Employee resilience is more than just mindset

How has your team's resilience been affected by Covid-19?

One of the biggest challenges that companies face as they look to the future is understanding how to protect the resilience of their workforce.

Resilience is the foundation to sustainable high performance, regardless of a person’s seniority and industry.

With resilience, we can deal with uncertainty, face challenges, support others, lead ourselves and reach key goals.

Without resilience, everything is compromised. Our health is depleted. Our energy is compromised. Our clarity of mind and executive function is less than ideal.

So how do you talk about resilience with your employees? Are you aware of what resilience means, from a scientific rather than behavioural perspective?

Watch the video below, and get in touch with questions. At 360, we can not only educate your teams on resilience in high performance, we can measure it accurately too using our app.

There has never been a more important time to measure, understand and support the resilience of employees.

With a new “hybrid” workforce, the potential for post-pandemic fatigue, and the effect of cumulative stress from the past 18 months, now is the time to understand the needs of your team to support culture and productivity.

We offer a guarantee of impactful data in 30 days or your money-back. Get in touch today.

Understand the resilience of your teams in 30 days, of your money-back.

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Checking-In on 360

How to Check-In on the 360 App

We’ve done all we can to make checking-on 360 quick, simple and intuitive.

There is nothing special you need to do to get going with 360, such as linking the Polar H10 to the Apple device in Bluetooth settings.

As long as you have wet the sensor and are wearing it, you can check-in on 360 within seconds.

The video below shows you how.


Quick Troubleshooting Guide

Two-minute Troubleshoot

Checking-in on 360 has been built to be quick and easy. If there any issues (either connecting or saving a score) we recommend double-checking the following in case external apps or devices are causing issues:

1) Bluetooth:

Depending on the version of iOS you have in your device, it may be that sometimes Bluetooth is held by another app or wearable, preventing 360 from connecting. If you cannot connect to the Polar in 360 when checking-in, swipe close all apps (including 360), turn Bluetooth off and on again, and then try again in 360.

2) Polar battery status and firmware:

Bluetooth connection may drop out when the battery on the Polar H10 is low. The Polar device firmware also needs to be updated occasionally. ​​You can check the status of your H10 battery by downloading and opening the free Polar Beat app, and connecting to the sensor there. You can check for device firmware updates by downloading and opening the free Polar Flow app and checking your device status there. Please swipe close the Polar apps once you have checked here, should you want to get a reading with 360.

3) Internet connection:

To save scores, 360 needs access to the internet because your scores are stored in the cloud.

If you have any other issues, please get in touch at [email protected].

Thanks, and enjoy 360!


360 Wins Digital Health Award

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We are over the moon to learn that 360 has won Gold at the London Design Awards for Digital Health. 

We are so happy for everyone involved; our digital team at Tigerspike, our clients who have given us amazing feedback since we first launched the app in 2016, and of course those in 360 who have helped shape everything from concept to completion.

You can learn more about the awards here. From ground-breaking apps accelerating medical research to apps helping consumers make healthier choices, Driven by Design looks for apps that are making health information and medical services more accessible to all.

We are incredibly proud to have won the Digital Health category and truly excited about the future.

Protecting Physical and Mental Health.

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Prevent illness, protect mental health and live proactively.

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Immune Responses and the Clinical Spectrum of COVID-19

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Introduction

When the pandemic hit in the early part of 2020, the world was dealing with an unknown virus. As of today, 56,236 peer-reviewed research papers have been published on COVID-19. We know so much more.

In this piece, we briefly review normal immune responses, abnormal immune responses, and the opportunity lifestyle medicine offers all of us to improve immune resilience. Why is this important now?

Top-down epidemiolgiocal modelling of the virus has its place for public policy, as long as it uses approriate assumptions. Bottom-up understanding of how our biology responds to the virus is vital from a personal wellbeing perspective. Education is king.

Coronavirus disease 2019 (COVID-19) is a disease caused by SARS-CoV-2. What follows is an overview of how the body becomes infected, our immune response to SARS-CoV-2 in both healthy and abnormal situations, and the lifestyle implications this brings.

SARS-CoV-2

SARS-CoV-2 belongs to the family of Coronaviruses. Coronavirus includes several species capable of infecting various animals, and some of which also affect humans.

SARS-CoV and MERS-CoV had a low level of transmission, but a high level of lethality. SARS-CoV-2 is easier to spread compared to former coronaviruses, but it is not as lethal. A September 2020 systematic review estimated worldwide infection death rate of 0.68%. However, this number will change over time as data collection improves. Death rate appears to be primarily dependent on age and underlying health status.

Research suggests that nearly 80% of all infections remain undocumented because patients are either asymptomatic or present with very mild symptoms. 

SARS-CoV-2 incubates for an average of 5.8 days. Incubation represents the time in days from the point of COVID-19 exposure to the onset of symptoms.

Upon entry into cells, viral RNA from SARS-CoV-2 gets released into the cytosol, and the virus exploits the cell machinery to replicate. The rapid viral replication causes cell damage, the release of pro-inflammatory cytokines, and the recruitment of inflammatory cells.

How Novel Is This Coronavirus?

Early in the pandemic, public health officials were unsure how the immune system would respond to SARS-CoV-2, and if a level of immunity was even possible after infection. This concern may have formed one of the assumptions behind initial lockdown strategies. We now understand a lot more about the virus, and the body’s response to infection. Two takeaways are essential here:

First, research shows that the immune system does identify SARS-CoV-2.

