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It's estimated that almost half of Americans now use wearable technology to monitor their health. Whether using a smartwatch, ring or fitness tracker, we have access to a steady stream of data that tech companies say can tell us about everything from our sleep to our metabolic and heart health. But is that sleep score or biological age your wearable suggests real? In this episode, we examine wearables, the data they offer and what they can and can’t tell us about our health.
Expert: Dr. Eleonora Avenatti, cardiologist and obesity specialist
Notable topics covered:
Why we’re drawn to hyper-personalized health data
The differences between wearables and medical-grade devices
How reliable are wearables at detecting hypertension, AFib and other heart conditions?
Which metrics produced by your wearable you can trust
Can AI help us make sense of our health data? Is it safe?
How your doctor may feel about using wearable technology
- Tips for using this tech responsibly
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ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore, I'm a photographer and editor here, and I'm also a longtime podcaster.
KIM RIVERA HUSTON-WEBER: I'm Kim Rivera Huston-Weber, and I'm a copywriter here at Houston Methodist.
ZACH: And Kim, are you a fan of fitness trackers, wearables?
KIM: Yeah. You know, I've -- Jeez, I think I got my first one maybe 15 years ago. Do you remember, like, those tiny, tiny smart pedometers?
ZACH: They clip on your belt?
KIM: Uh-huh.
ZACH: I never had one but I saw people who had one.
KIM: Oh yeah, no. Those were very popular with one of the companies I used to work for.
ZACH: And they just tracked your steps, right?
KIM: Just tracked your steps.
ZACH: But technology has evolved hasn't it, Kim?
KIM: Oh, has it. And, I -- The one that I have is probably a decade old now, and so.
ZACH: And you still use it?
KIM: I still use it.
ZACH: Okay.
KIM: But it does not have all the whiz-bang features that the new ones do.
ZACH: I think the first one I had, wearables, as we're calling them now, I don't know if we called them that then, but we call them that now. Wrist, you know, it was like a watch and it tracked steps, for sure, then tracked -- I think it tracked heart rate as well. This is like 10 years ago so it was still -- still in the kinda early age of the digital wearable. And I liked wearing that. I wore it a lot, and it was always very satisfying when it buzzed and you met your step goal for the day, and -- But it was very basic, it was like LED screen, basically like an alarm clock level screen. Now, we have such amazing technology now, we can track so much of our health on these things.
KIM: Yeah, and the tech's just more sophisticated. There is ECG technology so it can tell you, potentially, if you are having AFib or high heart rate. I think some might give you hypertension notifications now. It's kind of out there in terms of this, like, very hyperspecific data you can get.
ZACH: But how much can we trust these wearables? That's what we're talking about today, and who did we talk to, Kim?
KIM: Yes, we spoke to Dr. Eleonora Avenatti, she's a Cardiologist and Obesity Specialist here at Houston Methodist.
[Sound effect plays to signal beginning of interview]
Thank you so much for being with us today, Dr. Avenatti.
DR. ELEONORA AVENATTI: Well of course, thanks for having me. This is gonna be fun.
KIM: Yeah! So, health tracking using wearable devices has become increasingly popular over the past decade or so. What started with smart pedometers has expanded to watches and rings. And the manufacturers of these devices say they can give us insights into everything from our sleep quality to our heart health, fertility tracking, and some say that they can even help us, you know, calculate our biological age. So, why are consumers so drawn to this technology and the very hyperspecific health data that it purports to provide?
DR. AVENATTI: So, I think there's two components there, and one is those devices fill in a gap in what the knowledge of people is regarding their own body. You know, people can go to the physician, maybe they have their annual, maybe they have some specialists they see with a certain frequency because they're particularly focused or they have a health condition. And so, in those encounters they get a very in-depth, specialized assessment of whatever it is. And then, there's this kind of void in which they're left for the rest of 6 months or every, you know, a year if they do yearly checks. And so, they kind of need that guidance that comes from the numbers that they use to discuss with their physicians and it's just not there in between those visits. So, that's one aspect. And then, you have the other population of patients who never saw a physician, right? But they're still interested in what their health is, and maybe focusing more on wellness more than treating diseases, and that's a way to get insight on their own health. And then, when it comes to the hyper-personalization of those data, that is really something that has been missing, and is still missing from the general literature and science publication and data, right? Whenever we look at data in science we have these huge databases and we have the clinical trial results. All the good data we have its aggregate, and that gives us an answer on what the average response is to "X" treatment, how much weight people on average lose on the newest drugs, but it doesn't tell the single patient what they can expect from that. So, I think those are two very important factors that drive people to those devices, kind of having a better insight on their own specific issues.
KIM: Yeah. And so, I noticed that the FDA recently updated their guidance on non-invasive wearables. Some of them that measure blood pressure or blood glucose, and said that these could be used as wellness devices rather than medical-grade devices. And I think as long as they meet the definition of being low risk, of course. So, I think it's trying to maybe, open up the market a little bit and get innovation going. But I do think it's important to know so, what are the differences between a wearable wellness device and something that is medical-grade and used for diagnosis and treatment?
DR. AVENATTI: Right, I think you're hitting on a very good point there and I think we have all to remind ourself those are two incredibly different things. So, the bottom line is a wearable that's marketed for wellness tracking it's something that you can use to track yourself, and I would say the best use in that way is compare yourself to yourself through time. And it can be helpful in screening to kind of raising red flags. But it cannot be used and should not be used for diagnostic purposes, meaning we are not at the place where we can use the wearable devices to make a diagnosis of arrhythmia or blood pressure disorders. And that is because the FDA said those are wellness devices and not health standard devices. The process to get those to market is completely different. A health care device is subjected to strict controls and validation. We know how they work and we can replicate those number over and over and over and over, and so those number are precise and reliable, meaning that they specifically measure what they're supposed to measure and under different condition the number is still gonna be the same. On the wearable we don't have the same degree of those certainties. And so, again, it's helpful to track yourself over time, you can see trends, and I think that's very important, and it can raise the red flags. Say, "Hey, something's off, why don't you check?" That check has to be the health care device. That check has to be talk to the physician and see if there's anything that has to be digged out.
KIM: You kind of helped me get to my next question. So, I have a wearable, this thing is probably almost ten years old now, it is -- I'm an earlier adopter, let's say, but –
DR. AVENATTI: The enthusiasm.
KIM: Yeah, by -- but by the tech standards this thing is a dinosaur, and things have gotten a lot better, some now have electrocardiogram (ECG) technology among other sophisticated tech. So, I'm curious to know what reliability or, I guess I would say, accuracy do these devices have when we're thinking of heart conditions, whether it's AFib, heart palpitations, and some now some even say that it can help identify hypertension.
DR. AVENATTI: So, multiple things to unpack there but let me start with the first.
KIM: Mm-hmm.
DR. AVENATTI: Technology progress. Obviously technology has boomed, and I'm not a tech expert, I'm the tech dinosaur probably, and I do have a wearable that's a very basic one, okay. We can go back to that.
KIM: Mm-hmm.
DR. AVENATTI: But, I'm not trying to convince anybody that ten years ago trackers are the same as of today, it's not my point. But the way we're using them should still be the same.
KIM: Mm-hmm.
DR. AVENATTI: Right? So, despite technology improvement they are still useful to raise flags and not for diagnosis.
KIM: Mm-hmm.
DR. AVENATTI: And so, my point is there's a lot of marketing in all of this, and you're probably not gonna go out and buy a ten-year-old device regardless, right?
KIM: Yeah.
DR. AVENATTI: But I don't think that there is a need, necessarily, for health purposes, to update your 5-year-old smart watch or, you know, pedometer...
KIM: Mm-hmm.
DR. AVENATTI: Just because. And that goes back to how reliable are those when we're talking about medical condition. And going back to the FDA standard I would say they're not, absolutely not.
KIM: Yeah.
DR. AVENATTI: And if I had to pick one parameter that I would trust those devices to be good across the spectrum of aging or across the spectrum of cost is your heart rate.
KIM: Mm-hmm.
