March 15, 2024

 

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"Stress and Wearable Devices", by Dr Howard Rankin

"Stress Measurement Model via Continuous Personal Monitoring" by Michael Hentschel 

 "My Smartwatch Investment", by Grant Renier

 
 

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Stress and Wearable Devices

As wearable devices become more reliable and sophisticated, questions will arise about how each of the various measures like Heart Rate Variability, Blood glucose, blood pressure, etc., contribute to the identification and measurement of different types of stress.

If you Google something like “how many types of stress are there?” you will unquestionably become stressed by the fact that are numerous different answers.

The biggest differentiator is between acute and chronic stress. Acute stress subsides fairly quickly and the mind-body returns to normal , but chronic stress begins to alter fundamental physiology making it much more dangerous and detectable.

Other types of stress refer more to the origins of the problem and are identified as

Physiological stressors.

Lifestyle stressors.

Major life event stressors.

Organizational stressors.

Financial stressors.

Social stressors.

Environmental stressors.

If you were to ask ChatGPT about the different physical manifestations of stress, it would probably come up with something like this:

Muscle Tension: Stress can cause muscles to tense up, leading to headaches, neck pain, backaches, and overall stiffness in the body.

Headaches: Tension headaches or migraines are often triggered or exacerbated by stress.

Gastrointestinal Issues: Stress can affect the digestive system, leading to symptoms such as stomachaches, indigestion, nausea, vomiting, diarrhea, or constipation.

Cardiovascular Changes: Stress can elevate heart rate and blood pressure, increasing the risk of heart palpitations, chest pain, and hypertension.

Respiratory Symptoms: Stress may lead to shallow or rapid breathing, chest tightness, or exacerbation of respiratory conditions such as asthma.

Skin Problems: Stress can worsen existing skin conditions like acne, eczema, or psoriasis. It may also cause hives, itching, or general skin sensitivity.

 Sleep Disturbances: Stress often disrupts sleep patterns, leading to insomnia, difficulty falling asleep, waking up frequently during the night, or experiencing restless sleep.

Fatigue: Chronic stress can result in persistent fatigue, even after adequate rest, due to the constant activation of the body's stress response system.

Changes in Appetite: Stress can affect appetite, leading to overeating or undereating. Some people may turn to food as a coping mechanism, leading to weight gain, while others may experience a loss of appetite and weight loss.

Weakened Immune System: Prolonged stress can suppress the immune system, making individuals more susceptible to infections, colds, and other illnesses.

Sexual Dysfunction: Stress can contribute to decreased libido, erectile dysfunction in men, and menstrual irregularities in women.

Increased Pain Sensitivity: Stress can amplify the perception of pain, making pre-existing chronic pain conditions feel more intense.

Stress is obviously a complicated construct but hopefully, with regular reliable measurement of different systems and metrics, we can become more astute at  discerning types of stress, how they manifest and the best ways of managing them.

by Howard Rankin PhD, Intuality Science Director, psychology and cognitive neuroscience

 

Stress Measurement Model via Continuous Personal Monitoring

  Stress can be quantified (as in an algorithm) using continuous personal health measurements facilitated by wearable technology such as rings, watches, and skin sensors. These devices can monitor physiological indicators of stress, including heart rate variability (HRV), skin conductance (also known as galvanic skin response), and cortisol levels through sweat analysis. HRV, for example, measures the time variation between heartbeats and is a reliable marker of autonomic nervous system activity, reflecting the body's stress response.

A lower HRV indicates higher stress levels, as it shows less

 variability between heartbeats, suggesting that the body is under sympathetic ("fight or flight") dominance rather than parasympathetic ("rest and digest") control. Skin conductance changes with sweating, which can increase during stress as part of the sympathetic nervous system's arousal. By analyzing these and other markers, such as sleep patterns and physical activity levels, wearable technology can provide insights into an individual's stress levels and overall well-being. This continuous monitoring offers the potential for early detection of elevated stress, allowing individuals to take proactive steps to engage in stress-reduction techniques and improve their resilience and wellness. Without continuous monitoring, reaction to change and prediction of change becomes difficult or impossible.