Second, it appears we also have a level of pre-existing immunity. At least six studies have reported T cell reactivity against SARS-CoV-2 with no known exposure to the virus.

A paper published in the prestigious journal Nature found SARS-CoV-2-reactive T cells in at least 35% of unexposed healthy individuals. The authors of this study concluded by saying:

Our study reveals pre-existing cellular SARS-CoV-2-cross-reactivity in a substantial proportion of SARS-CoV-2 seronegative healthy donors. This finding might have significant epidemiological implications regarding herd immunity thresholds and projections for the COVID-19 pandemic.

SARS-CoV-2 may be novel, but our immune system does an excellent job of recognising it.

A Healthy Immune Response to SARS-CoV-2

First Line of Defence: Innate Immunity

The first line of defence against SARS-CoV-2 is the innate immune system. Mucosal immunity refers to the production of mucus, designed to trap viral particles, be swallowed and eliminated via the gastrointestinal tract. If this barrier gets breached, there is another line of defence involving pattern recognition receptors (PRRs).

PRRs are like reconnaissance soldiers. They look for “stranger and danger” recognising different molecular structures characteristic to SARS-CoV-2. PRRs identify known viruses, bacteria and other types of pathogens that humans have had over many millennia.

PRRs recognise the SARS-CoV-2 virus and begin the inflammatory response via signalling pathways, such as NF-kB. The result is the activation of various cytokines, such as IL-6, TNF-a and IL-1b.

You can think of these cytokines as the troops. They attack and kill the virus. They are also crucial in communicating with the adaptive immune system so that we develop appropriate antibodies, and with it, the potential prevention of reinfection to SARS-CoV-2 in the future.

Second Line of Defence: Adaptive Immunity

The adaptive immune system helps to build memory and future immunity against the virus. T cells are hugely crucial in long-term immune resilience to SARS-CoV-2:

– CD4+ T cells stimulate B cells to produce SARS-CoV-2-specific antibodies

– CD8+ T cells target virus-infected cells and kill them with cytotoxic molecules, such as granzyme A

80% of the infiltrating cells in COVID-19 are CD8+ T cells.

It is worth noting that current estimations of community immunity cited by many in the medical community refer only to B cell SARS-CoV-2-specific antibodies. However, this approach ignores the role of sIgA and T cells in generating a level of immunity and protection against the virus. 

For example, a study into the original SARs-CoV virus found that six years after the virus, there were no SARs-CoV-specific B cells detectible in 91% of patients. However, there were SARs-CoV-specific memory T cells present in 61% of the SARS survivors studied.

In the image below you can see the difference between normal and abnormal responses to COVID-19:

An Unhealthy Immune Response to SARS-CoV-2

Given the capacity of the immune system to target, kill, clear and remember SARS-CoV-2 for future protection, what happens in the immune system to cause poorer outcomes with COVID-19? Let’s look at the innate and adaptive immune system in this situation.

Abnormal Innate Immune Response

First, suppose the innate immune system is not functioning correctly due to chronic illnesses, such as obesity, type II diabetes and cardiovascular disease. In that case, patients can experience the well-known “cytokine storm”.

A “cytokine storm” results from a sudden acute increase in circulating levels of different pro-inflammatory cytokines including TNF-a, IL-6, and IL-1b. Think of it as meta-inflammation in action, and way too many marines going to the site of infection causing huge collateral damage. The cytokine storm can cause lung injury, viral sepsis, pneumonitis, ARDS, respiratory failure, shock, and organ failure.

Abnormal Adaptive Immunity

Second, in response to the cytokine storm, the adaptive immune system can also go awry. Lower numbers of T cells, such as CD4 and CD8 T cells, have been found in detected in patients infected with SARS-CoV-2 with worse outcomes. The number of T regulatory (Treg) cells are also significantly decreased in severely ill patients. Regulatory T cells are vital in the maintenance of immune homeostasis: a balanced and effective immune response.

Lifestyle Medicine Implications

Understanding healthy and abnormal immune responses to COVID-19 is important. It enables us to stand back from the noise and establish our risk factors, and take control of certain lifestyle variables accordingly. 

For most, poorer outcomes with COVID-19 occur in those individuals who are already experiencing high levels of inflammation. COVID-19 and the cytokine storm is a meta-inflammation process. When you look for a common theme linking obesity, cardiovascular disease, COPD and other groups of people with poorer outcomes with COVID-19, it is the preexistence of chronic inflammation.

For example, CRP (a common generalised inflammatory marker that shows up on any blood test with your GP/doctor) quite literally predicts COVID-19 outcomes. The odds ratio of someone with high CRP being admitted to ICU in the hospital is 7.09. This is not something to be scared of: it is something to take action on. 

Preventative lifestyle measures have never been more critical in helping our immune system manage COVID-19 infection. Given that the virus is now endemic in society and here to stay, proactive wellness takes on new levels of importance.   

Diet, exercise, and other anti-inflammatory lifestyle changes can have a transformational effect on risk factors with COVID-19. This insight should be celebrated and shared, especially given the existing mental health crises caused by fear and a perceived lack of control. 

Gut HealthResearch shows that the higher the levels of a circulating pro-inflammatory cytokine called IL-6, the worse the outcomes for COVID patients. Lifestyle-induced imbalances in the gut are triggers for IL-6. Excess stress, a high-fat diet and too much alcohol can trigger dysbiosis and increase circulating IL-6. 

