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Cited by 537Advanced Sensor and Energy Harvesting MaterialsNon-Invasive Vital Sign MonitoringElectrochemical sensors and biosensors

Wearable sensors for monitoring the physiological and biochemical profile of the athlete

Open access
Seshadri, Dhruv R., Li, Ryan T., Voos, James E., Rowbottom, James R., Alfes, Celeste M., Zorman, Christian A., Drummond, Colin K.·2019·npj Digital Medicine
DOI 10.1038/s41746-019-0150-9PMC PMC6646404
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Abstract

Athletes are continually seeking new technologies and therapies to gain a competitive edge to maximize their health and performance. Athletes have gravitated toward the use of wearable sensors to monitor their training and recovery. Wearable technologies currently utilized by sports teams monitor both the internal and external workload of athletes. However, there remains an unmet medical need by the sports community to gain further insight into the internal workload of the athlete to tailor recovery protocols to each athlete. The ability to monitor biomarkers from saliva or sweat in a noninvasive and continuous manner remain the next technological gap for sports medical personnel to tailor hydration and recovery protocols per the athlete. The emergence of flexible and stretchable electronics coupled with the ability to quantify biochemical analytes and physiological parameters have enabled the detection of key markers indicative of performance and stress, as reviewed in this paper.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review surveys wearable sensors for monitoring athletes’ physiological and biochemical status, with emphasis on noninvasive biomarkers from saliva and eccrine sweat. It argues that continuous, validated multimodal sweat/saliva sensing remains an unmet need for tailoring hydration, recovery, and stress protocols.

Key findings

  • Current sports wearables mainly track movement and physiological parameters; biochemical monitoring from saliva/sweat is emerging. Table 4 lists sweat ranges including glucose 10–200 µM, lactate 5–20 mM, Na+ 10–100 mM, Cl− 10–100 mM, K+ 1–18.5 mM, pH 3–8, NH4+ 0.1–1.1 mM, and cortisol 8–140 ng/L; saliva ranges include alpha-amylase 5–17 U/mL, glucose 1 µM, lactate 5–50 µM, and phosphate 3.6–300 µM.
  • Mouthguard biosensors showed salivary lactate measurement with a correlation coefficient of 0.988 in human saliva and stable response over 2 h; a salivary uric acid mouthguard measured sustained high salivary UA for 5 h in an untreated hyperuricemia patient.
  • Sweat microfluidic/iontophoresis devices showed translational promise: a fluorometric microfluidic device measured sweat Cl− 28–31 mM, Zn2+ ~2.5 µM, and Na+ 35–50 mM, matching laboratory methods (Cl− 28 mM, Zn2+ 3.6 µM, Na+ 36 mM); a waterproof epidermal device adhered for >2 h and measured during the IRONMAN triathlon; an iontophoretic ethanol sensor showed blood-to-sweat lag times of 2.3–11.41 min.
  • For stress/mental acuity, a systematic review of 18 studies (16 ECG-HRV, 2 PPG-PRV) found HRV correlation validated at rest but declining with exercise intensity; a stress patch reported skin temperature sensitivity 0.31 Ω/°C, skin conductance sensitivity 0.28 μV/0.02 μS, and pulse wave response time 70 ms; a cortisol sensor correlated with standard ELISA with an RSD of 5%.

Methods

  • Narrative review of wearable sensors for athlete physiological and biochemical monitoring, covering scientific literature and the commercial landscape (Tables 1 and 2).
  • Commercial device tables were compiled from company websites and social media; the biomarker table was adapted from Malon et al. and Bariya et al. No systematic search strategy, inclusion criteria, or meta-analysis is described.
  • The review discusses device examples, biomarker concentration ranges, and validation studies across saliva, eccrine sweat, heart rate variability, skin conductance, and stress biomarkers.

Limitations

  • The paper states that many devices are not yet validated in clinical studies for real-time assessment of human performance; it calls for formal clinical studies in nonstationary conditions and larger populations. It also notes saliva is limited to sports requiring mouthguards and current salivary devices do not permit continuous measurements; sweat sensing faces skin contamination, dried sweat, low sampling rates, weather dependence, and motion artifacts; and there remains a need to differentiate physical from mental stress.
  • Evident from the text: this is a narrative review without a systematic search or meta-analysis, and the commercial landscape relies on company websites/social media rather than peer-reviewed validation; many cited device studies are proof-of-concept or small-N.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/s41746-019-0150-9

Cites

135 of 135 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 164 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Analyte concentrations found in saliva are far below those detected in eccrine sweat.

    “In addition, analyte concentrations found in saliva are far below those detected in eccrine sweat (Table 4).”
    Quote in the paperSubstantial claim
  • Findingnone given

    Companies such as Epicore Biosystems, Halo Wearables, GraphWear, and Kenzen Wear are currently developing epidermal sensors for sweat detection.

    “Companies, such as Epicore Biosystems, Halo Wearables, GraphWear, and Kenzen Wear are currently developing epidermal sensors for sweat detection.”
    Quote in the paperNot a substantial claim
  • Premisenone given

    Over the last decade, significant progress has been made to develop wearable electrochemical sensors that detect biomarkers non-invasively from biofluids such as saliva and sweat, both of which are easily accessible without impeding the performance of an athlete.

    “Over the last decade, significant progress has been made to develop wearable electrochemical sensors that detect biomarkers non-invasively from biofluids such as saliva and sweat, both of which are easily accessible without impeding the performance of an athlete.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Electrochemical wearable sensors have received considerable attention recently because of their potential to monitor a wide array of biomarkers in a continuous and non-invasive manner.