DR. AVENATTI: Because, honestly, that's the only thing, mostly, those devices can directly measure. Everything else so derived in some way by some algorithm that combines the heart rate with the way you're moving around and the velocity at which your hands are moving if you're wearing it on your wrist. But the direct measurement is really just your heart rate. And so, things like your heart rate, heart rate variability, and how regular your heart is those are the most reliable measures. On specific devices the EKG has become pretty good.
KIM: Mm-hmm.
DR. AVENATTI: So those are the two things that I would focus. If a patient has a known arrhythmia I still would want to have a full EKG to call atrial fibrillation for example. On the blood pressure management, interesting, we had new guidelines coming out in 2025 by the AHA, ACC, so the big cardiovascular societies in the United States. And there was a specific paragraph saying that blood pressure measured with wearables is not to be considered clinical. So, we should not rely on those numbers. And I'm saying, don't throw it away but know that it's not the direct measurement and the way it's extracted from the heart rate and pulsation its proprietary for every single device, and we have no insight on how those algorithm were created and so not the best thing to do. Now, it raises a question go talk to your physician. Absolutely, that's a good way of thinking of that.
KIM: So really heart rate is what is the kind of gold standard among all of these devices?
DR. AVENATTI: Correct, because that's the only thing they do directly measure through, basically, the optic, like, impacting in your vessels at your pulse level. They literally see the pulsation in your vein through some light. And the other thing that can be measured that way is through your pulse ox, so your sats.
KIM: Yeah.
DR. AVENATTI: Basically.
KIM: Yeah, because a lot of these devices offer things like the biological age or they're saying how much, like, load you have on your body.
DR. AVENATTI: Yes, yes.
KIM: So, are you just for clarity, are you saying that we should take those kind of measurements with a grain of salt?
DR. AVENATTI: Oh, two grains of salt. [Laughter] And, don't get me wrong, I look at my numbers basically on a daily basis but, again, the only direct measurements are very, very limited, and it's your heart rate and maybe your SO2, so your stats, and maybe how much activity you had the day before. But, they're not perfect, you know. They're smart devices but they're not perfect. I was sitting in Houston traffic the other day coming to work and I was listening to something that evidently, didn't agree with my body and my tracker goes off, it was like, "Oh, good job exercising," because my heart rate was 140. I was like, yeah, no. [Laughter] No, I just saw someone swerve in front of me. [Laughter] Right. That's not good exercise that raised my heart rate.
KIM: Yeah.
DR. AVENATTI: Or, you know, the other example might be on your sleep habits tracking. We know good sleep habit and having a regular sleep schedule helps with longevity and all of that. And so I -- On my wearable I have my set sleep schedule and a few months ago I got a notification that's like, "Hey, you should really get back on your sleep schedule. You've been losing, blah, blah, blah." I said, "Yeah, tell that to my teething baby." It's like, I'm trying. [Laughter]
KIM: Yeah.
DR. AVENATTI: So again, my point is those numbers are made up. And they come up with, you know, "Your readiness for today is moderate," based on some algorithm that somebody decided to put together. Nobody validated that, nobody ran a clinical trial, right? So, it's not stone, it's not solid science. If it helps you and guides you through the way you wanna approach your health journey I think it's valuable, but it's not necessarily the truth. I don't know if that makes sense.
KIM: No, it does. And, you know, you bring up a great point about sitting in traffic and getting "Congratulations on working out." These notifications that the wearables can give us some of them, again, they can tell you you're having high heart rate, they can pinpoint -- They say they can pinpoint things like sleep apnea, hypertension, and I think there's one that's even called loss of pulse?
DR. AVENATTI: Yeah.
KIM: So -- which may indicate, you know, losing of breath or maybe potentially, like, heart attack or cardiac arrest. When we see these notifications are there ones that we should absolutely take action on or are there some that -- or should we be taking all of these with, kind of, a grain of salt?
DR. AVENATTI: Well, I think that all technology needs the human input. We're not supposed to use any of this stuff without our brain turned on. [Laughter] Now, what we do with a notification is a different story, right? Again, I was sitting in traffic, I know I'm not exercising, I know that the active minutes I get at the end of the day shouldn't go to my exercise bank for the week, right?
KIM: Yes.
DR. AVENATTI: I'm trying to get to the 150 minutes, those minutes of increased heart rate shouldn't go there but the watch will not know the difference, right?
KIM: Mm-hmm.
DR. AVENATTI: My watch is telling me, "Oh, you lost pulse" and I'm here talking to you probably it's just because the watch fell on the ground. [Laughing]
KIM: Yeah.
DR. AVENATTI: And I know I'm trivializing this but it -- Because those things happen, you know? And so, again, I think it very much depends on the education we provide to people, the public in general, and to our patients. If we have patients with known clinical condition that we know are wearing their devices. And so, if I have a patient that has known atrial fibrillation, which is a pretty common arrhythmia, and it's pretty well picked up by the wearables and I know that in the past their episodes have been picked up by their watch I'm totally gonna tell them, "Please, if your watch sends you a notification let me know."
KIM: Mm-hmm.
DR. AVENATTI: Right. We talk about this. It has to be a part of the conversation. Now, a totally healthy patient that has been exercising and gets a notification for arrhythmia I think that's most likely to be a false positive.
KIM: Mm.
DR. AVENATTI: It doesn't mean we completely ignore it, I always encourage my patients, and patients in general, go have the conversation and say, "Hey, what do I do about this?" And then, it can be a conversation about, what were you doing? Was that a stressful time? Were you exercising? Were you just out of exercising? You know, what else was going on in your life? So, I would say all of this require a grain of salt, maybe two.
KIM: Yeah. Well because, to your point, if you're completely at rest and your heart rate jumps up crazy, like, you have to use your judgment in what's actually happening in the moment when you're getting these notifications.
DR. AVENATTI: Correct. And, you know, your heart rate is supposed to jump up and down throughout the day.
KIM: Mm-hmm.
DR. AVENATTI: Our body is an incredibly well-structured machine in which we have multiple inputs, in our brain, in our body, and the output are things like your blood pressure and your heart rate. And so, changes in those are supposed to be there. Our heart is supposed to respond to stress and to anxiety and to fear, and to danger, and that's its way to protecting us. And so, the heart rate is important and it has to both go up and down. It's not necessarily a bad thing, it's supposed to happen. Now, again, within a certain threshold and a certain limit. And then, again, things can happen. You can have an episode of tachycardia that has no clinical consequences.
KIM: Mm-hmm.
DR. AVENATTI: I just don't think those wearables, because they're not medical-grade, can make the differentiation.
KIM: So, A.I. is becoming a big part of our daily life and whether we're using it at work or school, or what have you, people are more interested in it that ever before. An A.I. company recently launched a chatbot that allows people to give access to their medical records and the data that is includes their wearable device data to inform the chatbot's answers to the user. And this is all with, of course, the user's consent.
I'm curious, what do consumers need to be aware of if they want to use something like this for managing their care or managing their health in general?
DR. AVENATTI: Yeah, that's a tough one. I would say, again, keeping in mind the difference between the wearable and the wellness purposes and a medical device, medical-grade devices. I would not put those together.
KIM: Mm-hmm.
DR. AVENATTI: And so, I'm not -- I wasn't familiar with the new chatbot for guiding wellness...
KIM: Mm-hmm.
DR. AVENATTI: But that's extremely interesting. I cannot say that I'm surprised by it.
KIM: Hmm.
DR. AVENATTI: Regarding concerns, I would obviously be worried about privacy issues.
KIM: Mm-hmm.
DR. AVENATTI: You know, working a hospital system we have all those layers of protection, making sure we don't share patients’ information that are sensitive because that can have on impact on their life insurance policies, or the ability to find a job, or whatnot. And so having that outside in an unprotected system worries me, just like it worried me when there was all that, you know, interest in the genetic phenotyping and the one-two-three genes, and or your genotype because they wanted to know if you had, like, a sliver of, I don't know, Spanish ancestry in our DNA.