Probiotics may be an important weapon in helping individuals to successfully adapt to SARS-CoV-2 infection. This can be seen below from a recent paper addressing the potential effect of Lactobacillus rhamnosus CRL1505:

Diet: It well established that a whole food nutrient-dense diet reduces chronic low-grade inflammatory markers across the board. Working from home provides each of us with the opportunity to eat more wholesome foods to look after our immune resilience. 

If you are interested in learning about potential strategies to improve your nutrition to support immune resilience during this time, this is a useful research paper.

Exercise: Research also shows that exercise helps to reduce chronic inflammatory markers, such as CRP, thereby improving the chances of a positive outcome after SARS-CoV-2 infection.

Justin Buckthorp

Justin Buckthorp is Founder and CEO of 360 Health & Performance International. He has 20 years of experience healthcare, elite sport and performance coaching, and is passionate about helping others unlock their potential.

Measure Resilience | Surface Insight | Empower Teams

To learn how 360 can help you improve the health, resilience and productivity of your employees, get in touch today.

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The Importance of Gut Health in the Treatment of COVID-19

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360 is dedicated to using evidence-based medicine to proactively inform decision-making in our health. Now, more than ever, it is important we utilise peer-reviewed literature to help us navigate the pandemic on a personal level.

We live at a time of great uncertainty. Rules and regulations that affect our daily lives are changing frequently. The future is unsure. There is currently no clear finishing line to many of the challenges we face at home, at work and in society. However, whilst we cannot control all these factors in the outside world, we can take charge of factors impacting our inner world. Personal wellbeing is central here.

Nutrition is one of the many pillars we can address through small impactful lifestyle changes to look after our wellbeing. It is also an emerging area of interest in the successful management of COVID-19.

More specifically, research suggests that improving the health and diversity of the gut microbiome through a diet lower in saturated fat, higher in fibre and including probiotics may be of value in the pandemic because of the impact the gut microbiota in regulating immune tolerance and the lung microbiota.

As the authors of this paper put it:

Gut microbiota diversity and the presence of beneficial microorganisms in the gut may play an important role in determining the course of this disease. Elderly, immune-compromised patients and patients with other co-morbidities like type-2 diabetes, cardiovascular disorders fare poorly in combating Covid-19. It is interesting to note that a general imbalance of gut microbiota called “dysbiosis” is implicated in such patients and the elderly

A recent Research Review looked at the potential impact of the gut microbiome in determining outcomes of COVID-19 infection. The gut microbiota refers to the trillions of microorganisms that live inside the gastrointestinal tract, and collectively it plays a central role in regulating immune and brain function. For a deep review of the topic, this is a very good research paper by leaders in the field.

The current paper, entitled “Potential contribution of beneficial microbes to face the COVID-19 pandemic“, addressed biological mechanisms by which a healthy and diverse gut microbiota appears to be central in successfully regulating our immune responses to COVID-19 and helping to prevent the hyper-inflammatory “cytokine storm”.

The “cytokine storm” has been shown to be a key determinant of outcomes with COVID-19. Therefore, if there are proactive lifestyle medicine tools that can be used to reduce the risk of negative outcomes, it is worthy of note. This research review in question builds on the weight of research from evidence-based medicine and postulates that dysbiosis (an imbalance in the gut microbiota) is a risk factor in COVID-19 outcomes.

Simply put, an unhealthy and imbalanced gut appears to put an individual at greater risk of a “cytokine storm” and pathology within the lungs after infection by SARS-CoV-2. This risk is chiefly caused by the fact that dysbiosis promotes a release of pro-inflammatory cytokines in the gut which impairs the integrity of the lining of the gut, thereby increasing the chances of a cytokine storm within the lungs. The image below illustrates these mechanisms at play:

As you can see in the image there is a gut microbiota and a lung microbiota. An imbalance in the gut microbiota caused by poor diet sets up a chain of pro-inflammatory events in the body that affect the lung microbiota and can contribute to the cytokine storm.

As the authors of the paper postulate:

Dysbiosis in the microbiome may create an inflammatory environment that the coronavirus can exploit. Gut-related inflammatory proteins, cytokines, are amplified by more cytokines when coronavirus hits. The combined inflammation may ignite a “cytokine storm”—a runaway immune reaction that can cause more damage than the virus itself, including multiorgan injury.”

At 360, we have a distinct philosophy in all of our work which is to be proactive and treat the cause, not the symptom. We focus on positively impacting the first domino rather than reactively chasing the fifth.

In this instance, it is important that hospitals use various anti-inflammatory medications to manage the cytokine storm once it hits, but from a preventative medicine standpoint, our interest is in helping people ahead of time prevent the cytokine storm in the first place if they become infected with SARS-CoV-2. The gut is one key piece of the immune resilience matrix in this respect. This is summarised well in a new research paper which concluded:

The gut microbiome can play a crucial role in modulating the immune responses of COVID-19 infected individual, and prevent the damage of vital organs, including lungs. Therefore, re-formulating the gut microbiota may emerge as a new therapeutic target in the disease management of COVID-19 patients employing nutritional therapy, probiotics or fecal microbiota transplantation (using standard guidelines).

As we approach winter, make gut health central to your wellness programme and that of your employees.

