Smart Watches Could Do More For Wheelchair Users

Smart watches and fitness trackers have transformed the world of exercise, spawning a generation of active tech users. The Apple Watch, FitBit and Strava have prided themselves on getting the world moving. But one group of people has been frequently left out of this fitness revolution: wheelchair users.

Steps, after all, are not easily comparable to pushes of a wheelchair. And yet, those in wheelchairs need fitness tools just as much as everyone else, if not more than those who don’t identify with a disability. A 2014 study by a team from the National Center on Birth Defects and Developmental Disabilities and the National Center for Chronic Disease Prevention and Health Promotion found a difference of 21 percentage points in reported activity levels between those with disabilities and those without.

Smart watch and fitness tracking companies have made efforts toward inclusion. The Apple Watch began supporting wheelchair users in 2016, and Strava also debuted wheelchair and handbike activity modes around that time. (Strava put out an update on Aug. 12 that made it possible to set designated wheelchair, handcycle, velomobile and e-bike goals rather than listing them as running or cycling.) Disability news and culture sites like The Mighty heralded the Apple Watch release as “good news” for both wheelchair athletes and the regular wheelchair user, but the apps and devices still aren’t serving wheelchair users as well as they could.

Research done by researchers at San Diego State University in 2017 found that the Apple Watch often did not have full accuracy when it came to push count. In their words, “[The] Apple Watch is suitable for tracking high-frequency standardized (i.e., treadmill) pushing and arm ergometry but not low-frequency pushing or overground tasks.”

For some, this may not seem like a large problem. After all, there is no perfect match within an activity data set. But the device’s accuracy could be much more important to, for instance, a national team athlete than a wheelchair user for whom elite movement is not an option. What happens next to the data coming out of these apps and devices is also crucial, since researchers may be using it in their studies. If the data on wheelchair users isn’t accurate, whatever recommendations come out of those studies might not help disabled users — and could even make fitness harder for them if they set unrealistic expectations.

While this lack of accuracy is a problem, the individual data collected by users is still important. It can be used to show tangible improvement for users and to motivate a population that can find it hard to exercise regularly. William Miller, a professor in the Department of Occupational Science and Occupational Therapy at the University of British Columbia, brought this forward in a call for participants for an as of yet unpublished research project in the same vein.

“Technology that is reliable and accurate has been shown to be able to positively motivate users to increase physical activity,” he wrote. “This knowledge is particularly important for a manual wheelchair user population due to decreased physical activity levels within this population.”

Take the Apple Watch, for example. A team of researchers from Finland and Australia found in 2019 that its “push-count estimates are acceptable for personal, self-monitoring purposes and for research entailing group-level analyses, but less acceptable where accurate push-count measures for an individual are required.” They did find that this error, averaging out to 13.5 percent, was comparable to the errors found in similar studies that matched visually monitored step counts with pedometer results in non-wheelchair users. But more accurate push counts might be needed in an elite sporting environment, for example, or when push count or distance is being used as a key health indicator by a medical professional. Users with disabilities might also want to compare their statistics to their non-wheelchair-using friends.

Apple sent a review unit for this story as I tried to determine if the research that I’d found was missing any aspects of my experience. Apple developed features that mirrored the step count available to able-bodied users, including the reminder to get up and move, and to create wheelchair-accessible workout modes. The integration asking me to go for a roll was a welcome addition.

I tested the Apple Watch by wheeling down a carpeted hallway at a regular pace. Though the 2019 study observed that the watch tended to undercount wheelchair pushes, I found that the watch tended to overestimate my number of pushes slightly. This could be because of many factors, as the researchers from Finland and Australia noted, including the speed at which the push was taken, a variable that they recommended go under further investigation.

When you initially set up the app on your phone – for me that’s an iPhone XR – it asks you whether you will be using steps or pushes to calculate. But there’s no easy way to switch between wheelchair and walking modes. As an ambulatory wheelchair user, I stand up and sit down regularly throughout the day. And I’m not alone: According to research published in 2014, approximately 6.8 percent of Americans identified as having “ambulatory difficulties.”¹ The separation between walking and wheeling means that users like me are unlikely to get an accurate reading when the movement of an entire day is taken into account.

The watch is clear in its commitment to accessibility. On the App Store, apps for voice recording, augmentative communication (AAC) and keyboard typing from the watch are included on the homepage. Some of these products cost more than $300, a steep price to pay when the newest version of the watch itself sells for $399 — particularly when considering the income levels of the potential users: A 2016-17 report by researchers at the University of New Hampshire’s Institute on Disability identified the share of disabled people at or below the poverty line in the United States at 20.9 percent, 7.8 percentage points higher than the non-disabled population.

While the watch was not perfectly accurate in my case, it still opens up the possibility for wheelchair users to improve their health outcomes. With a little more refinement, these apps and devices could be just as useful to wheelchair users as they are to the general population.