    “Electrochemical wearable sensors have received considerable attention recently because of their potential to monitor a wide array of biomarkers in a continuous and non-invasive manner.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Bandodkar, A. J. & Wang, J. Non-invasive wearable electrochemical sensors: a review. Trends Biotechnol. 32, 363–371 (2014). source

      Not checked in the free run.

  • Interpretationreasoning

    Existing wearable devices that focus on physical or physiological parameters do not permit team trainers and physicians to quantify the biochemical profile of an athlete in a real-time manner with the goal of alleviating soft-tissue injuries, dehydration, or cramping.

    “However, such devices, do not permit team trainers and physicians to quantify the biochemical profile of an athlete in a real-time manner with the goal of alleviating soft-tissue injuries, dehydration, or cramping.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 36
  • May combine two claims. 42

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The ability to monitor biomarkers from saliva or sweat in a noninvasive and continuous manner remains the next technological gap for sports medical personnel to tailor hydration and recovery protocols per the athlete.

    “The ability to monitor biomarkers from saliva or sweat in a noninvasive and continuous manner remain the next technological gap for sports medical personnel to tailor hydration and recovery protocols per the athlete.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Noninvasive continuous monitoring of biomarkers from saliva or sweat would allow sports medical personnel to tailor hydration and recovery protocols per athlete.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The majority of existing wearable devices utilized in the sporting community currently focus on monitoring physical or physiological parameters (e.g., motion, HR, respiration rate, RR).

    “The majority of existing wearable devices utilized in the sporting community currently focus on monitoring physical or physiological parameters (e.g., motion, HR, respiration rate, RR).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The use of wearable sensors for sports is at its infancy, with the majority of devices currently used to measure movement-based parameters such as distance, velocity, and acceleration.

    “The use of wearable sensors for sports is at its infancy, with the majority of devices currently used to measure movement-based parameters such as distance, velocity, and acceleration.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    One issue plaguing the wearables field is the translation of the data to create actionable insight in its respective clinical domain.

    “While beyond the scope of this review, one issue plaguing the wearables field is the translation of the data to create actionable insight in its respective clinical domain.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Wearable sensor data can be translated into actionable insight to improve athlete health and performance.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Proper hydration is key to success as under-drinking can lead to hypohydration and over-drinking can lead to hyponatremia (low-serum sodium concentration).

    “Proper hydration is key to success as under-drinking can lead to hypohydration and over-drinking can lead to hyponatremia (low-serum sodium concentration).10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Hew-Butler, T. et al. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin. J. Sport Med. 25, 303 (2015). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The development of electrochemical transducers has been especially promising due to their low cost, simplicity, and portability.

    “The development of electrochemical transducers has been especially promising due to their low cost, simplicity, and portability.7,8”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Barry, R. C., Lin, Y., Wang, J., Liu, G. & Timchalk, C. A. Nanotechnology-based electrochemical sensors for biomonitoring chemical exposures. J. Expo. Sci. Environ. Epidemiol. 19, 1–18 (2009). source

      Not checked in the free run.

    • cites [8] Couto, R. A. S. & Quinaz, M. B. Development of a Nafion/MWCNT-SPCE-based portable sensor for the voltammetric analysis of the anti-tuberculosis drug ethambutol. Sensors 16, 1–13 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970065/pdf/sensors-16-01015.pdf. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    There remains an unmet medical need by the sports community to gain further insight into the internal workload of the athlete to tailor recovery protocols to each athlete.

    “However, there remains an unmet medical need by the sports community to gain further insight into the internal workload of the athlete to tailor recovery protocols to each athlete.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Noninvasive continuous monitoring of biomarkers from saliva or sweat would allow sports medical personnel to tailor hydration and recovery protocols per athlete.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    There remains a major need to quantify the athlete by measuring biochemical markers such as electrolytes, analytes, and neuropeptides all of which are indicative of physical exertion and fitness, fatigue, and mental acuity.

    “There remains a major need to “quantify the athlete” by measuring biochemical markers such as electrolytes, analytes, and neuropeptides all of which are indicative of physical exertion and fitness, fatigue, and mental acuity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    These commercial hand-held sensors require blood samples, posing a barrier to their utility in real-time monitoring for sports medicine.

    “However, these sensors require blood samples thus posing as a barrier to their utility in real-time monitoring for sports medicine.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    The emergence of wearable biosensors to measure analytes from eccrine sweat to assess the performance and mental acuity of the athlete serve as next steps to assessing human performance.

    “The emergence of wearable biosensors to measure analytes from eccrine sweat to assess the performance and mental acuity of the athlete serve as next steps to assessing human performance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The emergence of flexible and stretchable electronics coupled with the ability to quantify biochemical analytes and physiological parameters has enabled the detection of key markers indicative of performance and stress.

    “The emergence of flexible and stretchable electronics coupled with the ability to quantify biochemical analytes and physiological parameters have enabled the detection of key markers indicative of performance and stress, as reviewed in this paper.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Recent advancements in wearable sensor technology from a device to systems standpoint have provided new avenues to change this paradigm and are currently being implemented by teams worldwide.

    “Recent advancements in wearable sensor technology from a device to systems standpoint have provided new avenues to change this paradigm and are currently being implemented by teams worldwide.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Real-time testing of the presented devices is needed to assess the true clinical efficacy of such technology for sports.

    “Real-time testing of the devices presented are needed to assess the true clinical efficacy of such technology for sports.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    There remains a clinical need to validate the sensitivity and reliability of mouthguard biosensors in real-time during athletic scenarios.

    “While the application of mouthguards to quantify biomarkers is relatively new from a commercial standpoint, there remains a clinical need to validate the sensitivity and reliability of these devices in real-time during athletic scenarios.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Initial work pertaining to electrochemical salivary sensors was conducted by Graf in the 1960s to measure pH and fluoride ion levels on a partial denture.