Justin Buckthorp

Justin Buckthorp is Founder and CEO of 360 Health & Performance International. He has 20 years of experience healthcare, elite sport and performance coaching, and is passionate about helping others unlock their potential.

Measure Resilience | Surface Insight | Empower Teams

To learn how 360 can help you improve the health, resilience and productivity of your employees, get in touch today.

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Using 360 Through COVID-19

Introduction

In this post, we want to show you how you can use 360 to help you look after your health through the COVID-19 pandemic. The cumulative effect of stress, uncertainty and exposure to the virus is having a significant impact on the population. Even with a successful vaccine, there will be a need to look after our immune resilience and take proactive steps to look after personal wellbeing. With 360, you have the unique ability to measure, learn and improve your health. This post will outline how to do so in the context of COVID-19.

360 Markers & COVID-19

360 measures your subjective and objective wellbeing. Both can be valuable in supporting you through the pandemic and into the future. Let’s have a look at each in turn.

Subjective Wellness Markers

As you are about to learn, the physiological measurements that you get from 360 can be powerful in successfully navigating COVID-19, but so too can your subjective data. Each day you have the opportunity to self-rate your sleep, energy, diet, exercise and happiness. You also have the chance to add tags each day, pinpointing specific lifestyle factors that are involved in the regulation of your health.

The subjective trends screen can be very helpful in managing your health. The bar graph shows your daily score (white line) compared to your average score over time (green bar). It is worth taking ten seconds to look at your strengths and gaps here to see what area you might want to prioritise to look after your immune resilience.

For example, nutrition is central to optimising immune function. Our innate and adaptive immune system needs sufficient nutrients to function correctly and in a balanced way. Diet also has a significant effect on the integrity of the gastrointestinal lining, which is where up to roughly 75% of immune-sensing cells reside. If we disrupt the lining of the gut through too much saturated fat, processed foods and alcohol, we are more at risk of immune dysfunction, and with it the effects of COVID-19.

How does this relate to 360? Well, the science of immune regulation is complicated, but the application for us is easy. If on the subjective wellness trends screen, you notice that diet is scoring low compared to other areas of your wellbeing, make it a priority and proactively support your immunity. 

Tags can also be powerful in helping you look after your lifestyle and support immune resilience. For example, if you notice on the subjective trends screen that “stress” is your top-rated tag, treat it as useful feedback. 

Chronic low-grade stress is has a pro-inflammatory effect on the body. It depletes the ability of the immune system to mount a balanced, robust and effective response to bacteria and viruses. 

A recent review looked at the links between mental and emotional resilience and immunity. The researchers authoring the paper found a bi-directional relationship. In other words, there was a top-down influence of the brain impacting immunity and a bottoms-up impact of immunity impacting the brain.

The researchers went on to explain that “exposure to recent and chronic stressful life events has repeatedly been shown to increase an individual’s risk of developing clinical illness following inoculation with the challenge virus.”

In the case of COVID-19, constant mental and emotional stress, therefore, makes us more vulnerable from an immune perspective, should we become infected. That is, unless, we take proactive control. 

This is why 360 is valuable. It helps because by becoming aware of the dominant factors in your lifestyle, you can take control of them. You cannot change what you are not aware of. 360 surfaces these habits and behaviours so you can nudge them in the right direction.

In the case of stress, you might find new approaches to manage your mental and emotional stress. This approach might include tools from CBT, using fitness training to look after your mental health, practicing mindfulness, journalling gratitude, connecting with others, or honouring your body’s need for downtime. 

In summary, use the subjective data to be proactive in your self-care. Everything we have built for you in 360 is there to surface insight quickly and easily. 

Objective Wellness Markers

The physiological markers in 360 are remarkably sensitive to immune challenges. You can use this to your advantage with COVID-19, and take early steps to mitigate its effects or protect others.

You tend to see three objective wellness changes if you experience coronavirus infection.

First, you will likely see a sudden and sharp rise in resting heart rate upon waking up and checking-in. This is a normal response to heightened activation of innate immunity, the release of inflammatory cytokines going to the site of infection, and the corresponding ramp of the sympathetic nervous system which helps in all of this. In such a scenario, you would expect your resting heart rate to jump up by at least 20%.

Second, you will likely see a sudden and sharp drop in levels of parasympathetic activity, as indexed by your morning objective wellness score. This too is a normal response to infection. Whilst the body is dealing with immediate needs driven by immune and inflammatory activity, long-term cellular renewal and regenerative processes are naturally inhibited and therefore parasympathetic tone decreases significantly.

Third, you will see your PNS fluctuation percentage increase. This is simply a result of sudden large changes in your objective wellness.

Often, these changes in your scores can happen prior to any major symptoms.

This is a sign that your first lines of immune defence have been mobilised, and are getting to work to kill the virus. Now, this might not be COVID-19 but another type of virus, but either way it is helpful. You are getting an early warning indicator which you will want to follow up on.

– Reach out to the relevant healthcare channels to ensure you get the support you need

– If you were meant to go to work, this would be a good day to stay at home to protect others

– Even if you do not have symptoms, avoid heavy exercise in such a scenario to ensure you do not compromise immunity

– Make sure you hydrate and eat a nutrient-dense, whole food diet that day to support immune resilience

– Optimise vitamin D status. Whilst there are many supplements that can help, vitamin D appears to be a clear winner based on the current incoming clinical research.

