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What has your T-shirt done for you lately?

It’s a given that clothes can preserve our modesty and protect us from the elements. But there’s a new generation of wearable technology being developed that goes much further, providing valuable insights about our physical well-being.

Some of the most innovative work in this area is being done in space. Astronauts at the International Space Station are currently involved in a five-year project testing smart shirts to monitor their health.

Astroskin is a smart shirt and sweatband combination developed by Montreal-based company Hexoskin that monitors physiological data like pulse, blood pressure, breathing rate and blood oxygen saturation. The system can be worn during sleep and exercise, and sends information down to earth while the astronauts orbit the planet.

The goal of the Astroskin, or Bio-Monitor, project is ultimately to reduce the effects that living in a zero-gravity environment have on the body, says Dr. Robert Amelard, a research scientist involved with developing Astroskin who is currently monitoring the project with the Canadian Space Agency.

Recent medical findings have indicated that after spending six months in space, astronauts’ arteries appear to have aged 20-30 years. Insulin resistance is another adverse effect caused by the lack of exercise in zero-gravity. With the information the Canadian Space Agency is gathering from the Astroskin project, scientists hope to find ways to curb these side effects, thereby making space travel more viable for longer periods of time.

While space travel for the average person is still a far-fetched idea, a better understanding of insulin resistance and the aging body could lead to important conclusions for those of us on Earth. Smartwatches are already equipped with wearable technology so advanced it can identify health issues, notes Dr. Amelard.

“When the Apple Watch recently became a Class 2 Medical Device, we started hearing case studies about people who didn’t know that they had arrhythmias who now had a warning [from their watch],” he says.

Dr. Amelard, who works at the Research Institute for Aging at the University of Waterloo, explains that the subclinical, or subtler, symptoms of disease can be recognized by wearable technology. These applications have the potential to be life-saving from a prevention perspective.

“If we can develop algorithms that learn to capture subclinical symptoms earlier,” Dr. Amelard says, wearables could detect medical conditions like cancer earlier, prompting medical intervention.

Dr. Richard Hughson, a fellow researcher on the Astroskin project, explains that the practical applications of the project are ultimately about predictions and prevention.

“If you track someone regularly over time, you will see deviations,” he says. With wearable tech, “[an alert] can say, ‘You should see your physician, and here’s why.’”

There are hurdles to overcome when it comes to adoption, however. In practical terms, the Astroskin is cumbersome and difficult to wear because it’s a snug fit, Dr. Hughson says. The goal is to have a “zero-effort technology that becomes more integrated into your everyday clothing, rather than a special shirt.”

Dr. Joanna Berzowska is associate dean of research at Montreal’s Concordia School of Fine Arts, and she says that designing smart textiles that people want to wear is a continuing challenge.

“We haven’t found that perfect convergence of fashion, tech, comfort [and] function,” she says.

With new, health-focused wearables emerging every day, there are other concerns, Dr. Berzowska says. She points to the dangers of misdiagnoses due to a phenomenon called algorithmic bias.

Algorithms can duplicate the biases in the data sets used to train them, she says. A lot of medical data is gathered from white male test subjects, which could create biases in the way a smart shirt predicts something like a heart attack, for example.“

The predictors and symptoms of heart disease for men and women are different, and they vary for people from different ethnic groups,” Dr. Berzowksa explains.

Even the most innocuous-seeming wearable devices have drawn criticism. For example, ten thousand steps per day is a common goal set by wearable step counters like the Fitbit. But that goal isn’t necessarily right for everyone.“

There is no scientific evidence that 10,000 steps a day is good for the population as a whole,” says Dr. Reed Ferber, head of the Wearable Technology Research and Collaboration (We-TRAC) program at the University of Calgary.

He notes that if someone has been newly diagnosed with mild osteoarthritis, 6,000 steps per day is enough.

“If you’ve just had knee surgery, too many steps can do more damage,” adds Dr. Ferber, who also directs the running injury clinic at University of Calgary. “Too few steps can lead to disease progression, and too many steps can lead to disease progression. It’s an interesting interrelationship.”

While Dr. Ferber says that wearable tech can be useful, “It’s buyer beware. There’s a lot of marketing with very little scientific validation.”

There are wearables in development that promise benefits beyond monitoring physical health. For example, Dr. Berzowska helped develop a smart shirt that sends the wearer’s partner a notification if they are feeling stressed. The idea is that the wearer would then get a text message or phone call filled with love and encouragement before they walk into that important work meeting.

Dr. Berzowska believes that we will eventually get to the point where “zero-effort” wearable clothing is commonplace. But for now, “it’s a lot of trial and error,” she says.

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