    “Initial work pertaining to electrochemical salivary sensors was conducted by Graf in the 1960s to measure pH and fluoride ion levels on a partial denture.13”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Graf, H. & Mühlemann, H. R. Telemetry of plaque pH from interdental area. Helv. Odontol. Acta 10, 94–101 (1966).

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    The chronoamperometric response of lactate in the presence and absence of physiological concentrations of ascorbic acid and UA showed that these potential interferences had a negligible effect upon the lactate response and that the biosensor system provided high selectivity to measure lactate in a noninvasive manner.

    “The chronoamperometric response of lactate in the presence and absence of physiological concentrations of ascorbic acid and UA showed that these potential interferences had a negligible effect upon the lactate response and that the biosensor system provided high selectivity to measure lactate in a noninvasive manner.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Kim, J. et al. Non-invasive mouthguard biosensor for continuous salivary monitoring of metabolites. Analyst 139, 1632 (2014). source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    The mouthguard lactate biosensor displayed a very high sensitivity toward lactate, with current-signals proportional to the lactate concentration.

    “Data from chronoamperograms for increasing concentrations of lactate in phosphate-buffered saline medium showed that the biosensor displayed a very high sensitivity toward lactate, with current-signals proportional to the lactate concentration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Kim, J. et al. Non-invasive mouthguard biosensor for continuous salivary monitoring of metabolites. Analyst 139, 1632 (2014). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Disadvantages of using eccrine sweat include skin contamination, existence of dried sweat on the glands thereby skewing analyte measurements, and low-sampling rates.

    “Disadvantages of using eccrine sweat, include skin contamination, existence of dried sweat on the glands thereby skewing analyte measurements, and low-sampling rates.18”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Heikenfeld, J. Non-invasive analyte access and sensing through eccrine sweat: challenges and outlook circa 2016. Electroanalysis 28, 1242–1249 (2016). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Detection of biomarkers from eccrine sweat glands poses tremendous advantages over those from urine, blood, tears, and apocrine sweat glands, including their abundance on the body (>100 glands/cm2), ease of access, sampling and detection efficiency without foreign contamination during testing, and the inability to degrade analytes.

    “Detection of biomarkers from eccrine sweat glands pose tremendous advantages over those from urine, blood, tears, and apocrine sweat glands. These, include their abundance on the body (>100 glands/cm2), ease of access, sampling and detection efficiency without foreign contamination during testing, and the inability to degrade analytes19 (Table 3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Sonner, Z. et al. The microfluidics of the eccrine sweat gland, including biomarker partitioning, transport, and biosensing implications. Biomicrofluidics 9, 031301 (2015). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Halo H1 sensor tracks hydration levels at a cellular level in the bloodstream and utilizes an algorithm to rank the levels out of 100; green (68-100), fully hydrated, yellow (35-67), caution to hydrate soon, and red (1-34), need to hydrate immediately.

    “The sensor tracks hydration levels at a cellular level in the bloodstream and utilizes an algorithm to rank the levels out of 100; green (68–100), fully hydrated, yellow (35–67), caution to hydrate soon, and red (1–34), need to hydrate immediately.25”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Miller, D. W. & Miller, D. R. Hydration Monitoring Apparatus. 1–15 (2014). https://patentimages.storage.googleapis.com/89/6c/7a/34703870dde191/US20140221792A1.pdf.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Epicore Biosystems has partnered with the Gatorade Sports Science Institute, Seattle Mariners (MLB), US Air Force (USAF), and the Shirley Ryan AbilityLab to further test and validate their devices.

    “The company has partnered with the Gatorade Sports Science Institute, Seattle Mariners (MLB), US Air Force (USAF), and the Shirley Ryan AbilityLab to further test and validate their devices.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Northwestern Engineering Teams with Sports and Rehabilitation Leaders to Advance Sweat Analysis Technologies. Northwestern Eng. http://www.mccormick.northwestern.edu/news/articles/2018/02/northwestern-engineering-teams-with-sports-and-rehabilitation-leaders-to-advance-sweat-analysis-technology.html. Accessed 16 Sep 2018.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Kenzen Wear's Echo patch is an epidermal sensor, adhered to the torso, which monitors sodium and potassium from sweat in addition to measuring pH and skin temperature.

    “Similarly, Kenzen Wear’s Echo patch is an epidermal sensor, adhered to the torso, which monitors sodium and potassium from sweat in addition to measuring pH and skin temperature.28”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] ECHO Smart Patch. Kenzen https://www.kenzen.com/. Accessed 5 May 2017.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    There remains a need to ensure that the administered current intensity does not cause cathodal vasodilation or erythema, leading to discomfort to the athlete.

    “However, there remains a need to ensure that the administered current intensity does not cause cathodal vasodilation or erythema, leading to discomfort to the athlete.22”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Roustit, M., Blaise, S. & Cracowski, J.-L. Trials and tribulations of skin iontophoresis in therapeutics. Br. J. Clin. Pharmacol. 77, 63–71 (2014). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The need to minimize body motion artifacts is crucial for sports to prevent false sensor readings or cause the sweat flow to accelerate or even reverse.

    “The need to minimize body motion artifacts are crucial for sports to prevent false sensor readings or cause the sweat flow to accelerate or even reverse.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The wrist-based Cl− sensor was placed on human subjects by a wristband or adhesive tape and tested during exercise to demonstrate the feasibility of this technology as a wearable device.

    “The sensor was placed on human subjects by a wristband or adhesive tape and tested during exercise to demonstrate the feasibility of this technology as a wearable device.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Choi, D.-H., Kim, J. S., Cutting, G. R. & Searson, P. C. Wearable potentiometric chloride sweat sensor: the critical role of the salt bridge. Anal. Chem. 88, 12241–12247 (2016). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The study showed large variations in sweat Na+ concentration between backs and receivers and linebackers and quarterbacks but not between linebackers and quarterbacks and linemen.