KIM: Yeah. [Laughter]
DR. AVENATTI: So that's a concern for sure. And the other thing is A.I. is an incredibly powerful tool that is definitely way better than the human mind at picking up trends and analyzing big numbers. And so, in that way applying A.I. technology and analysis to all those data that the wearables are able to pick up I think it's a huge potential.
KIM: Mm-hmm.
DR. AVENATTI: I would caution, in the interpretation of those number without the appropriate background and knowledge because it's a slippery slope.
KIM: Yeah, you know. And you bring up a good point because, you know, I've been working in creating health care content for well over a decade now. I have learned quite a bit but I am not, I know I'm not a doctor, and I know I'm not an expert like you and a lot of our wonderful guests that we have here on the podcast. So, for us everyday folk, is there a safe way for us to use A.I. at this moment in a safe way when we're talking about asking it for medical advice or asking it medical questions?
DR. AVENATTI: So, first off, I just wanna point out that knowledge doesn't reside with doctors only.
KIM: Sure, of course.
DR. AVENATTI: We're not the keeper of the knowledge, we don't necessarily know everything.
KIM: Mm-hmm.
DR. AVENATTI: And we should -- Sometimes we should be reminded of that so please do. [Laughter] There's a lot to learn. But I think that what medical training and practice gives you is a perspective that it's harder to pass, and it's also a deep -- Being aware of the fact that you don't know all the answers.
KIM: Mm.
DR. AVENATTI: And being able to live with that uncertainty and pass it on and have a discussion with your patient. A.I. doesn't do that, right? You ask a question, A.I. gives you all of the answer, and it's as detailed as it gets.
KIM: Mm-hmm.
DR. AVENATTI: The problem is, as of today, A.I. does still hallucinate.
KIM: Mm-hmm.
DR. AVENATTI: Right? We still have answers that are sometimes completely made up. If I ask for a reference, like, you know, what we do in the scientific world so, "Oh, where did you get that from?" It gives me a study that never existed. Like, puts together names of authors for a study with a title of a third one and a publication in a journal that's no longer published, for example. It happens. And so, to be actually able to get the most of the A.I. you need to be already knowledgeable in what you're talking about. So, I think it's a great tool for everybody to start a conversation. I encourage everybody, sure, use ChatGPT. You wanna kinda fine tune your question, you wanna have a better conversation with your physician when you're discussing those thing get your information, do your homework first. Or, you know, we're having the conversation now go home, do your homework, next time you come back we'll discuss. But I don't think we're at the point where it can substitute.
KIM: No.
DR. AVENATTI: Yet. [Laughter] Maybe one day.
KIM: Yeah. You know, if someone uses a wearable device it gives -- You basically have a access to a constant stream of information about yourself. And, which, as we've discussed, can be very good but also, and it seems to me that it might take a little bit of authority or agency away from us as individuals in being able to kind of understand what's happening in our body. Like, we might think more about what the watch or the ring is telling us versus how we actually feel.
DR. AVENATTI: Yeah.
KIM: So, I'm very curious to know, like, how do, in general, how do physicians feel about patients using this kind of tech?
DR. AVENATTI: Yeah, that's a good point. There is a tendency for some people to kind of, yes you're right, relinquish decision-making to whatever metrics they're looking at, right? And that's not necessarily helpful or healthy, right? Again, "readiness score," and I'm using quotation with my fingers here because I don't know how they make it up, right?
KIM: Yeah.
DR. AVENATTI: It is completely an idea that the manufacturer came up with. The other day my readiness score for the day was a little bit lower than usual, it was only moderate and it was like, "Oh, you should probably rest today." I was like, "Listen, thing. Listen, watch, this is the only day I have to exercise." "Because my week is otherwise packed so I don't care." [Laughter] "I'm gonna exercise regardless. And thank you for letting me know that maybe I'll be feeling a little bit more tired as I do my routine than I would've otherwise felt and I'll take that."
KIM: Yeah.
DR. AVENATTI: But again, it's -- We should use this as an extra input. It's a window inside our body and we should interpret what the numbers we're seeing in the context of how we are feeling, and the other thing that I sometimes worry about for my patient is that at some point they would tend to compare their numbers to somebody else's number.
KIM: Mm.
DR. AVENATTI: Right. "Oh, I am exercising with my buddy and their heart rate goes up to "x" and my heart rate it only goes up to "y." Am I getting the same benefits they're getting from the same exercise? Should I be pushing harder?" Or, "My heart rate variability is lower than theirs," or whatever it is, right? This is not the way that's supposed to work. This is your own body and so tracking yourself over time is gonna get you the most insight and it's gonna tell you whether, maybe, the lifestyle changes that you're wanting to implement or have been implementing are working to your benefit, right? You know, you start exercising and your heart rate shoots up to 170. Three weeks later on the same routine your heart rate only goes up to 165, that's great!
KIM: Yeah.
DR. AVENATTI: You're training your body, right? But it's a personal tracking. And I think that compared to a lot of the punitive systems we've had in the past these actually gives you positive feedback, like, "Hey, you completed your rings!" Or, you know, "Hey, you met your goals!"
KIM: Mm-hmm.
DR. AVENATTI: Which is a very good thing. Like, positive behavior reinforcement, so I appreciate that. So I am pro, it's just they don't tell you the whole story and they will never do.
KIM: Yeah. And you kind of have to take it in context of what your life is like at any given moment, how you're feeling in any given moment.
DR. AVENATTI: Yes. And the other thing that I like to remind my patient is we're humans, right? We're not perfect. If we strive for 100% we're gonna fail miserably 100% of the time. [Laughter] So taking into account where you are it's important. So, if you only have that much to give that day that's okay, maybe that's the day you don't exercise and maybe that's the day you end up, you know, heating mac and cheese in the microwave because that's all you can muster. That's fine.
KIM: Yeah.
DR. AVENATTI: You're gonna be better in the following day.
KIM: You know, you bring up a good point about having all of this data and being able to use it in context. I'm curious to know if there -- I'm curious to know, so, can having all of this data lead us to maybe have some anxiety or potentially having disordered exercise, or disordered eating based on. Because again, we might say we don't wanna be perfect but then our watch didn't tell us the thing that we wanted it to tell us.
DR. AVENATTI: Right.
KIM: And now we're very worried about it.
DR. AVENATTI: Yeah, no, definitely it's a concern. It might not apply to the broad population but there's definitely people for which this becomes an issue. And I think we kind of face the same problems on a different scale when we, as a medical community, health care people, talk about screening procedures or screening tests, right? You run a test that can diagnose "x" but in the meantime it can pick up 17,000 different things and then you have to talk to the patient about the fact, oh you know, "We did a test to look for this but we saw a nodule or we saw a shadow there we need to investigate." Probably this is scalable in a different way because a lot more people wear wearables than people get screening tests. And we go back to the issue of how reliable those are because they're not medical-grade. And so, I think -- I don't think we're in a position where we can roll back the use of the wearables but if we know ourself as persons that are, like, "Oh, I tend to get a little bit anxious if this doesn't go exactly the way I want it to be," then maybe it's time to discuss the use of a wearable with your providers. And if as providers we get to know a patient a little bit, right, and if you're like, "Yeah, you're probably not the one that's gonna get the most benefit out of this, probably just get a regular watch that's gonna wake you up in the morning and that's it."
KIM: Yeah. And, you know, or because I think now there's, like, different scales of how much technology. Maybe you just need one that's a little bit more dumb.
DR. AVENATTI: Yes, yes, 100%. [Laughter] Maybe just a basic one that tells you, "Oh, great job! You did 5,000 steps!" right?
KIM: Mm-hmm.
DR. AVENATTI: Instead of telling you all these fancy things that, again, are not necessarily true.
KIM: Yeah. And kind of to that point, you know, you went into it a little bit before but how can we make sure that we're using this technology to our benefit and still not lose that connection to our bodies in terms of what we're feeling and still maintaining that ability to stay in our bodies? For the lack of a better phrasing.
