Could Wearables, Gamification and AI transform the National Health Service NHS?
David Wortley
Director
IORMA Health & Wellness Technology Centre (HWTC)
November 2024
I am a great believer in serendipity and, after planning to write this article today, I woke up to find a headline on my smartphone
“Millions to receive health-monitoring smartwatches as part of a 10 year plan to save the NHS”
People who know me will have heard my stories over the last 11 years about how wearable technologies and gamification transformed my health and well-being and led me to continuously explore many different smartwatches and mobile apps.
All of this experience taught me the principles of Lifestyle medicine and how this combination of technology and gamification can influence lifestyle behaviour change and support healthy ageing.
Today we can add Artificial Intelligence (AI) to the technologies that could help to solve many of the problems of the NHS which were recognised by the former head of the NHS, Sir Simon Stevens several years ago when he said :-
“It’s quite clear that the best chance we have for increasing our life spans and overall improving our health is to adjust our personal behaviours and to do so at an early age.”
He made the point that modern lifestyles and obesity are a timebomb that could threaten the sustainability of public health services and lead to the problems we face today.
There will be many barriers to implementing a universal policy of providing wearables to everyone and these include :-
- Stigmatisation of obese people
- Data privacy
- The “Nanny” State
- Discrimination based on health data
- Education on effective use of wearables,
- Involvement of global tech companies
However, this combination of wearables, gamification and AI, in my opinion, is a far better and more sustainable solution than “Quick-fix” obesity jabs that do not tackle the fundamental problem of lifestyle behaviour change and assuming some personal responsibility for personal health management.
To illustrate how I believe wearables, gamification and AI could transform lifestyle behaviours, I want to share my insights into the best approaches.
- Smartwatches vs Smart Rings
I began my health journey 11 years ago with a wrist band called the “Jawbone UP” whose associated mobile app enable me to monitor my steps, sleep and calorie intake.
This image shows the mobile dashboards of 3 different early wearable devices and their approach to gamification that involved showing you your daily, weekly and monthly progress. The Jawbone UP dashboard on the left also gave some generic health advice.
It has been noticeable that there has always been a reluctance from wearable device solution providers to provide specific health advice for fear of potential litigation and so they have instead given very general advice or referred users to academic articles on the topic.
Most of the devices I have used, and continue to use, have been smartwatches which, in my experience suffer from these main problems :-
- Relatively short battery life
- Need to be taken off in the shower (although many are waterproof)
- Temptation to constantly refer to them
- Do not monitor health parameters and collect data in real time 24/7
- Health data is not as clinically accurate as a medical device
Over the last year, I have begun using a smart ring which, in my opinion, is far more practical as a device with the potential to transform healthcare. The ring I use has the following advantages over equivalent smart watch devices.
- The battery life is very good – around 10 days between charges
- It is unobtrusive and can easily be worn 24/7
- It collects a wider range of health data including some which matches traditional medical devices
Today the smart ring I use has added AI to the mobile device to give me personalised insights into my data that I would like to share :-
This screen shows some important developments which I see as being an important part of a holistic approach to individual health and wellbeing that leverages the best elements of wearables, gamification and AI, i.e
- A dashboard showing an overall health index derived from all your health data
- An indication of the trend from the previous week/month
- An ability to “drill down” into sleep, vitality and balance
- Personalised reflections and advice based on the data.
The text below shows an example of my insights and advice :-
Sleep Insights
According to the data you provided, your sleep duration is generally maintained at more than 8 hours, and the proportion of deep sleep duration and light sleep duration is relatively balanced, which helps you get adequate rest at night. Your REM sleep duration also stays within a healthy range, which is crucial for memory consolidation and emotional regulation. A shorter sleep duration indicates that you have less sleep disruption at night, which is a sign of good sleep quality. Your sleep average heart rate and blood oxygen saturation are within the normal range, and heart rate variability also shows good stability, which indicates that your heart and respiratory system are functioning normally during sleep. Your time to fall asleep is usually very short, which indicates that you are able to fall asleep quickly, but one night it takes longer to fall asleep, which may be due to certain external factors or physical discomfort. It is recommended that your best time to fall asleep is between 21 pm and 23 pm to ensure that you can get 8 hours of adequate sleep. Lack of sleep can lead to mood swings, memory loss, and cardiovascular health problems, so getting enough sleep is essential to maintain your overall health.
Sleep index trend
The sleep index is an indicator for assessing your sleep health, calculated based on various metrics such as total sleep duration, sleep efficiency, sleep latency, sleep heart rate, sleep oxygen levels, and HRV, etc.
