The wonderful world of wearables for wheelchair users

Wearables, such as health and fitness trackers, are gaining in popularity. More and more people are using them to monitor a variety of health indicators, such as heart rate, oxygen saturation, basal body temperature and sleep parameters. Fitness trackers measure, for example, calories burned, distance travelled, intensity, or total amount of physical activity per day.

Such health and fitness data give the wearable users real time feedback into how they are responding to daily events, such as a new workout routine. In addition, the features of certain wearables, such as the Apple Watch, provide an increased sense of security and promote a more active lifestyle among wheelchair users.

There is an ever-increasing array of wearables available on the market. They range from smartwatches (e.g., Apple Watch) and rings (e.g., Oura Ring) to chest straps (e.g., Polar) and armbands (e.g., Fitbit). However, which device suits the user? This depends on what one wants to track and what goal one is pursuing.

Despite an abundance of fitness trackers, the uptake among wheelchair users remains low. This is likely due to the belief that there are no suitable devices for them. In this blog we would like to introduce you to some wearables, inform you about their benefits, and address issues with the trackers.

“Wearables are the most important gadget for wheelchair users. They are extraordinary assistive device which enhance the user's independence and safety.”

Franz Rullo, wheelchair user and Apple Watch user from Switzerland

Community user Franz Rullo with his Apple Watch. (Copyright: Franz Rullo)

The Apple Watch as a pioneer of wearables for people in wheelchairs

The benefits arising from using wearables are manifold. There are still only a few devices that are suitable for people who use wheelchairs. The most prominent ones are smartwatches designed by Apple.

Since the introduction of the Apple watchOS 3 operating system in 2016, Apple has integrated a wheelchair mode into the device. If you indicate wheelchair use in the “Health Details,” the Workout app offers the options “Outdoor Push Walking Pace,” “Outdoor Push Running Pace,” and “Hand Cycling.” The Apple Watch counts pushes instead of steps.

The Apple Watch models Series 11, SE 3, and Ultra 3 also feature various safety functions that are attractive to wheelchair users. These include Fall and Crash Detection, as well as emergency calling. The watch detects falls and car crashes via various sensors. In response, it communicates with the person. If they remain unresponsive, an emergency call is made to the person’s emergency contacts and emergency services. The person’s GPS coordinates are also transmitted. Our Community member Franz Rullo explains that this feature is of integral importance for him because it has helped him feel less vulnerable and helpless in certain situations

The Apple Watch Series 11 (left), SE 3 (middle) and Ultra 3 (right) enhance the safety and independence of people who use wheelchairs. Here is a comparison of the three Apple Watch models by price and features. (Image source: https://www.apple.com)

Specifically, the Apple Watch Ultra 3 an additional safety feature, the siren. It allows the user to emit an alarm that increases in intensity and can be heard up to 600 feet away. This siren can be useful if someone is being threatened or needs assistance, e.g., being unable to navigate a certain terrain without assistance.

Franz owns the Apple Watch Ultra 3. As he says, he has yet to find anything comparable to these devices. He explains that the Apple Watch reduced his fear and reluctance to go on tours in the forest or in cities. Additionally, the loved ones of wheelchair users can rest assured that if something was to happen to the wheelchair user, they would be promptly notified.

“The technology is there, so if you are fearful, like I used to be, dare to try it!”

Franz Rullo, wheelchair user

Another advantage of the Apple Watch for people with disabilities is its accessibility features. For people with limited hand motor control, e.g., those with tetraplegia, AssistiveTouch can be helpful: it lets you control the watch using hand gestures without having to tap the display directly.

For people with limited vision, the Apple Watch offers VoiceOver. This built‑in screen reader reads aloud what’s shown on the display and supports navigation through menus and apps.

Garmin establishes the wheelchair mode

For a long time, Apple and its ecosystem were considered pioneers in accessible wearables. Meanwhile Garmin has caught up: with the Garmin Venu 3 introduced in August 2023, a wheelchair mode was integrated for the first time. This is also supported by newer Garmin models such as the Venu 4 and the Vivoactive 6. Here is a comparison of prices and features of the various Garmin models.

The Garmin Venu 4 (left) also records movements as pushes rather than steps when wheelchair mode (centre and right) is activated. (Image sources: left https://www.garmin.com/, centre and right https://www.garmin.com/)

In wheelchair mode you can choose between fast and slow wheelchair rolling and handcycling (the latter not available on the Venu 4). There are also several animated workouts for people in wheelchairs, e.g., strength training, HIIT, yoga, and Pilates.