    “The study showed large variations in sweat Na+ concentration between BKs and LB/QB but not between LB/QB and LM.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Godek, S. F. et al. Sweat rates, sweat sodium concentrations, and sodium losses in 3 groups of professional football players. J. Athl. Train. 45, 364–371 (2010). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Monitoring the change in Cl− concentration in a noninvasive manner along with or independent of sodium measurements utilizing wearables can expedite treatment and recovery to mitigate soft-tissue injuries.

    “Monitoring the change in Cl− concentration in a noninvasive manner along with or independent of sodium measurements utilizing wearables can expedite treatment and recovery to mitigate soft-tissue injuries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The screen printed epidermal tattoo sodium sensor withstood mechanical deformation without impeding analyte detection and wireless transmission, highlighting its translational potential for the sporting community.

    “The screen printed device withstood mechanical deformation without impeding analyte detection and wireless transmission thereby highlighting its translational potential for the sporting community.35”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Bandodkar, A. J. et al. Epidermal tattoo potentiometric sodium sensors with wireless signal transduction for continuous non-invasive sweat monitoring. Biosens. Bioelectron. 54, 603–609 (2014). source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Total whole-body sweat loss and whole-body sweating rate can be estimated.

    “Total whole-body sweat loss and WB sweating rate can be estimated.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Extracellular K+ is indirectly linked to the pump stimulus and the rate of reuptake is proportional to that of extracellular accumulation.

    “Extracellular K+ is indirectly linked to the pump stimulus and the rate of reuptake is proportional to that of extracellular accumulation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Medbø, J. I. & Sejersted, O. M. Plasma potassium changes with high intensity exercise. J. Physiol. 421, 105–122 (1990). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    While such core-sensor technology is promising, it remains impractical for sports medicine.

    “However, while such core-sensor technology is promising, it remains impractical for sports medicine.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The rate of sweat K+ loss has been reported to be indirectly related to sweat flow rate, but the underlying mechanism is unclear and requires further investigation.

    “The rate of sweat K+ loss has been reported to be indirectly related to sweat flow rate, but the underlying mechanism is unclear and requires further investigation.40”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Sato, K. The physiology, pharmacology, and biochemistry of the eccrine sweat gland. Rev. Physiol. Biochem. Pharmacol. 79, 51–131 (1977). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The K+ sensor demonstrated a smaller and faster response compared to current standard of care (e.g., clinical laboratory electrolyte analyzer) and required a smaller blood sample volume.

    “The sensor demonstrated a smaller and faster response compared to current standard of care (e.g., clinical laboratory electrolyte analyzer) and required a smaller blood sample volume.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Xu, H. et al. Disposable blood potassium sensors based on screen-printed thick film electrodes. Meas. Sci. Technol. 21, 055802 (2010). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The use of such adhesion platforms is not appropriate for long-term use in sports, but the electrochemical performance and stability of the device demonstrates promise for athletics.

    “While the use of such adhesion platforms is not appropriate for long-term use in sports, the electrochemical performance and stability of the device demonstrates promise for athletics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A luminol-based biosensor for lactate detection achieved a detection limit of 8.9 × 10−12 mol/L and an average recovery of 101.3% using athlete sweat samples during a training course.

    “A detection limit of 8.9 × 10−12 mol/L and an average recovery of 101.3% was obtained when utilizing athlete sweat samples during a training course.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Cai, X., Yan, J., Chu, H., Wu, M. & Tu, Y. An exercise degree monitoring biosensor based on electrochemiluminescent detection of lactate in sweat. Sens. Actuators B Chem. 143, 655–659 (2010). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sodium and lactate levels from saliva demonstrated the same correlation as noted with sweat; salivary cortisol levels exhibited the largest variation among the subjects.

    “Sodium and lactate levels demonstrated the same correlation as noted with sweat; however, salivary cortisol levels exhibited the largest variation among the subjects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Anastasova, S. et al. A wearable multisensing patch for continuous sweat monitoring. Biosens. Bioelectron. 93, 139–145 (2017). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Plasma lactate concentrations closely approximate those of sweat lactate and provide an indication of body exertion and exercise intensity.

    “Plasma lactate concentrations closely approximate those of sweat lactate and provide an indication of body exertion and exercise intensity.47”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Jia, W. et al. Electrochemical tattoo biosensors for real-time noninvasive lactate monitoring in human perspiration. Anal. Chem. 85, 6553–6560 (2013). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Temperature readings of the sensor varied between 20 and 40 °C across subjects.

    “Temperature readings of the sensor varied between 20 and 40 °C across subjects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Anastasova, S. et al. A wearable multisensing patch for continuous sweat monitoring. Biosens. Bioelectron. 93, 139–145 (2017). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    La Count et al.'s glucose model demonstrated a ten-minute blood-to-sweat lag time and a sweat/blood glucose level ranging from 0.001 to 0.02, depending on the sweat rate.

    “The glucose model, calibrated under a variety of experimental conditions including electrical enhancement, demonstrated a ten-minute blood-to-sweat lag time and a sweat/blood glucose level ranging from 0.001 to 0.02, depending on the sweat rate.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Count, T. D. L., Jajack, A., Heikenfeld, J. & Kasting, G. B. Modeling glucose transport from systemic circulation to sweat. J. Pharm. Sci. 108, 364–371 (2019). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The preliminary study suggested that the tattoo-based iontophoresis-sensor platform could be efficacious for diabetes management and could be relevant to monitor biomarkers from biofluids indicative of human performance.

    “The preliminary study suggested that the tattoo-based iontophoresis-sensor platform could be efficacious for diabetes management and could be relevant to monitor biomarkers from biofluids indicative of human performance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A printed flexible tattoo-based glucose sensor showed a linear response toward physiologically relevant glucose levels with negligible responses from electroactive species in vitro.

