Optimizing Athletic Performance and Safety With Wearable Technology

Abstract

Background:

Utilization of wearable technology can optimize athlete safety via monitoring and analyzing performance, transmitting real-time data to trainers and athletes, and providing biofeedback to users. Recent improvements in the size and durability of wearable sensors, sensor battery life, and the integration of web-based data storage have enabled sensors to be easily used both on and off the field for prolonged periods.

Indications:

In addition to optimizing physical performance during competition, wearable technology can also reduce the risk of injury through monitoring workload and identifying warning signs, improving rehabilitation and recovery, and predicting future physical performance.

Technique Description:

Wearable technology can calculate external workload, the physical or mechanical work performed by athletes, internal workload, and the physiologic response of an individual athlete to the external workload and environment.

Results:

Recently, such technology has been integrated into the National Football League for load management and Major League Baseball to monitor throwing workload and intensity during recovery. Data from wearable technology are expected to provide real-time biomechanical and physiologic data that can help quantify sport-specific performance and correlated injury risk. Muscle oxygen saturation, a biometric that can be collected through certain wearable devices, can track recovery in athletes.

Discussion/Conclusion:

This allows for comparison between surgical and healthy athletes to track recovery of normal physiology over time. This physiologic data can aid in a safer, timelier return to sports. Future validation of devices and data security are crucial for future adoption of this technology.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Graphical Abstract

This is a visual representation of the abstract.

Video Transcript

Welcome, my name is Helina VanBibber, and I am a second-year medical student at Case Western Reserve University. I also work with University Hospitals in Cleveland. The goal of this talk is to discuss the role of wearable technology in sports medicine and how it can be used to monitor athlete safety and optimize athletic performance. Wearable technology encompasses all noninvasive sensors worn on the body. Sensors may have a variety of sizes, but they universally perform similar tasks—including monitoring and analyzing performance, transmitting real-time data to trainers and athletes, and providing biofeedback to users. ¹⁸

Background

While technology in general has been able to do the above, it is only recently that we have been able to do so with wearable sensors in a noninvasive fashion. Recent improvements in the size and durability of wearable sensors, sensor battery life, and the integration of web-based data storage have enabled sensors to be easily used both on and off the field for prolonged periods.^19,7

With advancements in artificial intelligence, we are closer to creating systems that can interpret large datasets autonomously and provide meaningful feedback, removing the burden from physicians, trainers, scientists, and athletes alike.^20,26

Based on the current status of technology, wearable sensors seem best used to:

1. Optimize physical performance during competition

2. Reduce the risk of injury through monitoring workload and identifying warning signs ¹⁴

3. Improving rehabilitation and recovery ²³

4. And predicting future physical performance ⁸

While these goals can certainly change, they best align with the capabilities of current wearable technology.

With regard to the actual measurements, wearable technology falls into a couple of domains. The first domain is external workload. External workload is the physical or mechanical work performed by athletes. ²¹ This workload can be prescribed during training or incurred during competition. It is dependent on numerous factors related to the internal physiology and psychology of the athlete as well as the conditions of the external environment. ¹⁸

These wearable sensors measure external workload in a couple of ways. First, some sensors derive motion-based metrics via accelerometry and global positioning systems.^5,13 Second are Inertial Measurement Unit systems, which provide linear and rotational movement, such as angular velocity, and sport-specific movement patterns, such as pivoting and cutting. ³

In addition to external workload, some of the newer sensors can measure internal workload. Internal workload reflects the physiologic response of an individual athlete to the external workload and environment. In general, internal parameters fit within a few broad categories. These categories are systemic, or whole body, response, and local response. ¹⁹

One great example of a systemic parameter is the cardiovascular response to a workout. Within the cardiac bucket, variables such as arrhythmia, heart rate, heart rate variability, and resting heart rate have all been studied in great detail and linked to overall health and performance.^9,15 A newer variable includes training impulse response, which is an attempt to both learn the individual physiologic response to exercise and predict future performance based on the learned response. ⁸ While less studied, thermoregulatory parameters can importantly help with heat training and acclimation, exertion during exercise, prevention of heat-related illness, and optimization of cooling protocols.^6,12,16