One drawback of the Garmin shows up in safety. The Apple Watch automatically detects falls or crashes and, in an emergency, can trigger an automatic emergency call with location data even in wheelchair mode. By contrast, Garmin’s incident detection is not available while wheelchair mode is active. There is also no siren function. On the plus side, Garmin scores points for a significantly longer battery life than the Apple Watch and for a feature that reminds users to do pressure-relief exercises to prevent pressure sores.

Data sharing of health trackers with medical professionals

A fitness tracker itself does not make the wearer a healthier individual; rather it can be seen as a health-promoting tool. To reap the optimal outcomes from this device, it is essential to share one’s data with medical professionals or personal trainers.

In fact, the simple collection of health-related data is not particularly beneficial. Claudio Perret, researcher at Swiss Paraplegic Research in Nottwil, points out that the data should be properly analysed, interpreted, and implemented. Only then can the fitness or health tracker help produce the desired health-enhancing effects.

Claudio Perret is a sport scientist specializing on neuromuscular functioning and mobility at Swiss Paraplegic Research. He also coaches athletes with spinal cord injury and received the Swiss Olympic Coach Award for para-sports in 2021. (Copyright: Swiss Paraplegic Foundation, Photographer: Sabrina Kohler)

First, an individual must understand their health data. Based on their findings, they can discover what areas need improvement (e.g., more sleep), and then affect behaviour change to yield the desired results (e.g., develop a more regular sleep routine). They can also share their data with their loved ones, who can track the health status and developments of the wheelchair user as well.

Beyond one's partner or caregiver, it is also useful to share the data with medical professionals. Since it can be overwhelming for a person to interpret their health data alone, a doctor can assist this process. If someone feels unwell or has detected an abnormality in their data (e.g., an elevated heart rate), they can send this information (e.g., an ECG recording from the smartwatch) to their general practitioner. Via a teleconsultation or an in-person visit, if necessary, the doctor can inform the person of any steps that may be required to address the problem. It is important to note that a wearable cannot and should not replace a healthcare professional.

Additionally, wearables offer healthcare workers a unique opportunity to gain insight into a person’s daily functioning and health state. The doctor and patient can collectively investigate the data and come to a shared decision about what next steps could be taken to improve the person’s health. For example, an elevated resting heart rate may signal that someone is experiencing a cold or flu. It may also suggest that it may be beneficial to incorporate more physical activity into their daily routine.

“Resting heart rate is a simple but powerful measure, to see if you are increasing your cardiorespiratory fitness level.”

Wiebe de Vries, researcher

Wiebe de Vries is attaching measurement devices to a study participant in a wheelchair. Wiebe is doing research at on shoulder health and mobility in wheelchair users at Swiss Paraplegic Research. He is also working on the applicability of sensors to track wheelchair mobility metrics. (Copyright: Swiss Paraplegic Foundation)

Data sharing of trackers with fitness coaches

A fitness tracker can be a great motivator for people to become more active, researcher Claudio Perret explains. However, when seeking to change behaviour, it has been shown that a fitness tracker alone does not suffice. A person is more likely to maintain positive health behaviour, such as regular exercise, if they are accompanied by a coach.

This personal trainer can help a person reach their desired fitness goals. Based on the measured health data, the trainer and the person can design a tailored program that meets the individual's fitness-related needs. For example, if a person is striving to lose weight, consultation with a dietician and coach provides support in the development of a weight loss promoting lifestyle.

Regarding exercise recommendations for people with spinal cord injury, they are good general guidelines, however, they may not be the correct fit for everyone. Everyone is at a different stage on their fitness journey. Making slow and steady progress towards achieving one’s personal fitness objectives is key. Each meter of movement is better than doing nothing, as Claudio Perret puts it.

Claudio Perret is doing research related to physical activity of wheelchair users. (Copyright: Swiss Paraplegic Foundation, Photographer: Beatrice Felder)

When it comes to exercise, the most sustainable approach is to choose an activity that one finds enjoyable. “Becoming a mere gym sponsor via one's membership is not very beneficial”, researcher Wiebe de Vries points out. However, when a suitable and pleasurable physical activity is found, one can gain new insight, awareness, and connection to their physical bodies.

“Wearables are tools to learn about what you cannot directly feel.”

Wiebe de Vries, researcher

Areas of improvement for wearables

So far, the Apple Watch has not generated any negatives for the Community user Franz Rullo. However, there are various concerns linked to wearables. These include costs, wearability, and data privacy issues.

