Apple Watch could soon feature robust Stress monitoring capabilities

The upcoming watchOS 8 could feature stress monitoring and management capabilities.

Although there have been many rumors around newer health monitoring features such as blood pressure or the blood glucose level monitoring via Apple Watch Series 7, we think that it is more likely that Apple will unveil a robust stress monitoring feature this year.

Here’s why….

The need for Stress monitoring

According to a recently published Harvard health article, ongoing stress and the hormones it unleashes tend to push people toward overeating.

Overeating isn’t the only stress-related behavior that can add pounds. Stressed people lose sleep, exercise less, and drink more alcohol, all of which can contribute to becoming overweight.

According to APA (Amerian Psychological Association), we face a national mental health crisis due to the pandemic that could yield serious health and social consequences for years to come.

Apple has always had its finger on the pulse of its customer’s needs, and the company has adjusted its offerings accordingly.

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Since stress can lead to a variety of health problems, Apple must be exploring ways by which it can not only measure and monitor stress levels via the Apple Watch and offer intuitive mechanisms for people to beat stress and improve their overall health and wellness.

Solving the monitoring puzzle involves methods to reliably detect stress levels and offer services that can help mitigate them.

The first part of this puzzle has been solved during the peak of the pandemic.

Apple Watch Stress detection and Mt. Sinai Resilience monitoring study

According to researchers, Apple Watch has been tested during the peak of the pandemic for its stress monitoring capabilities and has performed well.

In a study conducted by Mount Sinai, the Apple Watch was used to measure healthcare workers’ stress and resilience during the pandemic.

A preliminary study of 361 Mount Sinai health care workers conducted between April and September 2020—a period that included the height of the COVID-19 pandemic in New York City—the researchers identified characteristics that indicate whether a health care worker is prone to worsening stress from the pandemic. 

They found that individuals with high resilience or emotional support were protected against the effects of stress and had different ANS stress patterns compared with those who had medium or low emotional support or resilience.

Training today app for HRV training apple watch
Intuitive interface with Recovery analytics and HRV

The physiological measurements were captured on Apple Watches worn by the participants, who downloaded a customized app. 

The researchers found that the participants’ physiological results aligned with their self-reported surveys.

This leads us to believe that an important study like this Mt. Sinai study has shown the efficacy of using the Apple Watch to monitor stress.

There is also another significant initiative in-flight…

US Special Forces Redline events and Apple Watch

US Special Forces use the Apple Watch to study red-line behavior.

The University of Southern California launched this study last year in collaboration and already inducted elite US warfighting groups.

  1. 250 warfighters from the 3rd Special Forces Group (SFG(A)) (Fort Bragg, NC) and 
  2. 250 warfighters from 1st Recon Battalion (Camp Pendleton, CA)
  3. Reconnaissance Marines 
Apple Watch and US Special forces
US Special forces are using Apple Watch to monitor stress and understand and monitor signs of degradation among US special forces using the Apple Watch.

This degradation has been loosely linked to behavior termed “red-line” events, such as alcohol abuse, suicide, and divorce.

However, there is a lack of comprehensive evaluation directly linking “red-line” behavior to physical and mental degradation.

This new study will continuously and comprehensively measure US Military Special Operation Forces (SOF) ‘s mental and physical status through a confidential and cybersecurity research mobile application (app) over a six-month period. 

Apple Watch provides continuous metrics to the app.

This suggests that the essential parameters collected via the Apple Watch and phone are being used to perform assessments for stress and evaluate critical decision-making capabilities.

Relationship of Stress levels and Heart Rate Variability (HRV) scores  

The basis of stress interpretation is not new. Researchers have used Heart Rate Variability (HRV) to understand the stress and ANS patterns.

Apple Watch is currently able to read and interpret your HRV scores. There is also the integration of HRV with the existing Breathe app. 

If you want to force an HRV reading on your Apple Watch, all you need to do is use the Breathe app.How to Analyze HRV (Heart Rate Variability) on your Apple Watch

Since, in all likelihood,  Apple’s stress management feature will leverage existing HRV measurements via the watch, it is very much possible that older Apple Watch models will also use Apple’s stress monitoring feature when released.

The other approach to monitoring stress is via measuring electrodermal activity. This would, however, require new sensors on the Apple Watch. 