Prediction: An ability to anticipate future conditions and events based on knowledge of the past and holistic (broadly-based) knowledge of patterns and related influences. Only AI effectively tracks the importance of relevant information in a variety of available continuously changing data. Only IntualityAI effectively predicts future data based on past data streams.

Resilience: The capacity of an individual to maintain or quickly regain mental health and well-being in the face of adversity, stress, or trauma. My Oura ring for example gives me a continuous graph of HRV stress, and considers low-stress times a “Recovery” where the body has a chance to regain a better state of health.

Wellness: A holistic integration of physical, mental, and spiritual well-being, fueling the body, engaging the mind, and nurturing the spirit. This ambitious goal is the goal of all bodily architecture and function, but this biological machine often needs positive interventions to optimize every fiber of our being.

Stress Metrics Model - Ranking of Importance and a potential Weighted Algorithmic Combination of Factors:

20% Heart Rate Variability (HRV): A direct marker of stress and autonomic nervous system balance, foundational for assessing stress and recovery.

15% Blood Pressure: Directly impacts heart health and can indicate chronic stress, making it vital for long-term health monitoring.

14% Glucose Monitoring: Essential for metabolic health and energy regulation, impacts a wide range of health conditions.

13% ECG: Critical for detecting heart conditions early, providing a deeper understanding of heart health beyond simple heart rate or HRV.

12% Blood Oxygen Level (SpO2): Indicates respiratory and cardiovascular health efficiency, essential for overall well-being.

8% Galvanic Skin Response (GSR): Reflects emotional states and stress, useful for real-time stress monitoring.

7% Cortisol Levels via Sweat: Direct marker of stress hormone levels, but less easily measured continuously, placing it slightly lower in real-time applicability.

6% Sleep Quality and Duration: Fundamental for recovery, mental health, and stress management, impacting all aspects of health.

4% Physical Activity Intensity and Frequency: Directly affects cardiovascular health, weight management, and stress reduction.

1% Body Temperature: While important for detecting illness or infection, its variations are less directly tied to stress and chronic health issues compared to other metrics.

The above ranking considers the direct impact on long-term health, the ability for continuous and real-time monitoring, and the significance of each metric in predicting and preventing serious health issues. It's worth noting that the importance and value vary based on individual health conditions and goals. Further research projects and funding are needed to pursue proper average weighting of these factors in measuring current and ongoing health. Predictio of future ongoing health will be highly sensitive to these algorithmic weightings.

Accurately and dependably predicting the ten health metrics mentioned previously will revolutionize individual health management and the broader healthcare system. Here are several key benefits:

Early Detection of Health Issues: Continuous monitoring and prediction of these metrics can lead to the early detection of potential health problems before they become more serious, allowing for preventative measures or early treatment. This is particularly crucial for conditions like heart disease, diabetes, and respiratory issues, where early intervention can significantly impact outcomes.

Personalized Health Insights: With accurate predictions, individuals can receive personalized insights into their health, enabling them to make informed decisions about diet, exercise, and lifestyle adjustments tailored to their unique health profile.

Enhanced Stress Management: By understanding and monitoring stress-related metrics (like HRV and cortisol levels), individuals can better manage stress through targeted interventions, improving mental health and reducing the risk of stress-related health issues.

Optimized Treatment Plans: For those with chronic conditions, precise predictions of health metrics can help healthcare providers tailor treatment plans more effectively, optimizing medication dosages and interventions based on the patient's current health status.

Preventive Healthcare: The ability to predict health metrics shifts the focus from reactive to preventive healthcare, reducing the incidence of chronic diseases by encouraging healthy lifestyle choices supported by real-time data.

Improved Quality of Life: Overall, the combination of early detection, personalized health insights, and preventive healthcare leads to an improved quality of life. Individuals can enjoy better health for longer, with fewer medical interventions and lower healthcare costs.

Reduced Healthcare Costs: Early detection and preventive healthcare not only improve individual health outcomes but also reduce the overall cost to the healthcare system by lowering the incidence of expensive, late-stage treatments and hospitalizations.

Advancements in Medical Research: The data collected from continuous monitoring of these health metrics can contribute to medical research, offering insights into the early indicators of diseases and the effectiveness of treatments, ultimately leading to new discoveries and therapeutic approaches.