If you get a diagnosis of COVID-19, please use the SARS-CoV-2 tag in the Journal to note the day it happened. Just tag it once and on that day. This will help you keep a record of events and track your recovery afterwards. 360 will be a powerful partner in your journey back to full health by giving you insight and helping you understand when you are adapting well and can push, and when you are driving systems too hard and need to prioritise regeneration. Enjoy!

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Vitamin D in the Treatment of COVID-19

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Justin Buckthorp

Justin Buckthorp is Founder and CEO of 360 Health & Performance International. He has 20 years of experience healthcare, elite sport and performance coaching, and is passionate about helping others unlock their potential.

In recent months, a significant amount of research has been published on risk factors, medical treatments, and lifestyle medicine tools to help in the management of SARS-CoV-2. 

There is a matrix of solutions in this respect, and one of those solutions to mitigate risk and effect is nutrition. A new study from August 2020 looked at the potential role of Vitamin D in the treatment of patients hospitalised with COVID-19.

Entitled “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”, this paper is worthy of mention.

Vitamin D is an inexpensive supplement with few contraindications at the appropriate dose, and with winter coming, the results have important implications in protecting our health.

Design Set-Up

There were 76 participants in the trial; all hospitalised with COVID-19. The average age of patients was 53, and at the start of the study, there were no significant differences in the number of subjects with at least one risk health factor.

Results

Of the 50 patients treated with Vitamin D, only one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%).

Of the patients treated with Vitamin D, none died, and all were discharged, without complications. Of the 13 patients admitted to the ICU who were not given Vitamin D, two died.

Implications

This trial into the therapeutic effect of Vitamin D is the first study of its kind. More well-controlled RCTs are currently taking place, and they are needed to add confidence to the data. But the results of this study are very encouraging.

Mechanisms of Success

From a biological perspective, why might Vitamin D help patients recover from COVID-19?

Research suggests the Vitamin D works through multiple mechanisms. These include:

1) Decreasing the cytokine and chemokine storm 

2) Regulating the renin-angiotensin system 

3) Maintaining the integrity of the epithelial barrier in the lungs

4) Stimulating the repair of the epithelial barrier in the lungs

5) Modulating neutrophil (immune) activity 

The image above provides a visualisation of these potential mechanisms. As the study concluded,

“Coronavirus infection is a serious health problem awaiting an effective vaccine and/or antiviral treatment. The major complication of SARS-Covid-19 pneumonitis is ARDs (Acute Respiratory Distress syndrome) mediated by a variety of mechanisms that may be aggravated by vitamin D deficiency and tapered down by activation of the vitamin D receptor.

We would add that even in the presence of a vaccine, the virus is endemic and not all parts of the population are going to receive or take up the opportunity of a vaccine. As such, it is important to get ahead of the curve and find ways to protect our health ahead of time. Vitamin D status is one of the multiple avenues to help optimise immune resilience.

As we approach winter, ensure you optimise vitamin D for yourself and your employees.

Measure Resilience | Surface Insight | Empower Teams

To learn how 360 can help you improve the health, resilience and productivity of your employees, get in touch today.

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Using Tags to Help You Achieve Your Goals

Introduction

We built 360 to help you measure, learn, and take control of your health. The combination of subjective data with objective data is powerful, especially when you add tags too. This post gives you an introduction to the different tags in 360, and how they can help you.

Once you have completed your subjective check-in and objective check-in, 360 asks you to complete the process by adding tags. Each day you can select up to three tags. We only allow three for a reason: we want you to master your health and this requires a moment of mindful reflection.

Tags allow you to think through lifestyle factors that you feel really impacted your scores that day. Sometimes, you’ll only feel one tag is relevant. For example, let’s say you have been working really hard for several weeks, and finally get a day of genuine downtime. Picking that as your tag would be really worthwhile, and help you understand your response to a day of recovery on the back of a challenging period of work.

Sometimes, you will feel three tags are relevant. For example, you might notice a notable change in objective scores after a combination of late-night eating, alcohol, and stress. It’s worth tagging that and making a Journal note so that you can learn from your lifestyle over time.

Using Tags

We use different tags in 360, which relate back to your physical, mental, and emotional health. These tags include:

Feeling positive: A simple catch-all term to describe days when you have felt purposeful, upbeat and productive, and you feel this might have impacted your scores.

Downtime: Use this tag when you have deliberately created time for rest and relaxation, and believe it has stimulated your objective recovery score.

Good company: This describes times when you have been able to connect with family, friends, and loved ones, and that feeling of belonging and community has helped your scores.

Stillness: This tag is useful when you have sat quietly and done nothing or practiced forms of mindfulness and meditation

Light Workout: Use this tag when you have performed easy regenerative forms of exercise such as stretching, gentle yoga, easy aerobic exercise between Zones 1-3 using the Polar Beat app, or reduced volumes and intensity of strength training compared to your normal.

Hydrotherapy: This tag can be useful when you have incorporated regenerative practices such as a hot-cold contrast shower, cold plunge, cryotherapy, sauna, steam or floatation tanks into your day.

Hard Workout: Use this tag when you have pushed time, intensity and overall load in your workout compared to your normal. This can be relevant to strength training, aerobic conditioning, challenging forms of yoga or novel forms of training that demand something new from you.

Supplements: This tag refers to nutrition and herbal supplements you use to look after your health and wellness. It can be useful to tag when you begin a new supplement or programme of supplements and want to test the impact it has on your subjective and objective wellness over time.