Within the internal workload, new emerging technology has focused on local parameters. ¹⁰ The two examples include muscle oxygen saturation and nitric oxide. Muscle oxygen saturation provides a quantitative measure of local muscular performance, derived from oxygen utilization physiology, and reflects vascular tone, blood flow, and the binding/unbinding of oxygen to hemoglobin.^19,23 Nitric oxide is thought to play a similar role in red blood cell and vascular physiology. While data on this are emerging, these parameters have been characterized in the literature through invasive testing. Included is an example of a wearable sensor that helps to create the continuous SmO₂ curve during exercise.

These are examples of real-life wearable devices that measure internal workload. Included is a core body temperature device. ⁶ This also shows multiple examples of electrocardiogram wearables.^24,15 It is important to note that all these devices have minimal footprint, do not impede athletic performance, and are built to operate for multiple hours in a variety of environments. ¹⁸

Technique Description

Now that we have laid the groundwork for much of the wearable technology today—including the types of data they measure—the next logical focus is the translation of wearable product data into clinical applications. This can be done during training, in-game, and during recovery.

During training, the National Football League (NFL) has used accelerometry and global positioning system devices for load management. Using the specific data shown here, an NFL team was able to correlate the athlete's risk of myotendinous and ligamentous injury with a higher workload, an acute-to-chronic workload ratio, and the timing of increased workload. ¹⁴

In-game, newer devices can help provide for real-time assessment of workload. A live feed of acceleration efforts, total work over the course of competing, heart rate, and core temperature can help track athletes to prevent reaching critical workloads when performance drops or when injury may occur.

These two figures are examples of how athlete workload has been tracked during the preseason and regular season and correlated with injury risk. ¹⁴

Especially during recovery, wearable devices can help moderate workload to optimize recovery both during regular sports performance and in response to injury.

For example, acute and chronic workload in response to throwing can be measured and tracked both for an individual over time and for an entire roster.^1,4,11,25

For throwing specifically, rotator cuff testing has been used to risk-stratify athletes for both general shoulder injury and shoulder injury requiring surgery, based on internal and external rotation strength, external and internal rotation ratio, and supraspinatus strength.^2,4

Muscle oxygen saturation is another parameter used to track recovery, either by comparing surgical athletes with healthy athletes or by tracking a single athlete over time.^23,20 As shown here, muscle oxygen sensors can be worn with aerobic and strength exercises, allowing for direct comparison of muscle oxygen consumption between a surgical and a healthy limb, or in the same athlete over time.

Results and Discussion

In summary, wearable devices help to identify and produce biometric data (both internal and external) that were previously only measurable with invasive machinery. While there is much promise to this, future research needs to help elucidate the following to maximize the impact that these variables have on live athletes:

1. Translation of basic science data to enable use in wearables

2. An understanding of where biometric data is needed

3. The interaction of important biometric variables with each other

4. Increased sampling of both the amount and type of biometric data to identify statistically significant conclusions

5. Application of biometric data to live athletes in training, in-game, and during recovery

6. Validation of wearable sensor performance

At the moment, there is little scientific validation for most of these products. One study reported that only 5% of 61 consumer wearable technologies matched demarcated claims within an acceptable reference standard. ¹⁷ Moving forward, scientific validation needs to be emphasized as new technologies are adopted.

Finally, new barriers will be encountered regarding data privacy and ownership. These barriers also need to be addressed when moving forward. ²²

With this, we would like to acknowledge the teams that helped put this talk together—including the University Hospitals Sports Medicine Research Team led by Dr. Voos, Dr. Seshadri at Lehigh University, the Case Western Reserve University undergraduate students, as well as funding through the AOSSM Playmaker grant and the Aircast Foundation grant.