    “In vitro studies using the biosensor demonstrated a linear response toward physiologically relevant glucose levels with negligible responses from electroactive species.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] Bandodkar, A. J. et al. Tattoo-based noninvasive glucose monitoring: a proof-of-concept study. Anal. Chem. 87, 394–398 (2015). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sweat rates in swimmers are lower than that of athletes on land and range from 0.33 to 1.6 l/h, depending on workout intensity and water temperature.

    “The sweat rates in swimmers is lower than that of athletes on land and has been shown to range from 0.33 to 1.6 l/h, depending on the workout intensity and water temperature.70–72”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [70] Cox, G. R., Broad, E. M., Riley, M. D. & Burke, L. M. Body mass changes and voluntary fluid intakes of elite level water polo players and swimmers. J. Sci. Med. Sport 5, 183–193 (2002). source

      Not checked in the free run.

    • cites [71] Macaluso, F. et al. Effects of three different water temperatures on dehydration in competitive swimmers. Sci. Sports 26, 265–271 (2011). source

      Not checked in the free run.

    • cites [72] Maughan, R. J., Dargavel, L. A., Hares, R. & Shirreffs, S. M. Water and salt balance of well-trained swimmers in training. Int. J. Sport Nutr. Exerc. Metab. 19, 598–606 (2009). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Clinical studies demonstrated that Reeder et al.'s device measured local sweat chloride concentrations, local sweat loss, sweat rate, and skin temperature during intense physical activity in controlled indoor conditions and in open-ocean swimming during the IRONMAN triathlon.

    “Clinical studies demonstrated the ability of the device to measure local sweat chloride concentrations, local sweat loss, sweat rate, and skin temperature during intense physical activity in controlled, indoor conditions and in open-ocean swimming during the IRONMAN triathlon.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] Reeder, J. T. et al. Waterproof, electronics-enabled, epidermal microfluidic devices for sweat collection, biomarker analysis, and thermography in aquatic settings. Sci. Adv. 5, eaau6356 (2019). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The sympathetic and parasympathetic nervous systems maintain cardiovascular homeostasis by responding to beat-to-beat perturbations that are sensed by baroreceptors and chemoreceptors.

    “The sympathetic and parasympathetic nervous systems maintain cardiovascular homeostasis by responding to beat-to-beat perturbations that are sensed by baroreceptors and chemoreceptors.80”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Heartbeat Analytics. Firstbeat. https://www.firstbeat.com/en/. Accessed 13 Jan 2019.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The self-reported method is disadvantageous to measure human stress levels due to the lack of standards for stress status and the inability to assess the wellness and mental acuity of the athlete in a real-time manner.

    “The self-reported method is disadvantageous to measure human stress levels due to the lack of standards for stress status and the inability to assess the wellness and mental acuity of the athlete in a real-time manner.75”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Lee, J.-H., Hwang, Y., Cheon, K.-A. & Jung, H.-I. Emotion-on-a-chip (EOC): evolution of biochip technology to measure human emotion using body fluids. Med. Hypotheses 79, 827–832 (2012). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The work confirmed that sweat can be stimulated and the desired ions or analytes can be measured in a continuous manner to correlate with that in blood.

    “Nonetheless, the work confirmed that sweat can be stimulated and the desired ions or analytes can be measured in a continuous manner to correlate with that in blood.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Ethanol is 1:1 between sweat and blood due to its lipophilic nature.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Fluctuations in HR caused by respiration are referred to as respiratory sinus arrhythmia (RSA); HR increases during inspiration and decreases during expiration.

    “Fluctuations in HR caused by respiration are referred to as respiratory sinus arrhythmia (RSA).79 Specifically, HR increases during inspiration and decreases during expiration.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Yasuma, F. & Hayano, J.-I. Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Chest 125, 683–690 (2004). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Monitoring HRV provides useful knowledge for observing the interplay between the sympathetic and parasympathetic nervous systems, and is reflective of ANS activity.

    “Monitoring HRV provides useful knowledge for observing the interplay between the sympathetic and parasympathetic nervous systems, and is reflective of ANS activity.82”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [82] Heart rate variability: a review | SpringerLink. https://link.springer.com/article/10.1007/s11517-006-0119-0. Accessed 10 Jan 2019.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    HRV is affected by the training load of individual exercise sessions; the higher the training load, the lower the HRV after exercise.

    “HRV is also affected by the training load of individual exercise sessions; the higher the training load, the lower the HRV after exercise.85”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Kaikkonen, P., Hynynen, E., Mann, T., Rusko, H. & Nummela, A. Heart rate variability is related to training load variables in interval running exercises. Eur. J. Appl. Physiol. 112, 829–838 (2012). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A stress reaction causes the activation of the ANS and the production of stress hormones along with an increased HR and an increased force of heart contractions.

    “A stress reaction causes the activation of the ANS and the production of stress hormones along with an increased HR and an increased force of heart contractions.76”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Chrousos, G. P. & Gold, P. W. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. J. Am. Med. Assoc. 267, 1244–1252 (1992). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A low HRV (short-time interval) is suggestive of a stressful period whereas a prolonged HRV (long-time interval) is suggestive of a calm period.

    “Thus, a low HRV (short-time interval) is suggestive of a stressful period whereas a prolonged HRV (long-time interval) is suggestive of a calm period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [82] Heart rate variability: a review | SpringerLink. https://link.springer.com/article/10.1007/s11517-006-0119-0. Accessed 10 Jan 2019.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The normal resting HR in a sitting position ranges between 60-80 beats/min due to the sympathetic and parasympathetic nervous systems, hormonal factors, and reflexive factors.