Run Down: This is a useful catch-all term when you are feeling burned out, have pushed systems too far for too long and feel under par, experience issues such as brain fog, or have lacklustre energy.

Stress: This tag is useful when you have had a distinctly challenging day from a mental and emotional perspective, and feel it has affected your objective scores on the day.

Late Eating: Use this tag when you have eaten within 2 hours of going to sleep or have eaten after 10pm.

Alcohol: This tag is appropriate when you feel that alcohol intake has impacted your scores that day.

Late Screen Time: If you work late into the evening or scroll through your device in bed prior to sleep, use this tag to begin to notice how it impacts wellness scores.

Travel: This tag is useful when you have spent more time commuting than usual, been in the car for longer than normal or got on a plane

Medication: Applying this tag is helpful when you begin a new medication and want to see if there is an impact over time on your subjective and physiological wellbeing markers. You can also use it when you take NSAID painkillers on a given day, such as Ibuprofen.

COVID-19: Use this tag just once when you have a confirmed positive case of coronavirus. It will help you delineate wellbeing trends pre and post diagnosis.

Tags are important to us at 360 as part of the equation in providing you with relevant, personalised feedback.

"Awareness is the greatest agent for change."

 Eckhart Tolle

Using the Journal

What do you do in the situation where you feel other factors influcned your scores which are not captured by one of the tags? No problems, use the Journal to help record variables impacting your scores that day.

Journalling in 360 is a great way to learn from your lifestyle and identify unique factors that uniquely help or hinder your personal wellbeing.

From a privacy perspective, it’s worth remembering here: you are entirely anonymised with 360. We have no way of linking tags and notes to your name or email because we do not use names or emails in the 360 application. Your account is a complex series of random digits on AWS. This means you can write what you want, and know that your data is yours and yours alone. We reverse-engineered 360 with privacy in mind.

With peace of mind that your notes, reflections, and health data are truly anonymised, you can fully immerse yourself into 360. This built-in privacy and trust are essential, and one reason why our clients prefer 360 over any other health technology. Consumer apps using your name, email and/or social media login to create an account inherently create personal risk on the backend. This is because your health data and personal data are together and identifiable. Even with the most robust processes and security in place, there is a potential risk there. At 360, we remove the risk by not having any personally identifiable data in 360 in the first place.

Getting Results

As we all know, habits are the key to great success. Our health and wellbeing are lag indicators of habits. 360 enables you to surface those habits, see how they impact your wellbeing, and then proactively take control of them.

Our algorithms are designed to help you in this process. By analysing your subjective, objective, and tag data over time, 360 can offer personalised insight which prevents problems or lets you know when you are on the right path.

For example, 360 understands when physiological systems are trending down, and you are potentially moving towards burnout. If this were to occur, you would get a message in the application after checking-in, making you aware of what is happening and when to counter-balance back towards health.

An ounce of prevention is, after all, worth more than a pound of the cure.

On the flip side, 360 will also let you know when you are crushing it in your lifestyle. This is empowering from a personalised wellness perspective because you can look trends in the Calendar, Journal and Tags to understand your unique blueprint for health and wellness.

Each of us is different, and our approach to health should reflect that.

For too long, we have all been vulnerable to the latest, greatest, celebrity-endorsed wellness “secret”. There is no one-size-fits-all approach in diet or fitness or emotional wellbeing that works for all. Using 360, you can learn what works for you and leave the noise behind. The more you use 360, the more useful it can become. Keep checking-in daily, keep adding tags, and move forward with confidence. We are here to support you every step of the way.


The Accuracy of Wearable Technology

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Introduction

The rise of wearable devices in the consumer wellness market can feel overwhelming at times. So too can the number of digital biomarkers that companies claim to accurtely measure from these devices – such as sleep cycles, heart rate variability, recovery, temperature, respiratory rate, emotions, body fat, and many more. If we forget the marketing for a moment, it is important to ask two questions when you invest in a wearable or digital health:

1) Has the technology been validated in evidence-based medicine? In other words, is the device accurate according to impartial scientific studies, not just company-sponsored studies?

2) Does the wearable serve your goals? As more digital biometrics hit the market it is important to stand back from the noise and make sure it works for you. Measuring more physiological variables is not always better. Sometimes, less is more.

In this article, we’ll help you answer both these questions. Every technology has pros and cons (including 360), and we hope to empower you with objective information about emerging health technologies, and the rationale behind ours.

"Technology is a useful servant but a dangerous master."

 Christian Lous Lange

Accuracy of Polar Devices

Heart Rate Variability (HRV) 

Various devices claim to able to measure heart rate variability (HRV) from the wrist. HRV is a marker of parasympathetic tone. This is the part of the autonomic nervous system responsible for regeneration, repair, and rebalancing of systems.

HRV has traditionally been measured by electrocardiography (ECG), which measures the electrical activity of the heart. The gold standard is to use a device like a Holter device that uses electrodes and electrical leads to measure moment-to-moment changes in the variability in the time between each contraction of the heart.

ECG can compute multiple different metrics beyond heart rate, including SDNN, RMSDD, AVNN, PNN50, LF, HF, LF/HF Ratio, ULF, and VLF. These different heart rate variability metrics have been studied extensively in clinical research across health and disease and can provide very powerful insight into what keeps us healthy and makes us unwell.

