKit Health Projects
Allen G. Taylor1
A physician’s guiding principle is “First, do no harm.” As a result, new treatments for diseases must be tested thoroughly, preferably in double-blind, placebo-controlled, randomized clinical trials, before they can be approved and then prescribed to patients. For trial results to be considered statistically significant, a large number of study participants are needed, and typically recruiting enough participants with a given disease or with susceptibility to the disease is difficult. Progress in translating research into clinical treatments is slower than it could be because of this bottleneck in the process of conducting clinical trials.
The recent phenomenon of crowd sourcing has the potential to break the logjam by opening up a large pool of potential test subjects for research into common ailments. Millions of people own iPhones and Apple Watches. Many of these people would like to see medical research move ahead faster and are willing to devote some of their time and effort to help. Apple’s ResearchKit is aimed at those public-minded Apple Watch and iOS device owners.
What ResearchKit Is and How Researchers Can Use It
ResearchKit is a platform upon which applications can be built that gather information from the sensors on the Apple Watch and iPhone, which specifically address highly targeted health-related questions. Researchers in a wide variety of medical fields can team up with app developers to create apps that monitor the location, activity, and vital signs of participants on a continuous basis.
With millions of Apple Watches on the wrists of people all over the world, researchers will have little difficulty recruiting thousands of participants. The large number of enrolled participants massively increases the statistical power of the conclusions that are drawn from the research studies. The research can be conducted much more cheaply than would normally be the case, an important point at a time when research grants are getting harder to win.
Diseases Initially Addressed by ResearchKit Apps
The first research studies to use ResearchKit apps are designed to gain insight into five diseases that cut a path through huge swaths of the populace, causing great suffering and drastically shortening lives. Let’s take a brief look at each.
Asthma is a respiratory disease due to chronic inflammation of the airways in the lungs. It is characterized by wheezing, shortness of breath, chest tightness, and coughing. In severe cases, it can be fatal. Approximately 300,000 people die per year worldwide from asthma, and about 280 million people are affected by it to a greater or lesser degree. Asthma is the third leading cause of death in the United States after heart disease and lung cancer.
Asthma is caused by a combination of genetic and environmental factors. There are a number of genes that are involved and a wide variety of environmental conditions that can trigger a severe asthma attack among those who are genetically susceptible.
Mt. Sinai, Weill Cornell Medical College, and LifeMap have developed the Asthma Health app with ResearchKit. In addition to collecting data daily on the condition of study participants, using the Apple Watch link to its paired iPhone’s GPS capability, it can also warn them of a potential asthma attack trigger, such as high air pollution when they are about to enter an area that is currently under an air pollution alert. Maybe it would be better to wait and go downtown on another day.
Parkinson’s disease is a degenerative disorder of the central nervous system. It is characterized by movement-related symptoms including shaking, rigidity, slowness of movement, and difficulty walking. It is a progressive disease and in advanced stages affects cognitive function and behavior. Most cases occur after age 50, and the disease becomes progressively more prevalent at higher ages.
Globally, about 7 million people are affected by Parkinson’s disease, of which about 1 million reside in the United States. In 2013, approximately 103,000 people died of Parkinson’s disease worldwide. The disease is a tremendous and growing drain on the healthcare systems of all the countries of the world.
The University of Rochester and Sage Bionetworks have developed the mPower app, which uses the sensors and computing power in the iPhone and Apple Watch to measure a person’s dexterity, balance, memory, and gait. The gyroscope in the Apple Watch can sense abnormal movements, enabling researchers to track the progression of the disease. Participants may also notice their own symptoms and report them.
There are several types of diabetes, the most prevalent of which is diabetes mellitus, also known as Type 2 diabetes. It is a metabolic disorder, characterized by high levels of glucose in the blood, due to insulin resistance. Incidence of diabetes mellitus has grown dramatically coincident with the worldwide growth of obesity in recent decades. As of 2010, approximately 285 million people had been diagnosed with the disease. Diabetes mellitus is a chronic disease, which typically chops ten years off the life expectancy of people who have the condition. People with diabetes are more likely to suffer complications such as heart disease, stroke, diabetic retinopathy, and kidney failure. Blood flow to the limbs is impaired in advanced cases, sometimes requiring amputation.