DR. AVENATTI: Yeah. Oh jeez, that's a lifelong commitment, you know? There's this mindfulness. This is realizing you are a unique person with unique features and those features now some of them, at least, can be measured, like your heart rest, heart rate at rest, heart rate when you're exercising. But those are not the one defining you all together and it's just part of the conversation. So, first off, those are just numbers they don't tell the whole story, right? No number on itself tell a whole story.
KIM: Yeah.
DR. AVENATTI: So you always have to keep those in context and in the studying of who are you and what you're doing, and what your goals are. And then, once you have your goals if you're changing things or you wanna maintain things then use those numbers to help you, guide you. It's like, "I wanna improve my fitness." Great, what does it look like? If I'm doing absolutely nothing, which happens, then deciding that, "Okay I'm gonna start, I'm just gonna pick one thing randomly, I'm gonna start walking 3,000 steps a day." That's a great goal, and the wearable can actually help you get there, right? Because it can track how many steps you did. If your goal is, I wanna, you know, go to the gym three times a week your wearable is gonna tell you, "Hey, you slacked." [Laughter]
KIM: Yeah. [Laughter]
DR. AVENATTI: But again, we have to be able to maintain the flexibility, more importantly remembering that it's not the whole story.
KIM: Well, and then, I think another important point too is maybe acknowledging, because we're tracking -- we should be tracking just ourselves.
DR. AVENATTI: Yes.
KIM: And measuring ourselves over time, but also maintaining grace because our bodies are gonna change whether we want them to or not.
DR. AVENATTI: Oh yes. [Laughter] Especially if we don't want them to. [Laughter] You know, I tell all my patients, short of turning back time and I don't have my wand with me today so we're not gonna be able to do it. Aging is part of living and so I think that going into the mindset of getting the most at every stage of our lives. Maximizing health, right, is really where we should be focusing. We haven't cracked the code for eternal youth, yet, and so we'll have to keep that in mind. And again, what worked for us 15 years ago will not work for us now, and will not work for us 10 years down the line so we have to be mindful of that too.
KIM: You know, is there -- When you're counseling patients and maybe they're considering getting a piece of device like this how do you usually counsel them? If they say, "Oh, you know, I'm thinking of getting a smart watch," or one of the rings or whatever, how -- what do you talk to them about?
DR. AVENATTI: So, I usually ask them what their goal is. So, why do you think you're gonna do that, you know? And some people are just, "Oh, I'm just a techno geek, I want that because everybody has it and it's super cool." Great.
KIM: Mm-hmm.
DR. AVENATTI: Because again, the way I can help and support them will be widely dependent on what they're looking for, right? And if the idea is, "Oh I wanna, you know, beat my buddy and have my heart rate go less higher than he does," this is not the right way to do things. Or they're like, "Oh, I am worried about arrhythmia running in my families and I wanna monitor." I'll say, "Okay, then maybe we should probably have a deeper look, see what your current situation is. With a couple of non-invasive, low-cost tests that are medical-grade, everything's fine there then sure, have a monitor, and if we pick up some red flags we'll have a different conversation and we'll do a deep dive, again." But I really -- I really think it depends on where they're coming from.
KIM: Yeah.
DR. AVENATTI: And so often in medicine we come to those conversation, or other conversation for that matter, with a very structured, preconceived idea. It's like, "I have my mind set, I'm gonna talk to you about this," and maybe that's not -- completely different from what you were expecting or wanting to go to. And so, I think that taking the time and talk about what the actual thought process is and the goals make the conversation so much productive.
KIM: Yeah, and then, you know, maybe before just hitting "click to buy"... [Laughter] On the website interrogating for ourselves why we want to use this technology.
DR. AVENATTI: And maybe consider and pause for a second, what are the downsides of that technology? Am I somebody that's gonna be easily stressed about a message or notification about something off from that wearable? Do I have the mental bandwidth to stop and think that, "That not might be true," right? Did I have the conversation? Do I understand what those numbers are telling me?
KIM: Yeah. Is there anything that we haven't talked about that you would want our listeners, our viewers, to understand about this topic? Because, it's pretty big, and we also talked about A.I. and, you know, that's a whole, whole bigger issue.
DR. AVENATTI: Bigger issue.
KIM: Yeah.
DR. AVENATTI: No, I think we covered it to the extent that it was reasonable, you know, into small pieces that I hope are digestible. [Laughter] But again, kind of -- if I had to summarize, these are incredibly good tools that needs to be used with two grains of salt. And they're not medical devices.
KIM: That's a really good reminder because I think we all get our notifications and may think we're dying. [Laughter]
DR. AVENATTI: Hopefully not.
KIM: Hopefully not, but you know how sometimes you can be like, "Ugh, I didn't sleep well, the sky is falling."
DR. AVENATTI: Yes, absolutely. Those days I just can't get out of bed.
KIM: Yeah, but this has been a great conversation Dr. Avenatti, thank you so much.
DR. AVENATTI: Thanks for having me.
[Sound effect plays to signal end of the interview]
ZACH: So Kim, what was your favorite take away from your conversation with Dr. Avenatti?
KIM: It made me chuckle when she talked about getting the high heart rate while she was in Houston traffic.
ZACH: Yeah. [Laughter] We can all relate to that.
KIM: Ugh, I certainly can. And I think it's important to remember you can't, basically, blindly trust these devices. So, if you're getting a notification that you just did a great workout and you're sitting in your car in traffic, you know, you have to take all of this in context of what's going on in your life and with your general health as well.
ZACH: Well, it's always amusing when you're kind of looking back, like, "What was I doing at 4 o'clock?" And like, you weren't, like, "Hey, nice workout," and I'm like, "What are you talking about?" Like, I don't know. Obviously, I was very stressed out or something was going on.
KIM: Yeah, yeah, I was in a meeting or something. [Laughter]
ZACH: We both say meetings. Yeah so, obviously there's that. But there's also, like, there is the human element to it, right? As she mentioned herself, right?
KIM: It's definitely the human element. And these devices and the data should be able to enable you to track your health over time. And track you against you, not tracking you against someone else. Like, I think –
ZACH: That's a very important point.
KIM: Yeah, you know? And so, it's about focusing on your own data and maybe if you're paying a little too much attention to your own data, maybe, and it's stressing you out then potentially wearing a wearable or a smart watch, or ring, or whatever, it just might not be for you.
ZACH: Yeah. Well, we all wanna know more about ourselves, right? We're obsessed with data, right?
KIM: Mm-hmm.
ZACH: But sometimes some data can be too much data, right? And you can turn off certain settings, you don't have to check every setting it offers either.
KIM: Mm-hmm.
ZACH: So that's an option for you as well, so. Things to think about with the wearables, right? I do wanna ask you though, after having this conversation, talking about the leaps and bounds of technology over the past decade, do you wanna upgrade your wearable?
KIM: You know, I do. I mean, the one that I have now is probably considered dumb by the today standards, but it's still... still chugging along. It still updates. So, if it's still updating I think it's still okay but –
ZACH: That's the rule.
KIM: I feel like I'm sort of a data agnostic person where it's just, I'm interested in it but I'm only interested in it in a very, like, finite time, I guess. So, I might wanna look at it before I have my annual physical with my doctor but otherwise, I'm not sweating it because it's just too much. What about you?
ZACH: Yeah, I mean, my watch here it looks like a dumb watch. Is that what we call 'em? But it's actually a smart watch, it's a hybrid, right? So, it looks analog but it does connect to my phone and to other apps so I can track certain things. I like it, I think if I were to upgrade I'm interested in the ring technology. I mean, there's companies that obviously you wear a ring. You can wear that a lot more places, right? Because obviously if I'm like at the beach. I'm not gonna take my phone in the water, and -- This watch, I know some watches are waterproof but I mean, I don't know guys, if I had one of these high end smart watches do I wanna go in the ocean with it? Like, what if I get hit, right, I'd be so paranoid of losing it, right? But a ring you can put on and you can track all this activity. Because, I think some of the times I'm most physically active is I'm at the beach. With these waves and all that sort of thing. So, I want credit for that is what I'm trying to say, Kim. So, that appeals to me. So if I were to upgrade at some point I would probably look at something like that.
