Why “Smart Clothing” is the Next Frontier for Wearable Health Tech

When Eric Blue goes to the gym, he sports a wafer-thin shirt that tracks his every move.

Blue’s shirt contains tiny sensors, which are woven into the fabric. They monitor his heart rate, the calories he burns and other metrics, like breathing rate. And a companion mobile app on his smart phone informs him about the intensity of his workouts.

Blue, a Los Angeles entrepreneur, says regular use of the shirt has pushed him to “up his game” during exercise.

This is no ordinary shirt. It represents the evolution of the wearable-tech trend from accessories, like watches and bands like Fitbits, to full-blown clothing.

Blue, 38, was among the first people to buy a biometric shirt from Montreal-based startup Hexoskin. Blue is a self-professed “fitness junkie” who goes to the gym at least five times each week, so he said the shirt is worth the $399 price tag. For Blue, it’s far easier to throw on a Hexoskin shirt and go, rather than fiddle with a smartphone or chest strap.

"My old heart rate monitor is now sitting in the closet, gathering dust," he said.

"It sounds very sci-fi right now, but in the future all of the personal data being collected by health and fitness sensors and smart watches will alternatively be readily available in our clothing."

Blue isn’t alone in embracing the smart clothing trend.

Famous athletes, astronauts, and even Cirque du Soleil performers have all espoused the benefits of using Hexoskin and other smart clothing products. Smart shirts, athletic pants and even socks started hitting stores last year.

But medical experts say they hope patients with serious and chronic conditions also can benefit from smart clothing. When will these products reach the health care market, where they may be needed most?

“These companies will hit fitness fans first,” said Stephanie Tilenius, founder of Vida, a mobile app that matches sick patients with personal health coaches.

“But I see huge potential for chronic care.”

Rapid Evolution

It’s still early for smart clothing, but the technology is evolving rapidly.

One company, Athos, based in Redwood City, develops garments that can track people’s muscles as they move. Sensors in its shirt can detect whether a user is putting too much pressure on one side of the body, for instance.

Athos is focused on reaching passionate exercisers who want to make improvements to their exercise regimes, like training more intensively while avoiding injury, said CEO Dhananja Jayalath.

"The people who buy our stuff are into fitness -- they typically spent a lot of time working out," he said.

As is the case with many startups, Jayalath started Athos to solve a personal problem.

He came up with the idea while studying electrical engineering in college. Jayalath, who frequently goes to the gym, said he couldn’t stop thinking about whether technology could replace a personal trainer.

“After we came up with the idea, people told us we were crazy and it wasn’t possible,” he said.

It took Jayalath and a fellow electrical engineer just five years to build a working prototype.

Against all expectations, Jayalath succeeded in developing apparel that can track muscle activity, heart rate recovery times and breathing rates. In the past, athletes would have needed to be hooked up to a machine in a performance lab to access this information.

Jayalath didn’t intend to build a product for sick people. But Athos has already received a great deal of interest from the medical community.

The company anticipates that its clothing will eventually be used in all kinds of clinical settings, such as hospitals and rehabilitation clinics. Smart clothing could benefit patients with a variety of medical conditions, including heart disease and obesity.

“Gradually over the next few years, these low-cost, consumer-focused, data-rich devices and apps will bring to bear vastly more data than physicians have in some circumstances,” said Pete Moran, a general partner at the venture capital firm DCM, which invested in Athos.

But selling to hospitals comes with strings attached.

“It would be far easier for a product like this to remain in the ‘wellness’ category,” said Morgan Reed, an executive director at The App Association, a Washington, D.C. nonprofit that works with patient advocates and app developers.

By saying they are helping improve fitness and well being, Reed said, these companies may hope to avoid regulatory oversight from government agencies like the U.S. Food and Drug Administration.

Smart Training to Smart Recovery

NBA All-Star Jermaine O’Neal recently endorsed and made a personal investment in Athos because it helps him "train smarter."

But how about helping surgical patients recover smarter?

“Fitness shirts could find a market in rehabilitation and could facilitate home exercises. That's just a thought,” said Dr. Molly Maloof, a general practitioner based in San Francisco, who has been closely following the wearable tech trend.

Patients could wear biometric shirts and other apparel after surgeries, she said. Those who have recently undergone cardiac surgery, for instance, could be alerted if their heart rate is too high.

Smart clothing might also help people who are obese or overweight. Some doctors would consider recommending smart clothing to some of their patients, if it would inspire them to exercise regularly.

"The fact is that the majority of Americans are in terrible shape," said Maloof. According to Maloof, fitness shirts could help get people on their feet, as long as the product proves to be more compelling than a barely-used gym membership.

Other physicians said they remain unconvinced that the data is precise. This mistrust doesn’t just apply to smart clothing, but the wearable-tech trend in general.

“There has been an explosion in patient-generated data, but much of it may not be useful to physicians in the short-term,” said Dr. Pat Basu, a former chief resident at Stanford University and current chief medical officer at Doctor On Demand, an app that connects people to doctors.

“If a patient is showing me their blood pressure or heart rate they gathered from an app or device, I’ll always ask myself, ‘Is the fidelity of this information accurate or not?'”

Basu also said that wearable-tech makers should produce reports about each patient that doctors and nurses can skim. Many physicians are already inundated with the wealth of data that patients are generating from new wearable apps and devices, he said.

Moreover, some doctors fear that they will be liable if they miss something in the growing pile of patient data.

Privacy is another concern. The App Association’s executive director, Morgan Reed, has examined the privacy policies of companies like Athos.

He’s satisfied that patient’s sensitive health information is protected – for now.

But Reed expressed fears that the next crop of smart clothing companies might opt to offset the high cost of their products by selling people’s health data to pharmaceutical companies, insurance providers and even employers.

Fears are mounting among policymakers that many of the most popular wearable tech companies are selling people’s personal health data, including step counts, hours of sleep and location.

“Would consumers understand that they’re buying the version that is monetizing through data-sharing?” Reed said. “That’s the problem that everyone in the wearables industry is working on right now.”