Wearables & IBD flares

March 11, 2025

Issue 05

Clinical Question

Can wearable devices identify and predict IBD flares?

Editor’s Bottom Line

Data from wearable technology may help to monitor and predict the activity of IBD and could be incorporated into strategies to maintain tighter disease control.

Reference

Hirten RP, Danieletto M, Sanchez-Mayor M, et al. Physiological Data Collected from Wearable Devices Identify and Predict Inflammatory Bowel Disease Flares. Gastroenterol. Epub ahead of print Jan 16, 2025; https://www.gastrojournal.org/abstract

Synopsis

This study, conducted by researchers at Mount Sinai Hospital in New York, included 309 adults with IBD enrolled across 36 states. Participants answered daily disease activity surveys and wore one of three devices: an Apple Watch, Google Fitbit or Oura Ring. The devices collected several physiological metrics longitudinally, including heart rate, resting heart rate, heart rate variability, and tracked steps and oxygenation. Participants were required to wear the devices at least eight hours each day.

Researchers also measured C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin throughout the study to determine the presence of inflammation, and surveyed participants about symptoms daily.

One-hundred and ninety-six participants had Crohn’s disease (CD), individuals were a mean 40 years of age and 67.3% were female. The mean duration of follow-up was 213 days.

Analysis showed that circadian patterns of heart rate variability differed significantly between periods of inflammatory activity and remission. Specifically, the rhythm-adjusted mean of the circadian pattern of heart rate variability (measured as standard deviation of normal-to-normal intervals [SDNN]), was lower during inflammatory periods (39.26 milliseconds [ms]; 95% Confidence Interval [CI], 36.69–42.10 ms), compared to periods of inflammatory remission (41.06 ms; 95% CI, 38.65–43.80 ms; p<0.0001).

Additionally, mean heart rate was higher during periods of active inflammation (79.31 beats per minute [BPM]), compared to periods of inflammatory remission (78.92 BPM; p=0.03). Similarly, mean resting heart rate was also higher during inflammatory flares, compared to periods of remission (65.30 BPM vs. 64.64 BPM, respectively; p=0.02).

Participants also walked fewer steps during inflammatory flares, compared to periods of inflammatory remission (daily mean: 5,082 vs. 5,507, respectively; p=0.01).

Other findings included a higher amplitude of the circadian pattern of SDNN during symptomatic flares (4.68 ms; 95% CI, 3.87–5.60 ms), compared to asymptomatic periods (3.69 ms; 95% CI, 2.96–4.51 ms; p=0.006) and significantly lower mean oxygenation among those with CD during symptomatic flares, compared to periods of symptomatic remission (oxygen saturation of arterial hemoglobin (SpO2): 96.44% vs. 96.63%, respectively; p=0.0002). There was no difference in SpO2 levels among ulcerative colitis patients between flares and periods of remission.

Finally, analyses showed that changes in cardiovascular metrics and oxygenation occurred up to seven weeks ahead of an inflammatory and symptomatic flare.

Details

Study Design: Prospective, observational cohort study
Funding: Not stated
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b