Using a traditional ECG device is impractical for us in our day-to-day life – they are expensive, cumbersome, and only provide raw data. In recent years, new technologies have emerged claiming to be able to quantify HRV and give us insight on the back of it.

What does the science say?

Polar H10 Heart Sensor Vs ECG

Let’s begin with the device you use – the Polar sensor. The Polar H10 uses electrodes built into the strap alongside the sensor to capture the electrophysiological activity of the heart and quantify ECG status.

Independent research has tested Polar against gold standard ECG devices. You can see the results of this research in the image below:

The study, published in the European Journal of Applied Physiology, found a near-perfect correlation between the Polar H10 and Holter device (r = 0.997, p > 0.001).

In this study, the Polar H10 was validated against Holter ECG not just at rest, but also during exercise. Comparing accuracy during different types of exercise (household, walking, jogging, strength training) is useful because with more vigorous activity there is a greater chance of signal errors, noise, and interference called movement artefacts.

The study concluded that the Polar H10 was equal to Holter, and should be regarded as an equivalent gold standard in the measurement of ECG status and data for heart rate variability.

This research should provide you with genuine peace of mind. With independent validation against gold-standard ECG, you can be confident that when you check-in on 360, the objective data is clinical-grade quality.

"The accuracy of wearable optical heart rate measurements using PPG has been questioned extensively."

— Bent, B., et al. (2020). "Investigating sources of inaccuracy in wearable optical heart rate sensors." NPJ Digit Med 3: 18

Accuracy of Wrist Wearable Devices

Wrist wearables Vs ECG

When it comes to HRV and wrist wearables, the first and most important thing to say is that these devices cannot directly capture electrophysiological ECG data from the heart because they do not use electrodes close to the chest, like Holter and the Polar. Thus, when any company claims they measure HRV from the wrist, strictly speaking, they are not.

Because wrist wearables cannot directly capture HRV they use a surrogate called Pulse Rate Variability (PRV), but then refer to it as HRV. Pulse Rate Variability is captured using photoplethysmography (PPG), which involves using sensors to shine a light onto an area where capillaries are easy to access. The light is then reflected back to the sensor to depict blood volume in the vessel and thus forms the grounds of a heartbeat.

It’s worth emphasising again: pulse wave variability is not the same as heart rate variability. They are different physiological events. New research this year suggests that PWV and HRV are a distinctly different phenomenon in the body and should be treated as different biomarkers. Nevertheless, consumer wearables claim to measure HRV accurately off the wrist.

What does the research show when comparing wrist wearables to gold-standard ECG?

The scientific evidence is still very mixed, and for this reason, 360 does not use wrist wearables for the measurement of biomarkers including HRV nor recommends them.

Part of the problem here is that much of the research coming out by various wrist wearables is sponsored by the manufacturers themselves. This is normal in the sense that emerging technologies want to validate themselves, and in essence, have to sponsor early studies using their technology. But funding a study naturally makes it open to bias, so cannot be included in any final analysis at this point.

Independent research suggests wrist wearables can measure pulse wave variability accurately generally in just young and healthy populations at rest. For example, a recent study measured PRV versus clinical-grade HRV across different population types (from young and healthy to older and unhealthy).

The researchers only found strong agreement between PRV and clinical-grade HRV numbers in a small group of the population (those in their early twenties who were lean, fit, and healthy). For everyone else, it was not accurate. As you can imagine, this is a problem for most of us.

A recent study stands out for measuring pulse wave variability in wrist wearables in emergency physicians for a year. The goal of the study was to see if PPG data could help understand and prevent burnout in these workers by understanding changes in physiology over time.

A lot of studies measure PPG or HRV for a short-time: one night, one day, or one week. Therefore, as a longitudinal study, the design of this research study was important.

All-in-all more than 400 hours of PPG data was collected over the year in an attempt to understand changes in physiological well-being captured by pulse rate variability. Upon analyzing the data, researchers found that only 8.54% of data was interpretable. Put another way, 91.46% of data was unusable, such were the level of inaccuracies in the data.

The authors of this study concluded:

“Although the use of PPG biosensors to record real-time physiological data from emergency physicians while providing clinical care seems operationally feasible, this study fails to support the notion that such an approach can efficiently provide reliable estimates of metrics of interest.”

In other words, using PPG from wrist wearables to measure HRV is prone to errors. If we are to make daily decisions in our health based on data, we want the margin of error from that data to be as small as possible. This is why we do not use wrist wearables.

"The ECG sensor method is the gold standard for HRV recording because its sharp R-spike can be more precisely identified by a software algorithm than the peak of the pulse wave."

— Shaffer, F. and D. C. Combatalade (2013). "Don't Add or Miss a Beat: A Guide to Cleaner Heart Rate Variability Recordings." Biofeedback 41(3): 121-130.

The Challenge for Wrist Wearables

Rather than just cite the mixed evidence for wrist wearables, it is important for you to know why they can present challenges in terms of getting accurate data to drive daily behaviours.

Challenge 1: Poor Data In/Poor Data Out

Technology is only as good as the raw data coming in. The old saying of “junk in, junk out” is as true for digital health as any other form of technology.

There are a few reasons why wearables are at a disadvantage compared to heart rate sensors. The first reason is the errors caused by movement, change in pressure, change in light, change in temperature, and position of the wearable on the wrist. These issues can cause a sudden change in raw data. Just a single error can cause a major change in your HRV score. This is likely to be one of the reasons why in the physician study above, over 90% of data had to be excluded.