Activity insights
“According to your exercise activity index, number of steps, exercise time, exercise distance and calorie consumption, combined with your 75-year-old age, 172cm height and 84kg weight, we can calculate your BMI index to be about 28.4. According to the World Health Organization, this value falls into the overweight range. Long-term overweight may increase the risk of health problems such as cardiovascular disease and diabetes. Therefore, it is recommended that you pay attention to your diet, appropriately reduce the intake of high-calorie foods, and increase the amount of daily activities to help control your weight. Judging from the number of exercise steps and the total exercise distance, your average number of steps this week exceeded 10000 steps, and the average exercise distance also exceeded 7km. This is a very positive exercise habit. In order to further improve your health, it is recommended that you try a variety of exercise methods, such as adding some strength training to enhance muscle strength, or try some low-intensity aerobic exercises, such as brisk walking, swimming, etc., to improve cardiopulmonary function. At the same time, maintaining a regular schedule and ensuring enough rest time every day is also an important factor in maintaining health.”
Activity index trend
“The activity index is an indicator for assessing your exercise status, calculated based on various metrics such as daily steps, distance, calories, and exercise volume.
Vitality Index trend
Your Vitality Index trend has shown a steady upward trend overall this week, showing that you are doing a good job of maintaining vitality and energy. From the beginning of the week to the weekend, although your vitality index fluctuates slightly, it remains at a high level as a whole, which shows that your daily routine and exercise habits are quite regular. This level of vitality helps maintain good physical and mental health, which has a positive impact on your overall health. Please continue to maintain such a good habit, adjust the exercise intensity and rest time appropriately to maintain the balance of vitality and energy.”
Future Developments
Today, the information provided is in text and graphical format but the rapid developments in AI are likely to see the introduction of virtual health coaches on your smartphone or web browser delivering the same kind of insights to you like the video below :-
Epigenetics
Whilst my experience has been that socio-economic circumstances are one of the most important factors giving people the ability to change lifestyle behaviours , the role of genetics and inherited genes can also affect lifestyle medicine advice and adherence.
In my case, having a DNA test primarily to discover my family genetic origins led me to discover that I had a 50% greater chance of getting Diabetes 2. It was this discovery that prompted me to try to manage my health better.
There are a number of epigenetic solutions aimed at giving personalised dietary advice based on genetics.
MUHDO is one such solution that involves using a DNA test to provide both personalised exercise and diet recommendations alongside analytic data that shows your genetic propensity for various medical conditions along with analyses of your general health by using facial scans from your smartphone.
A proof of concept project put together at @Precision Life some years ago sought to extend these capabilities further through the use of big data analytics that consider both medical prescriptions linked to health problems and epigenetic dietary advice. The profile above shows an example of a patient profile.
Big data analytics is then used to identify the optimal diet for this patient based on a variety of interactions between drugs and diet.
This data is then used to help the patient when shopping by giving recommendations and advice on the best foods to put into the shopping basket.
Longevity and Ageing Younger
About 6 months ago I joined a brand new gym concept designed primarily to help older people “Age Younger”. The owner of this pilot gym in Milton Keynes, @Neil King, aims to provide a holistic approach for improving personal health management through this combination of technology, gamification and AI.
This pilot recognises the need to improve strength, cardiovascular, metabolic and stiffness health through lifestyle medicine strategies aimed at exercise and diet and nutrition.
Final Thoughts
This combination of wearable (and other) technologies, gamification and AI has enormous potential for transforming the health of the nation, improving the services offered and sustainability of the NHS and making a positive difference to the lives of both patients and clinicians. Implementing this strategy however is fraught with difficulty and avoidable dangers that come with any large-scale ambitious project.
This would be my advice to @Wes Streeting and the new Govt :-
- Do not be seduced by global health giants into massive investment at a national level other than to ensure that the infrastructure and compatibility with clinical digital health records is ensured.
- Begin with community-based pilot projects based on the use of different types of wearable and other technologies in different types of demographic areas with different age ranges
- Seek partnerships with organisations like @British Society of Lifestyle Medicine (BSLM) who have proven practical experience in lifestyle behaviour change
- Focus on the use of a “Health Index” based on agreed clinical parameters as a means of both engaging/motivating behavioural change and providing evidence of effectiveness
- Make participation in such pilots entirely voluntary
- Provide guarantees for both data privacy and non-discrimination based on health
- Use a “Group Dynamics” approach to engage/motivate users – this has proven success with organisations like BSLM and @GoodBoost
- Emphasise the health benefits of wearable for tracking changes in health and providing early warning of potential problems
- Use AI ethically and ensure to keep “humans in the loop”
- Avoid organisations offering expensive solutions aimed at those who can afford them rather than those who have the greatest need.
- Ensure both multi-disciplinary and multi-sector involvement in the strategy and include policy makers, technologists, retailers, food industry and social influencers as well as health professionals
The future of the NHS is in the hands of every man, woman and child!!
Declaration of Interests
I do not believe that I have any conflicts of interest in this article in that I have no vested financial interests. This article is based on my experience as a user of technologies, membership of named organisations and personal contact with named individuals