KIM: Yeah, I mean, if you work out and you don't have something to record that you worked out, did you work out at all?
ZACH: If a tree falls in the forest and no one hears it, did it really fall? Who's to say?
BOTH: Who's to say?
ZACH: So... All right, that's gonna do it for us this time on, On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings so until next time stay tuned and stay healthy.
KIM RIVERA HUSTON-WEBER: I'm Kim Rivera Huston-Weber, and I'm a copywriter here at Houston Methodist.
ZACH: And Kim, are you a fan of fitness trackers, wearables?
KIM: Yeah. You know, I've -- Jeez, I think I got my first one maybe 15 years ago. Do you remember, like, those tiny, tiny smart pedometers?
ZACH: They clip on your belt?
KIM: Uh-huh.
ZACH: I never had one but I saw people who had one.
KIM: Oh yeah, no. Those were very popular with one of the companies I used to work for.
ZACH: And they just tracked your steps, right?
KIM: Just tracked your steps.
ZACH: But technology has evolved hasn't it, Kim?
KIM: Oh, has it. And, I -- The one that I have is probably a decade old now, and so.
ZACH: And you still use it?
KIM: I still use it.
ZACH: Okay.
KIM: But it does not have all the whiz-bang features that the new ones do.
ZACH: I think the first one I had, wearables, as we're calling them now, I don't know if we called them that then, but we call them that now. Wrist, you know, it was like a watch and it tracked steps, for sure, then tracked -- I think it tracked heart rate as well. This is like 10 years ago so it was still -- still in the kinda early age of the digital wearable. And I liked wearing that. I wore it a lot, and it was always very satisfying when it buzzed and you met your step goal for the day, and -- But it was very basic, it was like LED screen, basically like an alarm clock level screen. Now, we have such amazing technology now, we can track so much of our health on these things.
KIM: Yeah, and the tech's just more sophisticated. There is ECG technology so it can tell you, potentially, if you are having AFib or high heart rate. I think some might give you hypertension notifications now. It's kind of out there in terms of this, like, very hyperspecific data you can get.
ZACH: But how much can we trust these wearables? That's what we're talking about today, and who did we talk to, Kim?
KIM: Yes, we spoke to Dr. Eleonora Avenatti, she's a Cardiologist and Obesity Specialist here at Houston Methodist.
[Sound effect plays to signal beginning of interview]
Thank you so much for being with us today, Dr. Avenatti.
DR. ELEONORA AVENATTI: Well of course, thanks for having me. This is gonna be fun.
KIM: Yeah! So, health tracking using wearable devices has become increasingly popular over the past decade or so. What started with smart pedometers has expanded to watches and rings. And the manufacturers of these devices say they can give us insights into everything from our sleep quality to our heart health, fertility tracking, and some say that they can even help us, you know, calculate our biological age. So, why are consumers so drawn to this technology and the very hyperspecific health data that it purports to provide?
DR. AVENATTI: So, I think there's two components there, and one is those devices fill in a gap in what the knowledge of people is regarding their own body. You know, people can go to the physician, maybe they have their annual, maybe they have some specialists they see with a certain frequency because they're particularly focused or they have a health condition. And so, in those encounters they get a very in-depth, specialized assessment of whatever it is. And then, there's this kind of void in which they're left for the rest of 6 months or every, you know, a year if they do yearly checks. And so, they kind of need that guidance that comes from the numbers that they use to discuss with their physicians and it's just not there in between those visits. So, that's one aspect. And then, you have the other population of patients who never saw a physician, right? But they're still interested in what their health is, and maybe focusing more on wellness more than treating diseases, and that's a way to get insight on their own health. And then, when it comes to the hyper-personalization of those data, that is really something that has been missing, and is still missing from the general literature and science publication and data, right? Whenever we look at data in science we have these huge databases and we have the clinical trial results. All the good data we have its aggregate, and that gives us an answer on what the average response is to "X" treatment, how much weight people on average lose on the newest drugs, but it doesn't tell the single patient what they can expect from that. So, I think those are two very important factors that drive people to those devices, kind of having a better insight on their own specific issues.
KIM: Yeah. And so, I noticed that the FDA recently updated their guidance on non-invasive wearables. Some of them that measure blood pressure or blood glucose, and said that these could be used as wellness devices rather than medical-grade devices. And I think as long as they meet the definition of being low risk, of course. So, I think it's trying to maybe, open up the market a little bit and get innovation going. But I do think it's important to know so, what are the differences between a wearable wellness device and something that is medical-grade and used for diagnosis and treatment?
DR. AVENATTI: Right, I think you're hitting on a very good point there and I think we have all to remind ourself those are two incredibly different things. So, the bottom line is a wearable that's marketed for wellness tracking it's something that you can use to track yourself, and I would say the best use in that way is compare yourself to yourself through time. And it can be helpful in screening to kind of raising red flags. But it cannot be used and should not be used for diagnostic purposes, meaning we are not at the place where we can use the wearable devices to make a diagnosis of arrhythmia or blood pressure disorders. And that is because the FDA said those are wellness devices and not health standard devices. The process to get those to market is completely different. A health care device is subjected to strict controls and validation. We know how they work and we can replicate those number over and over and over and over, and so those number are precise and reliable, meaning that they specifically measure what they're supposed to measure and under different condition the number is still gonna be the same. On the wearable we don't have the same degree of those certainties. And so, again, it's helpful to track yourself over time, you can see trends, and I think that's very important, and it can raise the red flags. Say, "Hey, something's off, why don't you check?" That check has to be the health care device. That check has to be talk to the physician and see if there's anything that has to be digged out.
KIM: You kind of helped me get to my next question. So, I have a wearable, this thing is probably almost ten years old now, it is -- I'm an earlier adopter, let's say, but –
DR. AVENATTI: The enthusiasm.
KIM: Yeah, by -- but by the tech standards this thing is a dinosaur, and things have gotten a lot better, some now have electrocardiogram (ECG) technology among other sophisticated tech. So, I'm curious to know what reliability or, I guess I would say, accuracy do these devices have when we're thinking of heart conditions, whether it's AFib, heart palpitations, and some now some even say that it can help identify hypertension.
DR. AVENATTI: So, multiple things to unpack there but let me start with the first.
KIM: Mm-hmm.
DR. AVENATTI: Technology progress. Obviously technology has boomed, and I'm not a tech expert, I'm the tech dinosaur probably, and I do have a wearable that's a very basic one, okay. We can go back to that.
KIM: Mm-hmm.
DR. AVENATTI: But, I'm not trying to convince anybody that ten years ago trackers are the same as of today, it's not my point. But the way we're using them should still be the same.
KIM: Mm-hmm.
DR. AVENATTI: Right? So, despite technology improvement they are still useful to raise flags and not for diagnosis.
KIM: Mm-hmm.
DR. AVENATTI: And so, my point is there's a lot of marketing in all of this, and you're probably not gonna go out and buy a ten-year-old device regardless, right?
KIM: Yeah.
DR. AVENATTI: But I don't think that there is a need, necessarily, for health purposes, to update your 5-year-old smart watch or, you know, pedometer...
KIM: Mm-hmm.
DR. AVENATTI: Just because. And that goes back to how reliable are those when we're talking about medical condition. And going back to the FDA standard I would say they're not, absolutely not.
KIM: Yeah.
DR. AVENATTI: And if I had to pick one parameter that I would trust those devices to be good across the spectrum of aging or across the spectrum of cost is your heart rate.
KIM: Mm-hmm.
DR. AVENATTI: Because, honestly, that's the only thing, mostly, those devices can directly measure. Everything else so derived in some way by some algorithm that combines the heart rate with the way you're moving around and the velocity at which your hands are moving if you're wearing it on your wrist. But the direct measurement is really just your heart rate. And so, things like your heart rate, heart rate variability, and how regular your heart is those are the most reliable measures. On specific devices the EKG has become pretty good.
KIM: Mm-hmm.