    “The normal resting HR in a sitting position ranges between 60–80 beats/min due to the sympathetic and parasympathetic nervous systems, hormonal factors, and reflexive factors.78”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] 2 easy, accurate ways to measure your heart rate. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979. Accessed 13 Jan 2019.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Concurrently, HR increases and HRV decreases with increasing exercise intensity.

    “Concurrently, HR increases and HRV decreases with increasing exercise intensity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Mitchell, J. H. Neural circulatory control during exercise: early insights. Exp. Physiol. 98, 867–878 (2013). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    To characterize stress, arterial pulsewave signals are transformed into HRV, which represents the chronic stress level and an individual's stress vulnerability.

    “To characterize stress, arterial pulsewave signals are transformed into HRV, which represents the chronic stress level and an individual’s stress vulnerability.98”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] Gil, E. et al. Photoplethysmography pulse rate variability as a surrogate measurement of heart rate variability during non-stationary conditions. Physiol. Meas. 31, 1271–1290 (2010). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An epidermal sensor for multimodal physiological data analysis of stress measured skin temperature with a sensitivity of 0.31 Ω/°C, skin conductance sensitivity of 0.28 μV/0.02 μS, and a pulse wave response time of 70 ms.

    “The stress patch measured skin temperature with a sensitivity of 0.31 Ω/°C, skin conductance sensitivity of 0.28 μV/0.02 μS, and a pulse wave response time of 70 ms.74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Yoon, S., Sim, J. K. & Cho, Y.-H. A flexible and wearable human stress monitoring patch. Sci. Rep. 6, 1–11 (2016). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The high-frequency component derived by the frequency domain analysis denotes the parasympathetic activity.

    “For example, the high-frequency component derived by the frequency domain analysis denotes the parasympathetic activity.87”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] Georgiou, K., Larentzakis, A. & Papavassiliou, A. G. Surgeons’ and surgical trainees’ acute stress in real operations or simulation: a systematic review. Surgeon 15, 355–365 (2017). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    ECG monitoring via wearable sensors poses challenges for athletics: surface EMG, increased electrode impedance, respiration induced baseline drift, and electrode contact movement can cause noise and motion artifacts.

    “Firstly, surface EMG, increased electrode impedance, respiration induced baseline drift, and electrode contact movement can cause noise and motion artifacts.88”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] Allen, J. Photoplethysmography and its application in clinical physiological measurement. Physiol. Meas. 28, R1–R39 (2007). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cortisol is responsible for maintaining homeostasis in the body via the regulation of neural, immune, cardiovascular, metabolic, and endocrine systems.

    “Cortisol is responsible for maintaining homeostasis in the body via the regulation of neural, immune, cardiovascular, metabolic, and endocrine systems.102”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Jia, M., Chew, W. M., Feinstein, Y., Skeath, P. & Sternberg, E. M. Quantification of cortisol in human eccrine sweat by liquid chromatography–tandem mass spectrometry. Analyst 141, 2053–2060 (2016). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior work using biosensors to measure stress and cognition has focused on the measurement of a wide array of biomarkers (10−6-10−12 M) such as Orexin-A, cortisol, dopamine, neuropeptide Y, and interleukin-6 (IL-6).

    “Prior work using biosensors to measure stress and cognition has focused on the measurement of a wide array of biomarkers (10−6–10−12 M) such as Orexin-A,113 cortisol,110 dopamine,114 neuropeptide Y,115 and interleukin-6 (IL-6).116”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [113] Hagen, J. et al. Detection of orexin A neuropeptide in biological fluids using a zinc oxide field effect transistor. ACS Chem. Neurosci. 4, 444–453 (2013). source

      Not checked in the free run.

    • cites [114] Roychoudhury, A., Basu, S. & Jha, S. K. Dopamine biosensor based on surface functionalized nanostructured nickel oxide platform. Biosens. Bioelectron. 84, 72–81 (2016). source

      Not checked in the free run.

    • cites [115] HAGEN, J. A. et al. Sweat Simulation, Collection and Sensing Systems (2013). https://patents.google.com/patent/WO2013152087A2/en.

      Not checked in the free run.

    • cites [116] Kumar, L. S. S. et al. Label free nano-aptasensor for interleukin-6 in protein-dilute bio fluids such as sweat. Anal. Methods 8, 3440–3444 (2016). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cortisol is a steroid hormone secreted from the adrenal glands in response to stress as a product in the hypothalamic-pituitary adrenal pathway.

    “Cortisol is a steroid hormone secreted from the adrenal glands in response to stress as a product in the hypothalamic–pituitary adrenal pathway.102”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Jia, M., Chew, W. M., Feinstein, Y., Skeath, P. & Sternberg, E. M. Quantification of cortisol in human eccrine sweat by liquid chromatography–tandem mass spectrometry. Analyst 141, 2053–2060 (2016). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cortisol has been measured in human blood, serum, urine, saliva, hair, interstitial fluid, and most recently eccrine sweat.

    “Cortisol has been measured in human blood,106 serum,107 urine,107 saliva,107,108 hair,109 interstitial fluid,110 and most recently eccrine sweat.111”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [106] Port, K. Serum and saliva cortisol responses and blood lactate accumulation during incremental exercise testing. Int. J. Sports Med. 12, 490–494 (1991). source

      Not checked in the free run.

    • cites [107] Turpeinen, U. & Hämäläinen, E. Determination of cortisol in serum, saliva and urine. Best. Pract. Res. Clin. Endocrinol. Metab. 27, 795–801 (2013). source

      Not checked in the free run.

    • cites [108] Manetti, L. et al. Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol. Eur. J. Endocrinol. 168, 315–321 (2013). source

      Not checked in the free run.