How much value is there in Prediction of Preventable or Ameliorable Health Event Alerts? Estimating the dollar value in "Prediction of Preventable or Ameliorable Health Event Alerts" is challenging due to the complexity and variability of healthcare systems, technologies involved, and the range of health events. However, considering the potential to reduce costly hospital admissions, improve patient outcomes, and decrease the burden of chronic diseases through early intervention, the value is significant. Savings could range from reducing the direct costs of medical care to enhancing productivity by minimizing disease-related work absences. The integration of predictive health technologies could potentially save healthcare systems billions annually by shifting from reactive to proactive care. Here are some of the major populations that need care but are as yet under-monitored and definitely under-predicted:

The U.S. population aged 65 and over reached 55.8 million, marking a 38.6% increase over ten years, according to census data. https://www.census.gov/topics/population/older-aging.html.

The U.S. population of children aged 0–17 is projected to be 74.4 million in 2023. https://www.childstats.gov/AMERICASCHILDREN/tables/pop1.asp

In 2021, 38.4 million people in the U.S., or 11.6% of the population, had diabetes, as reported by

the CDC. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Optional Discussion of Summary Model

It appears that accessing detailed information from the sources I tried to visit encountered restrictions. However, the concept of creating a weighted score for stress factors is an interdisciplinary area that intersects health science, psychology, and data analysis. While specific studies directly correlating to the weighted scoring of the metrics I listed may not have been directly accessible, the principle of weighted scoring is commonly used in health assessments, risk analyses, and predictive modeling in healthcare.

The data above allows us  an estimation of how one might allocate percentage weightings to the ten metrics for a hypothetical algorithm assessing continuous health/resilience/stress, recognizing that specific allocations could vary based on individual health priorities, existing conditions, and technological capabilities.

This allocation emphasizes the direct markers of stress and autonomic nervous system balance (HRV), the critical indicators of heart health (Blood Pressure, ECG), and metabolic health (Glucose Monitoring). It assigns lower weight to metrics that, while important, may offer more indirect insights into stress and resilience or are less feasible to measure continuously and accurately with current technology.

In terms of literature, while specific studies focusing on this exact weighting scheme might not be available, the broader field of health informatics increasingly employs complex algorithms that integrate multiple health indicators to predict health events. These models often use weighted factors, but the specific weight given to each metric can vary based on the model's goals, the population studied, and evolving understanding of health markers' significance. Academic journals in health informatics, medical informatics, and journals focusing on wearable technology in health care are likely sources for emerging research in this area.

by Michael Hentschel, Intuality CFO, anthropologist, economist, venture capitalist

 

My Smartwatch Investment

I wear a smartwatch that monitors many of my vital signs 24/7. Even though I have no  health issues, for the first time the status information that it reports has given me greater awareness of how my body is functioning in all kinds of environments.

Two of the fifteen outputs are blood pressure (systolic/diastolic) and heart rate variability (HRV). I learned about the simple relationship between these two values as they change while passing through a stressful experience. 

My ‘fight-or-flight’ response (sympathetic) will hopefully be offset by a following ‘rest-and-digest’ (parasympathetic) mode.

And tracking my heart rate variability over time can show me how incorporating healthy habits, like regular exercise and good sleep, can affect my health.

This is no longer an annual exam status report; it’s now a 24/7 update. Theoretically, it’s telling where I am right now. But not quite. It updates every 10 minutes. So, on average, it’s probably 5 minutes behind reporting on my emotional state during an instantaneous event that has most likely already been experienced. Great for studying history, but useless for a real-time response to what’s happening now!

Predictive AI can come to the rescue with probabilities about the future, however. While it can’t predict an instantaneous event, like dodging a car coming out of a side street, it could do well predicting my emotional stress level and response to anticipated future events, even though they may never happen. For example, if I’m confronted with five important people who want me to immediately call them back, the predictive AI alarm bell may ding, “Your stress level is predicted to explode in 5 minutes!”, I could decide to “screw it!” and go for a bike ride. Maybe in that one instance 24/7 monitoring by predictive AI has been well worth the small investment.

We know well that stress can be a killer! Predictive AI could be the stress cop!

by Grant Renier, Intuality Chairman, engineering, mathematics, behavioral science, economics

 

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