The Apple Watch: Shaping the Future of Health Technology

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The evolution of health tech can be traced back to a pivotal device: the Apple Watch Series 4.

In 2018, smartwatches and fitness trackers were primarily focused on basic metrics like step counts, heart rates, and minimal sleep tracking. They were more about fitness than comprehensive health monitoring. While useful for boosting activity or shedding a few pounds, they weren’t exactly life-saving devices. That all shifted with the Series 4, which introduced FDA-approved atrial fibrillation detection—a groundbreaking feature for consumer wearables. While some critics pointed out that it lacked the accuracy of traditional EKGs and raised questions about interpreting wearable data, the impact was undeniable.

Now, FDA-approved digital health features are the gold standard in consumer health tech. Each year, we hear stories of how Apple Watches have positively impacted lives, prompting competitors to integrate similar functionalities into their devices. Fast forward eight years since the Series 4’s launch, and wearables now offer notifications for various health issues, including sleep apnea, hypertension, and even fertility tracking. Despite concerns about health anxiety stemming from these features, manufacturers are racing to uncover links between new health markers and longevity, leading to a focus on recovery metrics, metabolism, and even bodily fluids.

As we reflect on 50 years of Apple products, it’s essential to examine the company’s influence in this arena and the advancements that followed. I had a conversation with Deidre Caldbeck, senior director of Apple Watch and health product marketing, to discuss how Apple approaches health feature development and what it means for the future of the Apple Watch.

Back in 2016, my first Apple Watch was the Series 2. As a reviewer of wearables, I’ve tested every version since. One thing has always stood out about Apple’s strategy: the Watch is designed to be a health tool for everyone, not just fitness enthusiasts. (As long as you have an iPhone, that is.)

“We aimed to make Apple Watch features as inclusive and intuitive as possible. Technology has evolved, and so have people’s interests in health and fitness, but our main goal has remained: to create features that can genuinely impact a wide audience,” Caldbeck explains.

Caldbeck notes that while the Apple Watch has always included an optical heart rate sensor, it was initially used mainly for workout tracking. As more users adopted the Watch, feedback indicated a desire for deeper insights into heart health. The Series 3 introduced high and low heart rate notifications, but the real game-changer was the Series 4, which featured a significant redesign, a larger display, and a modernized interface. The addition of EKG functionality shifted the device’s focus from merely fitness tracking to a more comprehensive health tool.

“We started receiving more feedback about heart rate recovery insights, which led us to invest in features like low-cardio fitness,” she says, referencing the VO2 max metric. “While aFib notifications were already present, we began exploring how to enhance aFib history for those diagnosed with it, which accelerated our development of heart health features.”

Apple’s commitment to impactful health features often contrasts with the current trend in health and wearable tech: AI-driven personalization. Competitors are rapidly integrating AI to create highly customized user experiences. Brands like Garmin, Google/Fitbit, Samsung, Oura, Whoop, Strava, and Withings are all jumping on the AI bandwagon, but the results can be hit or miss.

In recent years, these companies have also been quick to adopt wellness trends. For example, with the rise of GLP-1 medications, metabolic health tracking and AI nutrition features have become highly sought after. Garmin launched its version of this feature earlier this year, and even Meta announced plans to introduce AI nutrition logging through its smart glasses.

On the flip side, Apple has been slower to embrace AI, facing criticism for it. The Workout Buddy feature, released last year, isn’t a true AI coach; it’s more of a motivational tool that highlights past milestones and progress toward daily goals. It doesn’t provide workout suggestions or guidance, which many users expect from AI fitness features.

Caldbeck emphasizes that this approach is intentional. “We aim to provide meaningful insights without overly specific recommendations. Our features are designed to be discreet, blending into the background while still alerting you to important information that may warrant a discussion with your doctor.”

Caldbeck points out that Apple has utilized AI in developing features like heart rate monitoring, fall detection, and hypertension notifications. However, the primary goal is to use AI to unlock health insights and empower users with actionable information. Importantly, every health feature must align with established scientific literature.

“What remains consistent is our commitment to delivering features with actionable insights grounded in science and built with privacy in mind,” says Dr. Sumbul Desai, Apple’s vice president of health and fitness.

Caldbeck acknowledges the temptation to jump on trendy wellness fads from a product perspective. However, Apple insists on validating its data across a broad population due to its extensive global reach. For instance, the inaugural Apple Heart Study involved over 400,000 participants—an unprecedented number at the time. When developing features, concepts like specificity and sensitivity are carefully considered.

“We’re cautious about rolling out new features because we want to ensure we’re not ahead of the science,” Caldbeck explains. “Sometimes, we wait a year or two. This may mean that others are ahead of us in areas users care about, but it requires discipline, and we’re committed to that.”

Many health tech companies claim to be science-backed, but Apple is serious about the patience and competitive sacrifices this approach entails. Last year, I spoke with Desai about the Apple Health Study, which has no specific goal and will cover various health aspects over five years, with the possibility of extension. There’s no guarantee of groundbreaking insights or features, meaning it could take a long time to see the results of such extensive research.

Hypertension notifications, launched last year, exemplify this approach. Although Apple had been eager to introduce this feature for some time, Caldbeck states that the company chose to wait until it could provide reliable, validated results for a global audience and successfully navigate the regulatory process. Apple even published a validation paper based on data from 100,000 study participants, detailing the technology and development process behind the feature. Similarly, the sleep score feature, which has been available on other devices for years, wasn’t rolled out by Apple until 2025, as the company prioritized scientific consistency.

Even if it takes time to unveil the next groundbreaking health feature, Caldbeck and Desai assure users that Apple plans to integrate health tech into its other devices as well.

“We’re focused on creating innovative, intelligent features that provide personal insights through products like Apple Watch, AirPods, and iPhone, fundamentally changing the concept of prevention by democratizing access to health information,” Desai states.

“If you consider what we’ve done with hearing health through AirPods and how we’ve used the iPhone to track mobility metrics, there’s still a lot we can achieve with devices that accompany you daily,” Caldbeck adds. “This is an area we’ll continue to invest in to maximize impact for more people across our product lineup.”

In Optimizer, I often express concern about how recent wellness trends seem to be steering health tech in a less-than-ideal direction. The increasingly blurred lines between wellness and medical technology genuinely keep me up at night, especially as health tech companies lobby for relaxed regulations. As a reviewer, I’ve noted how Apple Watch and health updates can feel iterative, particularly when competitors seem to be ahead. As I observe this space, I’m uncertain which approach will ultimately prevail: Apple’s slower, broader, yet scientifically rigorous method, or the startups chasing emerging wellness trends with AI-driven personalization. One thing is clear: Apple is one of the few companies that can afford to take its time.