    • cites [109] Wester, V. L. & Rossum, E. F. Cvan Clinical applications of cortisol measurements in hair. Eur. J. Endocrinol. 173, M1–M10 (2015). source

      Not checked in the free run.

    • cites [110] Venugopal, M., Arya, S. K., Chornokur, G. & Bhansali, S. A realtime and continuous assessment of cortisol in ISF using electrochemical impedance. Spectrosc. Sens. Actuators Phys. 172, 154–160 (2011). source

      Not checked in the free run.

    • cites [111] Parlak, O., Keene, S. T., Marais, A., Curto, V. F. & Salleo, A. Molecularly selective nanoporous membrane-based wearable organic electrochemical device for noninvasive cortisol sensing. Sci. Adv. 4, eaar2904 (2018). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Orexin peptides and their corresponding receptors in the brain contribute to autonomic control, attention, feeding, memory, sleep, and stress.

    “Orexin peptides and their corresponding receptors in the brain contribute to autonomic control, attention, feeding, memory, sleep, and stress.113”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] Hagen, J. et al. Detection of orexin A neuropeptide in biological fluids using a zinc oxide field effect transistor. ACS Chem. Neurosci. 4, 444–453 (2013). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The sensor selectivity was able to detect concentrations of approximately 100 aM in water, 10 fM in filtered human saliva, and 1 nM in filtered fetal bovine serum.

    “The binding was transmitted to an electrical signal and the sensor selectivity was able to detect concentrations of approximately 100 aM in water, 10 fM in filtered human saliva, and 1 nM in filtered fetal bovine serum.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [113] Hagen, J. et al. Detection of orexin A neuropeptide in biological fluids using a zinc oxide field effect transistor. ACS Chem. Neurosci. 4, 444–453 (2013). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The sensor integrated an electrochemical transistor and a biomimetic polymeric membrane, which permitted the detection of cortisol.

    “The team integrated an electrochemical transistor and a biomimetic polymeric membrane, which permitted the detection of cortisol.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [111] Parlak, O., Keene, S. T., Marais, A., Curto, V. F. & Salleo, A. Molecularly selective nanoporous membrane-based wearable organic electrochemical device for noninvasive cortisol sensing. Sci. Adv. 4, eaar2904 (2018). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Development of improved sensitivity and stability of biosensors is required for the real-time detection of such biomarkers.

    “The sensor platform demonstrated the potential of an FET device to measure a wide array of biomarkers in complex biofluids; however, development of improved sensitivity and stability of biosensors is required for the real-time detection of such biomarkers.113”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] Hagen, J. et al. Detection of orexin A neuropeptide in biological fluids using a zinc oxide field effect transistor. ACS Chem. Neurosci. 4, 444–453 (2013). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Kitman Labs utilizes machine learning platforms and motion technology to diagnose and uncover an athlete's unique stress response and various movements.

    “Kitman Labs utilizes machine learning platforms and motion technology to diagnose and uncover an athlete’s unique stress response and various movements.133”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [133] Labs, K. Kitman Labs Releases First Annual Injury Assessment Report. http://www.prnewswire.com/news-releases/kitman-labs-releases-first-annual-injury-assessment-report-300281383.html. Accessed 15 May 2017.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Devices seeking to measure biosignals, biomarkers, and biomechanical parameters are challenged by the device technology itself and systems level issues associated with data analytics/data mining.

    “However, as previously mentioned, devices seeking to measure biosignals, biomarkers, and biomechanical parameters are challenged by the device technology itself and systems level issues associated with data analytics/data mining.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Data mining techniques such as wavelet analysis for artifact reduction and data compression, rule-based methods for data summary and transmission, and Gaussian processing for secure authentication have been implemented.

    “To solve such problems, data mining techniques such as wavelet analysis for artifact reduction and data compression, rule-based methods for data summary and transmission, and Gaussian processing for secure authentication have been implemented.129”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [129] Banaee, H., Ahmed, M. U. & Loutfi, A. Data mining for wearable sensors in health monitoring systems: a review of recent trends and challenges. Sensors 13, 17472–17500 (2013). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The emergence of IC fabrication strategies, flexible electronics, device design, and e-garments has revolutionized the development of soft electronics and biological and chemical sensor technologies toward advancing sports medicine.

    “The emergence of IC fabrication strategies, flexible electronics, device design, and e-garments has revolutionized the development of soft electronics and biological and chemical sensor technologies toward advancing sports medicine.123–127”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [123] Bandodkar, A. J., Jeerapan, I. & Wang, J. Wearable chemical sensors: present challenges and future prospects. ACS Sens. 1, 464–482 (2016). source

      Not checked in the free run.

    • cites [124] Makin, T. R., Vignemont, Fde & Faisal, A. A. Neurocognitive barriers to the embodiment of technology. Nat. Biomed. Eng. 1, 0014 (2017). source

      Not checked in the free run.

    • cites [125] Bansal, A. K., Hou, S., Kulyk, O., Bowman, E. M. & Samuel, I. D. W. Wearable organic optoelectronic sensors for medicine. Adv. Mater. 27, 7638–7644 (2015). source

      Not checked in the free run.

    • cites [126] Choi, S., Lee, H., Ghaffari, R., Hyeon, T. & Kim, D.-H. Recent advances in flexible and stretchable bio-electronic devices integrated with nanomaterials. Adv. Mater. 28, 4203–4218 (2016). source

      Not checked in the free run.

    • cites [127] Parrilla, M., Cánovas, R., Jeerapan, I., Andrade, F. J. & Wang, J. A textile-based stretchable multi-ion potentiometric sensor. Adv. Healthc. Mater. 5, 996–1001 (2016). source

      Not checked in the free run.

69 of 69

  • The paper relies on this without support.