DR. AVENATTI: So those are the two things that I would focus. If a patient has a known arrhythmia I still would want to have a full EKG to call atrial fibrillation for example. On the blood pressure management, interesting, we had new guidelines coming out in 2025 by the AHA, ACC, so the big cardiovascular societies in the United States. And there was a specific paragraph saying that blood pressure measured with wearables is not to be considered clinical. So, we should not rely on those numbers. And I'm saying, don't throw it away but know that it's not the direct measurement and the way it's extracted from the heart rate and pulsation its proprietary for every single device, and we have no insight on how those algorithm were created and so not the best thing to do. Now, it raises a question go talk to your physician. Absolutely, that's a good way of thinking of that.
KIM: So really heart rate is what is the kind of gold standard among all of these devices?
DR. AVENATTI: Correct, because that's the only thing they do directly measure through, basically, the optic, like, impacting in your vessels at your pulse level. They literally see the pulsation in your vein through some light. And the other thing that can be measured that way is through your pulse ox, so your sats.
KIM: Yeah.
DR. AVENATTI: Basically.
KIM: Yeah, because a lot of these devices offer things like the biological age or they're saying how much, like, load you have on your body.
DR. AVENATTI: Yes, yes.
KIM: So, are you just for clarity, are you saying that we should take those kind of measurements with a grain of salt?
DR. AVENATTI: Oh, two grains of salt. [Laughter] And, don't get me wrong, I look at my numbers basically on a daily basis but, again, the only direct measurements are very, very limited, and it's your heart rate and maybe your SO2, so your stats, and maybe how much activity you had the day before. But, they're not perfect, you know. They're smart devices but they're not perfect. I was sitting in Houston traffic the other day coming to work and I was listening to something that evidently, didn't agree with my body and my tracker goes off, it was like, "Oh, good job exercising," because my heart rate was 140. I was like, yeah, no. [Laughter] No, I just saw someone swerve in front of me. [Laughter] Right. That's not good exercise that raised my heart rate.
KIM: Yeah.
DR. AVENATTI: Or, you know, the other example might be on your sleep habits tracking. We know good sleep habit and having a regular sleep schedule helps with longevity and all of that. And so I -- On my wearable I have my set sleep schedule and a few months ago I got a notification that's like, "Hey, you should really get back on your sleep schedule. You've been losing, blah, blah, blah." I said, "Yeah, tell that to my teething baby." It's like, I'm trying. [Laughter]
KIM: Yeah.
DR. AVENATTI: So again, my point is those numbers are made up. And they come up with, you know, "Your readiness for today is moderate," based on some algorithm that somebody decided to put together. Nobody validated that, nobody ran a clinical trial, right? So, it's not stone, it's not solid science. If it helps you and guides you through the way you wanna approach your health journey I think it's valuable, but it's not necessarily the truth. I don't know if that makes sense.
KIM: No, it does. And, you know, you bring up a great point about sitting in traffic and getting "Congratulations on working out." These notifications that the wearables can give us some of them, again, they can tell you you're having high heart rate, they can pinpoint -- They say they can pinpoint things like sleep apnea, hypertension, and I think there's one that's even called loss of pulse?
DR. AVENATTI: Yeah.
KIM: So -- which may indicate, you know, losing of breath or maybe potentially, like, heart attack or cardiac arrest. When we see these notifications are there ones that we should absolutely take action on or are there some that -- or should we be taking all of these with, kind of, a grain of salt?
DR. AVENATTI: Well, I think that all technology needs the human input. We're not supposed to use any of this stuff without our brain turned on. [Laughter] Now, what we do with a notification is a different story, right? Again, I was sitting in traffic, I know I'm not exercising, I know that the active minutes I get at the end of the day shouldn't go to my exercise bank for the week, right?
KIM: Yes.
DR. AVENATTI: I'm trying to get to the 150 minutes, those minutes of increased heart rate shouldn't go there but the watch will not know the difference, right?
KIM: Mm-hmm.
DR. AVENATTI: My watch is telling me, "Oh, you lost pulse" and I'm here talking to you probably it's just because the watch fell on the ground. [Laughing]
KIM: Yeah.
DR. AVENATTI: And I know I'm trivializing this but it -- Because those things happen, you know? And so, again, I think it very much depends on the education we provide to people, the public in general, and to our patients. If we have patients with known clinical condition that we know are wearing their devices. And so, if I have a patient that has known atrial fibrillation, which is a pretty common arrhythmia, and it's pretty well picked up by the wearables and I know that in the past their episodes have been picked up by their watch I'm totally gonna tell them, "Please, if your watch sends you a notification let me know."
KIM: Mm-hmm.
DR. AVENATTI: Right. We talk about this. It has to be a part of the conversation. Now, a totally healthy patient that has been exercising and gets a notification for arrhythmia I think that's most likely to be a false positive.
KIM: Mm.
DR. AVENATTI: It doesn't mean we completely ignore it, I always encourage my patients, and patients in general, go have the conversation and say, "Hey, what do I do about this?" And then, it can be a conversation about, what were you doing? Was that a stressful time? Were you exercising? Were you just out of exercising? You know, what else was going on in your life? So, I would say all of this require a grain of salt, maybe two.
KIM: Yeah. Well because, to your point, if you're completely at rest and your heart rate jumps up crazy, like, you have to use your judgment in what's actually happening in the moment when you're getting these notifications.
DR. AVENATTI: Correct. And, you know, your heart rate is supposed to jump up and down throughout the day.
KIM: Mm-hmm.
DR. AVENATTI: Our body is an incredibly well-structured machine in which we have multiple inputs, in our brain, in our body, and the output are things like your blood pressure and your heart rate. And so, changes in those are supposed to be there. Our heart is supposed to respond to stress and to anxiety and to fear, and to danger, and that's its way to protecting us. And so, the heart rate is important and it has to both go up and down. It's not necessarily a bad thing, it's supposed to happen. Now, again, within a certain threshold and a certain limit. And then, again, things can happen. You can have an episode of tachycardia that has no clinical consequences.
KIM: Mm-hmm.
DR. AVENATTI: I just don't think those wearables, because they're not medical-grade, can make the differentiation.
KIM: So, A.I. is becoming a big part of our daily life and whether we're using it at work or school, or what have you, people are more interested in it that ever before. An A.I. company recently launched a chatbot that allows people to give access to their medical records and the data that is includes their wearable device data to inform the chatbot's answers to the user. And this is all with, of course, the user's consent.
I'm curious, what do consumers need to be aware of if they want to use something like this for managing their care or managing their health in general?
DR. AVENATTI: Yeah, that's a tough one. I would say, again, keeping in mind the difference between the wearable and the wellness purposes and a medical device, medical-grade devices. I would not put those together.
KIM: Mm-hmm.
DR. AVENATTI: And so, I'm not -- I wasn't familiar with the new chatbot for guiding wellness...
KIM: Mm-hmm.
DR. AVENATTI: But that's extremely interesting. I cannot say that I'm surprised by it.
KIM: Hmm.
DR. AVENATTI: Regarding concerns, I would obviously be worried about privacy issues.
KIM: Mm-hmm.
DR. AVENATTI: You know, working a hospital system we have all those layers of protection, making sure we don't share patients’ information that are sensitive because that can have on impact on their life insurance policies, or the ability to find a job, or whatnot. And so having that outside in an unprotected system worries me, just like it worried me when there was all that, you know, interest in the genetic phenotyping and the one-two-three genes, and or your genotype because they wanted to know if you had, like, a sliver of, I don't know, Spanish ancestry in our DNA.
KIM: Yeah. [Laughter]
DR. AVENATTI: So that's a concern for sure. And the other thing is A.I. is an incredibly powerful tool that is definitely way better than the human mind at picking up trends and analyzing big numbers. And so, in that way applying A.I. technology and analysis to all those data that the wearables are able to pick up I think it's a huge potential.
KIM: Mm-hmm.
DR. AVENATTI: I would caution, in the interpretation of those number without the appropriate background and knowledge because it's a slippery slope.