The Massachusetts General Hospital has developed the GlucoSuccess app, which is used to track the diet, physical activity, and medication use of study participants. It can also inform participants how their food choices, activity level, and medication compliance affect their blood glucose level. This could lead to behavioral changes that improve the quality and length of the participant’s life.
Breast cancer is the most common invasive cancer in women. It affects men too but is 100 times more common in women than in men. Although treatment has improved dramatically in recent years and extended the lives of breast cancer survivors, there were still more than 521,000 breast cancer deaths worldwide in 2012. North America has the highest breast cancer rate in the world, so a disproportionate number of people with the disease reside in North America.
A diagnosis and treatment of breast cancer probably has a more devastating psychological impact on those who are diagnosed with it than on those with any other type of cancer. Depressed mood and fatigue are common side effects of treatment.
The Share the Journey app, developed by the Dana-Farber Cancer Institute, UCLA Fielding School of Public Health, Penn Medicine, and Sage Bionetworks enables study participants to give information about energy levels, cognitive ability, and mood. The object of the study is to find ways to improve the quality of life of people after they have been treated for their cancer.
Cardiovascular disease is the number-one killer in the developed world. It shortens lives and causes great distress for those affected by it, either directly or indirectly. The cardio part of the word cardiovascular has to do with the heart, and the vascular part has to do with the arteries and veins that the heart pumps the blood through in order to supply oxygen to all the cells of the body. If a cell doesn’t get oxygen, it dies. If enough cells die, the person dies.
Sometimes the blood cannot get to where it needs to go because blood vessels are clogged up with plaque. Other times a blood clot blocks a major vessel also preventing blood from going where it is needed. If the heart is not beating with a regular rhythm, that can also be deadly, as can various defects in the heart’s valves.
The MyHeart Counts ResearchKit application, created by Stanford University in association with the American Heart Association, first asks participants a series of questions about themselves. These include the usual statistics, such as birth date, sex, height, and weight. It also asks what time a person usually goes to sleep and when they usually wake up.
After people sign up, they are asked to check in every day and answer a few questions. Some of these questions are asked only once, while those that might change on a daily basis are asked every day. In addition to the questions answered, the app also takes data recorded by the watch’s gyroscope and accelerometer, as well as the iPhone’s GPS readings, to tell how active you are.
Periodically, the app will ask you to take the six-minute walk test. For this test you are asked to walk as far as you can in six minutes. Over the course of the study, any change in your maximum walking speed will be noted. In addition to the distance walked, your average and maximum heart rate during the test will also be recorded.
Every day, the app will ask you whether you wore your Apple Watch all day and all night yesterday, or just all day. Since the watch’s battery does not last 24 hours between charges, you will most likely answer “All day but not all night.” You may also answer “About half the time” or “Rarely if at all.” Figure 8-1shows this screen.
Question about how long you had your watch or iPhone on you yesterday
It will also ask you whether you engaged in any activities yesterday that were not recorded (Figure 8-2). If you say yes, it will ask how long and how vigorous those activities were. Finally, it will also ask you how many hours of sleep you logged last night (Figure 8-3).
Question about whether you engaged in any activity that was not recorded
Question about how much sleep you got last night
What Future ResearchKit Apps Will Do
As time goes on, you can expect that many more researchers will use ResearchKit apps as a means of tapping into a large population of potential test subjects. If one of these is on a subject that you would like to help advance, you can volunteer to participate. Ideally, the result will be a benefit to many people in the future and possibly even yourself.
This chapter covers the ResearchKit tool that researachers in a variety of fields can use to gather data from large numbers of Apple Watch users, thus increasing the statistical power of any conclusions they come to. The first applications are all medical in nature, but any research that can make use of the physiological parameters or movement data recorded by the Apple Watch is a candidate for a ResearchKit application.