The cost of many wearables limits who can access them. The Apple Watch, for example, is expensive. It must be used with an iPhone, which is also a costly device that not everybody owns. Nevertheless, users like Franz Rullo report that it is a worthwhile investment, due to its unique wheelchair adapted features.

Cheaper generic fitness trackers do exist, however, they may be less well adapted for wheelchair users. For example, currently, there is no fitness tracker with a wheelchair mode available in any Android wearables.

The James B7 safety watch, which was rated the best in a test carried out by the Swiss-German television programme “Kassensturz,” is considered especially user‑friendly and has only one button. Up to ten emergency contacts can be stored; in an emergency they are called sequentially while an SMS with location data is sent. However, the built‑in fall sensor is sensitive and can trigger false alarms.

A wearable also has the potential to be bothersome on a physical level for wheelchair users. A smartwatch, for example, may not be comfortable, since it interferes with pushing the wheelchair. Alternative locations for fitness trackers may be more appropriate and require further investigation.

Data privacy is also a major limitation linked to tracking devices. Personal health data is particularly sensitive. Therefore, data protection is essential. However, whether these devices meet all data safety criteria is not well-known. When considering a health tracker, one should evaluate if the loss of control over one's health data is compensated for by the benefits of the wearable.

“Most devices are data security Emmentaler, filled with many holes.”

Franz Rullo, wheelchair user

Outlook to future developments of wearables

In the next years, research on wearables will certainly develop. Dedicated researchers and passionate entrepreneurs will optimize existing wearables and create innovative new products. Additionally, more attention, investigation and funding will hopefully be put into wheelchair user friendly wearables.

Wiebe de Vries is attaching sensors to a research participant to measure physical exertion related parameters. (Copyright: Swiss Paraplegic Foundation, Photographer: Walter Eggenberger)

With more choice on the market, wheelchair users will be able to select a device suited for the parameters they wish to track. Therefore, the emerging wearables can be highly personalized and specialized to each user. The devices will also become more accurate and reliable.

Besides, as digital literacy improves and designs are optimized, wearables will be more intuitive in their use. To further enhance the user experience, the devices of the future will likely be smaller and less intrusive than the ones currently available. This will make them more comfortable and convenient to wear.

And rather than having wearables on the human, why not place them on the wheel instead? A wearable for wheelchairs is a concept that is currently being researched, including by Wiebe de Vries. This would ensure that wheelchair users would not be burdened by wearing the device.

The device would track all the movement the wheelchair does and would be able to capture most of the user’s activity. However, it cannot detect whether movement was assisted, e.g., someone else was pushing the wheelchair. Also, any activities a person does outside of the wheelchair cannot be monitored, e.g. physical therapy exercises. Though it is certain that these limitations will be overcome soon.

“In the domain of wearables, there have been quite some developments. But I believe a lot is still to come.”

Wiebe de Vries, researcher

Finally, the issue of costs will hopefully be addressed by insurances. Since wearables enhance activity levels, independence, and safety for wheelchair users, it appears plausible that health insurances will come to consider them as assistive devices. They will then either cover some or all costs associated with these devices, ideally soon. But even if this does not occur, due to the wide range of available products, an appropriate wearable will likely be found for people with lower incomes, as well.

Conclusion

There are various advantages to using wearables as a wheelchair user. These include possessing a greater sense of security and thus more freedom; and access to useful health or fitness indicators.

To make sense of the wearables’ data, sharing it with health professionals and personal trainers is crucial. In collaboration, personalized fitness programs, dietary plans or sleep schedules can be developed.

Overall, a wearable can be viewed as a tool to gain insight into one’s body and how it reacts to life events. It provides the user with additional autonomy and agency through this newly acquired knowledge.

Despite some issues such as cost, usability, wearability, and data privacy concerns, these devices are generally recommended for wheelchair users. It would be beneficial if doctors, other healthcare professionals and organizations informed wheelchair users about the usefulness of a health tracker. Currently, the Apple Watch is still the most suited device for wheelchair users.

If you decide to buy a health tracker, enjoy the journey of “discovering” your bodies and harnessing the new possibilities associated with this device!

Franz Rullo with a friend on a ride on their mountain handcycles. (Copyright: Franz Rullo)

 

The author does not have any conflict of interest. Nor is the author endorsing acquisition of one of the products listed above. For example, Apple is not sponsoring the author to write this text.