KIM: Yeah, you know. And you bring up a good point because, you know, I've been working in creating health care content for well over a decade now. I have learned quite a bit but I am not, I know I'm not a doctor, and I know I'm not an expert like you and a lot of our wonderful guests that we have here on the podcast. So, for us everyday folk, is there a safe way for us to use A.I. at this moment in a safe way when we're talking about asking it for medical advice or asking it medical questions?
DR. AVENATTI: So, first off, I just wanna point out that knowledge doesn't reside with doctors only.
KIM: Sure, of course.
DR. AVENATTI: We're not the keeper of the knowledge, we don't necessarily know everything.
KIM: Mm-hmm.
DR. AVENATTI: And we should -- Sometimes we should be reminded of that so please do. [Laughter] There's a lot to learn. But I think that what medical training and practice gives you is a perspective that it's harder to pass, and it's also a deep -- Being aware of the fact that you don't know all the answers.
KIM: Mm.
DR. AVENATTI: And being able to live with that uncertainty and pass it on and have a discussion with your patient. A.I. doesn't do that, right? You ask a question, A.I. gives you all of the answer, and it's as detailed as it gets.
KIM: Mm-hmm.
DR. AVENATTI: The problem is, as of today, A.I. does still hallucinate.
KIM: Mm-hmm.
DR. AVENATTI: Right? We still have answers that are sometimes completely made up. If I ask for a reference, like, you know, what we do in the scientific world so, "Oh, where did you get that from?" It gives me a study that never existed. Like, puts together names of authors for a study with a title of a third one and a publication in a journal that's no longer published, for example. It happens. And so, to be actually able to get the most of the A.I. you need to be already knowledgeable in what you're talking about. So, I think it's a great tool for everybody to start a conversation. I encourage everybody, sure, use ChatGPT. You wanna kinda fine tune your question, you wanna have a better conversation with your physician when you're discussing those thing get your information, do your homework first. Or, you know, we're having the conversation now go home, do your homework, next time you come back we'll discuss. But I don't think we're at the point where it can substitute.
KIM: No.
DR. AVENATTI: Yet. [Laughter] Maybe one day.
KIM: Yeah. You know, if someone uses a wearable device it gives -- You basically have a access to a constant stream of information about yourself. And, which, as we've discussed, can be very good but also, and it seems to me that it might take a little bit of authority or agency away from us as individuals in being able to kind of understand what's happening in our body. Like, we might think more about what the watch or the ring is telling us versus how we actually feel.
DR. AVENATTI: Yeah.
KIM: So, I'm very curious to know, like, how do, in general, how do physicians feel about patients using this kind of tech?
DR. AVENATTI: Yeah, that's a good point. There is a tendency for some people to kind of, yes you're right, relinquish decision-making to whatever metrics they're looking at, right? And that's not necessarily helpful or healthy, right? Again, "readiness score," and I'm using quotation with my fingers here because I don't know how they make it up, right?
KIM: Yeah.
DR. AVENATTI: It is completely an idea that the manufacturer came up with. The other day my readiness score for the day was a little bit lower than usual, it was only moderate and it was like, "Oh, you should probably rest today." I was like, "Listen, thing. Listen, watch, this is the only day I have to exercise." "Because my week is otherwise packed so I don't care." [Laughter] "I'm gonna exercise regardless. And thank you for letting me know that maybe I'll be feeling a little bit more tired as I do my routine than I would've otherwise felt and I'll take that."
KIM: Yeah.
DR. AVENATTI: But again, it's -- We should use this as an extra input. It's a window inside our body and we should interpret what the numbers we're seeing in the context of how we are feeling, and the other thing that I sometimes worry about for my patient is that at some point they would tend to compare their numbers to somebody else's number.
KIM: Mm.
DR. AVENATTI: Right. "Oh, I am exercising with my buddy and their heart rate goes up to "x" and my heart rate it only goes up to "y." Am I getting the same benefits they're getting from the same exercise? Should I be pushing harder?" Or, "My heart rate variability is lower than theirs," or whatever it is, right? This is not the way that's supposed to work. This is your own body and so tracking yourself over time is gonna get you the most insight and it's gonna tell you whether, maybe, the lifestyle changes that you're wanting to implement or have been implementing are working to your benefit, right? You know, you start exercising and your heart rate shoots up to 170. Three weeks later on the same routine your heart rate only goes up to 165, that's great!
KIM: Yeah.
DR. AVENATTI: You're training your body, right? But it's a personal tracking. And I think that compared to a lot of the punitive systems we've had in the past these actually gives you positive feedback, like, "Hey, you completed your rings!" Or, you know, "Hey, you met your goals!"
KIM: Mm-hmm.
DR. AVENATTI: Which is a very good thing. Like, positive behavior reinforcement, so I appreciate that. So I am pro, it's just they don't tell you the whole story and they will never do.
KIM: Yeah. And you kind of have to take it in context of what your life is like at any given moment, how you're feeling in any given moment.
DR. AVENATTI: Yes. And the other thing that I like to remind my patient is we're humans, right? We're not perfect. If we strive for 100% we're gonna fail miserably 100% of the time. [Laughter] So taking into account where you are it's important. So, if you only have that much to give that day that's okay, maybe that's the day you don't exercise and maybe that's the day you end up, you know, heating mac and cheese in the microwave because that's all you can muster. That's fine.
KIM: Yeah.
DR. AVENATTI: You're gonna be better in the following day.
KIM: You know, you bring up a good point about having all of this data and being able to use it in context. I'm curious to know if there -- I'm curious to know, so, can having all of this data lead us to maybe have some anxiety or potentially having disordered exercise, or disordered eating based on. Because again, we might say we don't wanna be perfect but then our watch didn't tell us the thing that we wanted it to tell us.
DR. AVENATTI: Right.
KIM: And now we're very worried about it.
DR. AVENATTI: Yeah, no, definitely it's a concern. It might not apply to the broad population but there's definitely people for which this becomes an issue. And I think we kind of face the same problems on a different scale when we, as a medical community, health care people, talk about screening procedures or screening tests, right? You run a test that can diagnose "x" but in the meantime it can pick up 17,000 different things and then you have to talk to the patient about the fact, oh you know, "We did a test to look for this but we saw a nodule or we saw a shadow there we need to investigate." Probably this is scalable in a different way because a lot more people wear wearables than people get screening tests. And we go back to the issue of how reliable those are because they're not medical-grade. And so, I think -- I don't think we're in a position where we can roll back the use of the wearables but if we know ourself as persons that are, like, "Oh, I tend to get a little bit anxious if this doesn't go exactly the way I want it to be," then maybe it's time to discuss the use of a wearable with your providers. And if as providers we get to know a patient a little bit, right, and if you're like, "Yeah, you're probably not the one that's gonna get the most benefit out of this, probably just get a regular watch that's gonna wake you up in the morning and that's it."
KIM: Yeah. And, you know, or because I think now there's, like, different scales of how much technology. Maybe you just need one that's a little bit more dumb.
DR. AVENATTI: Yes, yes, 100%. [Laughter] Maybe just a basic one that tells you, "Oh, great job! You did 5,000 steps!" right?
KIM: Mm-hmm.
DR. AVENATTI: Instead of telling you all these fancy things that, again, are not necessarily true.
KIM: Yeah. And kind of to that point, you know, you went into it a little bit before but how can we make sure that we're using this technology to our benefit and still not lose that connection to our bodies in terms of what we're feeling and still maintaining that ability to stay in our bodies? For the lack of a better phrasing.
DR. AVENATTI: Yeah. Oh jeez, that's a lifelong commitment, you know? There's this mindfulness. This is realizing you are a unique person with unique features and those features now some of them, at least, can be measured, like your heart rest, heart rate at rest, heart rate when you're exercising. But those are not the one defining you all together and it's just part of the conversation. So, first off, those are just numbers they don't tell the whole story, right? No number on itself tell a whole story.
KIM: Yeah.