    Noninvasive continuous monitoring of biomarkers from saliva or sweat would allow sports medical personnel to tailor hydration and recovery protocols per athlete.

    “The ability to monitor biomarkers from saliva or sweat in a noninvasive and continuous manner remain the next technological gap for sports medical personnel to tailor hydration and recovery protocols per the athlete.”

  • The paper relies on this without support.

    Wearable sensor data can be translated into actionable insight to improve athlete health and performance.

    “one issue plaguing the wearables field is the translation of the data to create actionable insight in its respective clinical domain”

  • The paper relies on this without support.

    Ethanol is 1:1 between sweat and blood due to its lipophilic nature.

    “Ethanol was selected because it is 1:1 between sweat and blood due to its lipophilic nature.”

  • The paper relies on this without support.

    Human performance is a function of the physical demands of the sport coupled with the mental acuity exerted on the athlete.

    “Human performance is a function of the physical demands of the sport coupled with the mental acuity exerted on the athlete.”

  • The paper relies on this without support.

    Overtraining without adequate rest may lead to the overtraining condition, characterized by decreased performance and subsequent detriments to long-term health.

    “Overtraining without adequate rest may lead to the overtraining condition, which is characterized by decreased performance and subsequent detriments to long-term health.”

  • The authors state this as an assumption.

    Stress can be physiologically characterized by a reduced recovery of the neuroendocrine reaction and sympathetic dominance of the ANS function.

    “While there currently lacks a formal definition of stress in scientific literature, we postulate that stress can be physiologically characterized by a reduced recovery of the neuroendocrine reaction and sympathetic dominance of the ANS function.77”

  • The authors state this as an assumption.

    Recovery can be characterized as parasympathetic dominance.

    “Recovery can be characterized as parasympathetic dominance.”

  • The paper relies on this without support.

    The body should adapt to the demands put upon it in various situations.

    “In other words, the body should adapt to the demands put upon it in various situations.”

  • The paper relies on this without support.

    Parasympathetic activity should be dominating the ANS activity during the sleep period.

    “Parasympathetic activity should be dominating the ANS activity during the sleep period.”

  • The paper relies on this without support.

    HRV remains the most common method to determine the stress.

    “HRV remains the most common method to determine the stress.”

  • The paper relies on this without support.

    Overtraining is caused by long-term stress or exhaustion due to imbalance between training, other external/internal stressors, and recovery.

    “Overtraining is caused by long-term stress or exhaustion due to imbalance between training, other external/internal stressors, and recovery.”

  • The paper relies on this without support.

    Successful derivation of HRV parameters is dependent on the recording quality, the subject's activity during the recording, the removal of artifacts, the detection of arrhythmic beats, and the recording duration.

    “Successful derivation of these HRV parameters is dependent on the recording quality, the subject’s activity during the recording, the removal of artifacts, the detection of arrhythmic beats, and the recording duration (seconds to days).”

  • The paper relies on this without support.

    A majority of devices presented in both scientific and commercial literature are not yet validated in clinical studies for real-time assessment of human performance.

    “However, a majority of the devices presented in both scientific and commercial literature are not yet validated in clinical studies for real-time assessment of human performance.”

  • The paper relies on this without support.

    There remains an unmet medical need to differentiate between physical and mental (psychological) stress to understand the physical and mental demands of the athlete.

    “Lastly, there remains an unmet medical need to differentiate between physical and mental (psychological) stress to understand the physical and mental demands of the athlete.”

  • The paper relies on this without support.

    Current acute-to-chronic workload ratio models from wearable devices focus on only select sports such as Australian Football, Cricket, or Rugby.

    “Current models focus in on only select sports such as Australian Football, Cricket, or Rugby.”

  • The paper relies on this without support.

    The wearables field has recently seen a variety of devices for detecting position and motion, coupled with the emergence of clinical studies to assess their validity in professional or collegiate sports teams.

    “The wearables field has recently seen a variety of devices for detecting position and motion, coupled with the emergence of clinical studies to assess their validity in professional or collegiate sports teams.”
16 of 16

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Table 6 denies commercial skin-conductance sensors listed in Table 2

    Minor

    Table 6 says there are no commercial sensors for skin conductance, whereas Table 2 lists a company product whose functionality includes skin conductivity measurements.

1 of 1

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Authors
Seshadri, D. R., Li, R. T., Voos, J. E., Rowbottom, J. R., Alfes, C. M., Zorman, C. A., & Drummond, C. K.
Affiliations
  • Case Western Reserve University (US)
  • University Hospitals of Cleveland (US)
  • Cleveland Clinic (US)
Corresponding author
Seshadri, Dhruv R.
ORCID
Venue
npj Digital Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-07-22
Volume
2
Issue
1
Pages
72-72
ISSN
2398-6352 (ISSN-L)
DOI
10.1038/s41746-019-0150-9
PMC
PMC6646404
OpenAlex
W2964108233
Semantic Scholar
f71913dd2c6c1cea045bddf24c4859be837ff4bb
Cited by
537
References
135
Citations by year
2026: 71 · 2025: 97 · 2024: 82 · 2023: 63 · 2022: 80 · 2021: 102 · 2020: 39 · 2019: 3
FWCI
4.52
Type
journal article
Language
en
Open access
Licence
Locations
  • npj Digital Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Scholarly Commons @ Case Western Reserve University (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
D.R.S and C.K.D. acknowledge financial support from the Brenda A. and Robert M. Aiken Strategic Initiative.
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Advanced Sensor and Energy Harvesting Materials
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Physical Sciences › Engineering › Electrical and Electronic Engineering › Electrochemical sensors and biosensors
Keywords
wearable sensors, athletes, recovery protocols, salivary biomarkers, sweat biomarkers, non-invasive monitoring, flexible electronics, stretchable electronics, hydration, stress symptoms, athletic performance

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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