Apple could very much surprise us by incorporating electrodermal sensors on the next watch, but we haven’t seen too many rumors around it this year.

Other wearables platforms such as Fitbit, Garmin, and Samsung are already providing stress score features using HRV scores.

Integration of Stress monitoring with other Apple service offerings

Now for the second part of the puzzle…

We think that Apple can do “Stress management” better than what other wearables offer today.

Here’s why.

By leveraging robust notifications and other integrations such as those offered via its current Sleep monitoring feature and Breathe app, Apple could provide a more comprehensive Stress Management feature.

Take this use case as an example.

Many users experience panic attacks due to episodes of high stress. 

In many cases, a panic attack triggers a fast heart rate, also known as tachycardia. The heart rate may speed up to 200 beats per minute or even faster. Apple Watch can easily identify this today and can distinguish it from an Afib event. 

When such an event occurs, the watch could alert its user and receive instructions such as breathing exercises to help manage the panic attack while allowing the users to use the SOS features built into the Apple Watch.

Role of VO2 max ( Cardio Fitness level) and Stress

When you stick to a regular workout schedule, your muscles, heart, and lungs adapt over time, making you fitter and stronger.

Experts measure this increase in fitness by testing your VO2 max, how much oxygen your body uses during a workout.

Currently, your Apple Watch shows this as Cardio Fitness levels.

When Finnish researchers monitored 44 people starting a new cycling regimen, those who rated their stress levels highest saw the least improvement in VO2 max in a two-week period, despite doing the same workouts as everyone else. 

There have been other studies that show the relationship between overall stress levels and aerobic fitness levels.

HRV Biofeedback apps
Marco Altini’s HRV apps are a great resource.

Apple could co-relate your HRV scores and your Cardio Fitness level scores and other important metrics to get a better sense of your overall stress and provide you with tailored resources that will help you beat the stress.

Apple Fitness+ Stress management offerings?

The other avenue where Apple could distinguish its stress management offerings is by adding in expanded mental health and stress management offerings into Apple Fitness+.

Currently, Apple showcases physical Fitness+ workouts rather than meditation, stress, and other mental exercises.

Although there are some Yoga and mindful cool-down features, Apple could easily integrate its stress management feature into new offerings in Apple Fitness+.

There are a handful of third-party Apple Watch apps that provide some form of stress score reporting. Apple Watch Stress Monitor app

Stress monitor and Stress Scan are two such apps that are used by many users today.

Although these apps have essentially leveraged HRV scores to produce stress heat maps and other nice features, they lack the deep integration required to offer any substantive stress management features.

Apple competitors such as Fitbit roped in Deepak Chopra for its mindfulness and meditation session offerings on its premium platform. 

We, therefore, think that it’s only a matter of time that Apple will start producing some serious mental health-related content offerings on the Apple Fitness+ platform and tie it with individual stress scores or partner up with Headspace or a similar firm to offer a comprehensive solution.

In Summary

Based on these studies and others and after evaluating the existing capabilities of the Apple Watch, we can only speculate that Apple may be on its way to offering a comprehensive stress monitoring feature via the next watchOS / new Apple Watch.

Apple’s WWDC is around the corner. We will be eager to see what new health and wellness features Apple has up its sleeve this year.

What are some of the health and wellness features you would like to see in Apple’s watchOS 8 and the Apple Watch Series 7?

References:

1.https://health.mountsinai.org/blog/new-study-uses-an-apple-watch-to-measure-stress-and-resilience-of-health-care-workers-during-the-pandemic/

2.Panick attacks versus Afib detection

3. HRV and Stress, Berntson and Cacioppo

4. Vagus Nerve as Modulator of the Brain-Gut axis

I am a technologist with years of experience with Apple and wearOS products and have a Bachelor’s degree in Computer Science. In my day job, I advise fortune 500 companies with their digital transformation strategies and also consult with numerous digital health startups in an advisory capacity. I'm VERY interested in exploring the digital health&fitness-tech evolution and keep a close eye on patents, FDA approvals, strategic partnerships and developments happening in the wearables and digital health sector. When I'm not writing or presenting, I run with my Apple Watch or Fossil Gen 5 LTE and keep a close eye on my HRV and other recovery metrics.

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