Second, because wrist wearables use light to measure changes in the waveform of pulse rate, human factors such as tattoos, skin colour, and hair on the wrist can be potential factors interfering with the ability of the sensor to collect high-quality raw PPG data.

Research suggests emotional stress can also cause errors in PPG pulse wave variability data. If we are to use metrics like HRV to measure how we are adapting to physical and emotional stress, we need to make sure it is capable of doing so successfully.

Challenge 2. Filtering Data Inappropriately

The second main issue with wrist wearables is understanding how manufacturers deal with data errors. What happens when you have several errors in raw data in a reading?

There are key recommendations from clinical research to guide digital health companies in identifying and rectifying ectopic heartbeats, movement artefacts and errors in HRV readings, and 360 follows these established recommendations.

Unfortunately, because of movement artefacts and noise unique to each wrist wearable, companies often have to add multiple in-house filters to deal with the problem, which aren’t based on established recommendations. As a result, they move away from evidence-based clinical guidelines. A recent study in the prestigious journal Nature found that it was not possible to determine the accuracy of data filtering in any wrist wearable, apart from one.

Challenge 3. Interpretation of the Data

If a company measuring HRV overcomes the first hurdle of accurate data collection and the second hurdle of accurate data filtering, there is a third and final challenge: understanding accurately what that final data point/score means. This is where so many digital developers and wearables companies go wrong.

For example, you will see companies tell users that low HRV is bad and high HRV is good. This is grossly simplistic. For a start, HRV tends to declines with age, so your score is relative. A low score for someone might be a great score for you, depending on your age.

Because age is one factor that impacts an understanding of your score, we give you the choice of putting your year of birth into 360 in the app. This enables you to see in the objective trends graph how your HRV compares to others in your decade of life (20’s, 30’s, 40’s, etc). We do not ask for your full date of birth because 360 is built on trust and privacy, and we want to ensure you remain anonymous at all times.

Second, because physical and mental health is a factor that impacts scores, we give you bands within those age ranges so that you can begin to see how your trendline compares to “average”, “good” and “excellent” scores of those in your age range. Once again, the goal here is to help you understand population norms. It is all too common to see companies tell users that their scores are so personalised they cannot be compared to anyone else. This is untrue. Like our scoring between 0-10, those bands we put in the objective trends graph are based on high-quality ECG-derived HRV data from tens of thousands of people from evidence-based medicine. It’s meaningful data.

Third, sometimes a low score can be a good sign, and sometimes and a high score can be a bad sign. For example, on days of competition, or in the run up to a competition, it is normal to see an elite athlete’s HRV drop. This is normal, and often very healthy. Peak performance requires sufficient activation of our sympathetic nervous system. If our HRV scores were really high on the day of competition, it may indicate that the sympathetic is not sufficiently active enough to mobilise resources in the body and brain to make the best decisions possible, such as adrenaline and noradrenaline that contributes to focus and attention. Stress can be a good thing for high performance.

Equally, high scores can be a bad sign. On occasions, people notice their HRV spikes up even though their lifestyle has not been that healthy and they feel tired, inflamed and/or under the weather. This spike can happen when the parasympathetic pushes recovery hard in an attempt to dampen inflammatory activity and rebalance systems. In this instance, a high score is not a green light to go train hard. It is a time to focus on regenerative lifestyle factors to bring the body back into autonomic balance.

Because low scores are not always bad and high scores are not always good, we built the 0-10 objective scoring range to be in line with population norms from the research. We also built a whole system behind the scenes powered by AI and machine learning that uses all the inputs you provide at check-in to understand how you are doing, the trajectory of your wellbeing, and what 360 can do to guide you personally based in your data.

"The only purpose of digital health technology is to make it easier to live your best life."

 Justin Buckthorp, CEO and Founder of 360 Health & Performance

Conclusion

We do not believe in technology for the sake of technology. We built 360 to make it easier for you to protect your health, energy, and performance.

At every step, we have done this with a view to making your digital health experience as simple, non-invasive, and accurate as possible.

This is why we ask you to use a sensor for 90 seconds each morning, and not ask you to wear a 360 wrist wearable all day.

This is why we focus on core metrics that do matter, rather than dozens of others that don’t.

This is why we anonymise your data completely, unlike technology companies that capture several layers of identifiable information.

No technology can be 100% accurate, all of the time. That includes 360. But we do our best to ensure that anything you read, touch, or experience with 360 is based on brilliant science from the incredible work of independent researchers all over the world, not just our own.

Over 2800 research papers go into what you experience with 360 – all with one aim – to help you make small improvements in your daily life that have a positive compound effect down the line.

In the excellent book Atomic Habits, author James Clear highlights the importance of small changes and the value of getting 1% better every day. You can see this in the image below:

Credit: James Clear, Atomic Habits

In the book, James Clear puts it very eloquently when he says:

“It is so easy to overestimate the importance of one defining moment and underestimate the value of making small improvements on a daily basis. Too often, we convince ourselves that massive success requires massive action. Meanwhile, improving by 1 percent isn’t particularly notable—sometimes it isn’t even noticeable—but it can be far more meaningful, especially in the long run. The difference a tiny improvement can make over time is astounding.”

Use 360 to provide you with the proactive and personalised insight you need to make those tiny improvements each day. We look forward to hearing about your success.