DR. AVENATTI: So you always have to keep those in context and in the studying of who are you and what you're doing, and what your goals are. And then, once you have your goals if you're changing things or you wanna maintain things then use those numbers to help you, guide you. It's like, "I wanna improve my fitness." Great, what does it look like? If I'm doing absolutely nothing, which happens, then deciding that, "Okay I'm gonna start, I'm just gonna pick one thing randomly, I'm gonna start walking 3,000 steps a day." That's a great goal, and the wearable can actually help you get there, right? Because it can track how many steps you did. If your goal is, I wanna, you know, go to the gym three times a week your wearable is gonna tell you, "Hey, you slacked." [Laughter]
KIM: Yeah. [Laughter]
DR. AVENATTI: But again, we have to be able to maintain the flexibility, more importantly remembering that it's not the whole story.
KIM: Well, and then, I think another important point too is maybe acknowledging, because we're tracking -- we should be tracking just ourselves.
DR. AVENATTI: Yes.
KIM: And measuring ourselves over time, but also maintaining grace because our bodies are gonna change whether we want them to or not.
DR. AVENATTI: Oh yes. [Laughter] Especially if we don't want them to. [Laughter] You know, I tell all my patients, short of turning back time and I don't have my wand with me today so we're not gonna be able to do it. Aging is part of living and so I think that going into the mindset of getting the most at every stage of our lives. Maximizing health, right, is really where we should be focusing. We haven't cracked the code for eternal youth, yet, and so we'll have to keep that in mind. And again, what worked for us 15 years ago will not work for us now, and will not work for us 10 years down the line so we have to be mindful of that too.
KIM: You know, is there -- When you're counseling patients and maybe they're considering getting a piece of device like this how do you usually counsel them? If they say, "Oh, you know, I'm thinking of getting a smart watch," or one of the rings or whatever, how -- what do you talk to them about?
DR. AVENATTI: So, I usually ask them what their goal is. So, why do you think you're gonna do that, you know? And some people are just, "Oh, I'm just a techno geek, I want that because everybody has it and it's super cool." Great.
KIM: Mm-hmm.
DR. AVENATTI: Because again, the way I can help and support them will be widely dependent on what they're looking for, right? And if the idea is, "Oh I wanna, you know, beat my buddy and have my heart rate go less higher than he does," this is not the right way to do things. Or they're like, "Oh, I am worried about arrhythmia running in my families and I wanna monitor." I'll say, "Okay, then maybe we should probably have a deeper look, see what your current situation is. With a couple of non-invasive, low-cost tests that are medical-grade, everything's fine there then sure, have a monitor, and if we pick up some red flags we'll have a different conversation and we'll do a deep dive, again." But I really -- I really think it depends on where they're coming from.
KIM: Yeah.
DR. AVENATTI: And so often in medicine we come to those conversation, or other conversation for that matter, with a very structured, preconceived idea. It's like, "I have my mind set, I'm gonna talk to you about this," and maybe that's not -- completely different from what you were expecting or wanting to go to. And so, I think that taking the time and talk about what the actual thought process is and the goals make the conversation so much productive.
KIM: Yeah, and then, you know, maybe before just hitting "click to buy"... [Laughter] On the website interrogating for ourselves why we want to use this technology.
DR. AVENATTI: And maybe consider and pause for a second, what are the downsides of that technology? Am I somebody that's gonna be easily stressed about a message or notification about something off from that wearable? Do I have the mental bandwidth to stop and think that, "That not might be true," right? Did I have the conversation? Do I understand what those numbers are telling me?
KIM: Yeah. Is there anything that we haven't talked about that you would want our listeners, our viewers, to understand about this topic? Because, it's pretty big, and we also talked about A.I. and, you know, that's a whole, whole bigger issue.
DR. AVENATTI: Bigger issue.
KIM: Yeah.
DR. AVENATTI: No, I think we covered it to the extent that it was reasonable, you know, into small pieces that I hope are digestible. [Laughter] But again, kind of -- if I had to summarize, these are incredibly good tools that needs to be used with two grains of salt. And they're not medical devices.
KIM: That's a really good reminder because I think we all get our notifications and may think we're dying. [Laughter]
DR. AVENATTI: Hopefully not.
KIM: Hopefully not, but you know how sometimes you can be like, "Ugh, I didn't sleep well, the sky is falling."
DR. AVENATTI: Yes, absolutely. Those days I just can't get out of bed.
KIM: Yeah, but this has been a great conversation Dr. Avenatti, thank you so much.
DR. AVENATTI: Thanks for having me.
[Sound effect plays to signal end of the interview]
ZACH: So Kim, what was your favorite take away from your conversation with Dr. Avenatti?
KIM: It made me chuckle when she talked about getting the high heart rate while she was in Houston traffic.
ZACH: Yeah. [Laughter] We can all relate to that.
KIM: Ugh, I certainly can. And I think it's important to remember you can't, basically, blindly trust these devices. So, if you're getting a notification that you just did a great workout and you're sitting in your car in traffic, you know, you have to take all of this in context of what's going on in your life and with your general health as well.
ZACH: Well, it's always amusing when you're kind of looking back, like, "What was I doing at 4 o'clock?" And like, you weren't, like, "Hey, nice workout," and I'm like, "What are you talking about?" Like, I don't know. Obviously, I was very stressed out or something was going on.
KIM: Yeah, yeah, I was in a meeting or something. [Laughter]
ZACH: We both say meetings. Yeah so, obviously there's that. But there's also, like, there is the human element to it, right? As she mentioned herself, right?
KIM: It's definitely the human element. And these devices and the data should be able to enable you to track your health over time. And track you against you, not tracking you against someone else. Like, I think –
ZACH: That's a very important point.
KIM: Yeah, you know? And so, it's about focusing on your own data and maybe if you're paying a little too much attention to your own data, maybe, and it's stressing you out then potentially wearing a wearable or a smart watch, or ring, or whatever, it just might not be for you.
ZACH: Yeah. Well, we all wanna know more about ourselves, right? We're obsessed with data, right?
KIM: Mm-hmm.
ZACH: But sometimes some data can be too much data, right? And you can turn off certain settings, you don't have to check every setting it offers either.
KIM: Mm-hmm.
ZACH: So that's an option for you as well, so. Things to think about with the wearables, right? I do wanna ask you though, after having this conversation, talking about the leaps and bounds of technology over the past decade, do you wanna upgrade your wearable?
KIM: You know, I do. I mean, the one that I have now is probably considered dumb by the today standards, but it's still... still chugging along. It still updates. So, if it's still updating I think it's still okay but –
ZACH: That's the rule.
KIM: I feel like I'm sort of a data agnostic person where it's just, I'm interested in it but I'm only interested in it in a very, like, finite time, I guess. So, I might wanna look at it before I have my annual physical with my doctor but otherwise, I'm not sweating it because it's just too much. What about you?
ZACH: Yeah, I mean, my watch here it looks like a dumb watch. Is that what we call 'em? But it's actually a smart watch, it's a hybrid, right? So, it looks analog but it does connect to my phone and to other apps so I can track certain things. I like it, I think if I were to upgrade I'm interested in the ring technology. I mean, there's companies that obviously you wear a ring. You can wear that a lot more places, right? Because obviously if I'm like at the beach. I'm not gonna take my phone in the water, and -- This watch, I know some watches are waterproof but I mean, I don't know guys, if I had one of these high end smart watches do I wanna go in the ocean with it? Like, what if I get hit, right, I'd be so paranoid of losing it, right? But a ring you can put on and you can track all this activity. Because, I think some of the times I'm most physically active is I'm at the beach. With these waves and all that sort of thing. So, I want credit for that is what I'm trying to say, Kim. So, that appeals to me. So if I were to upgrade at some point I would probably look at something like that.
KIM: Yeah, I mean, if you work out and you don't have something to record that you worked out, did you work out at all?
ZACH: If a tree falls in the forest and no one hears it, did it really fall? Who's to say?
BOTH: Who's to say?
ZACH: So... All right, that's gonna do it for us this time on, On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings so until next time stay tuned and stay healthy.
