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International Journal of Sports Physiology and Performance, 2017, 12, S2-55  -S2-62

http://dx.doi.org/10.1123/ijspp.2016-0423
© 2017 Human Kinetics, Inc. BRIEF REVIEW

Wearable Training-Monitoring Technology:


Applications, Challenges, and Opportunities
Marco Cardinale and Matthew C. Varley

The need to quantify aspects of training to improve training prescription has been the holy grail of sport scientists and coaches
for many years. Recently, there has been an increase in scientific interest, possibly due to technological advancements and better
equipment to quantify training activities. Over the last few years there has been an increase in the number of studies assessing
training load in various athletic cohorts with a bias toward subjective reports and/or quantifications of external load. There is
an evident lack of extensive longitudinal studies employing objective internal-load measurements, possibly due to the cost-
effectiveness and invasiveness of measures necessary to quantify objective internal loads. Advances in technology might help
in developing better wearable tools able to ease the difficulties and costs associated with conducting longitudinal observational
studies in athletic cohorts and possibly provide better information on the biological implications of specific external-load pat-
terns. Considering the recent technological developments for monitoring training load and the extensive use of various tools for
research and applied work, the aim of this work was to review applications, challenges, and opportunities of various wearable
technologies.

Keywords: internal load, training technology, wearable technology, external load, GPS

Training-load monitoring has recently gained momentum in and alterations in the hormonal profile7 and typically in underper-
sport science, possibly due to technological advancements and formance.8 The optimization of the training program resides in
better equipment to quantify training activities.1 The reason for such managing what the athlete does and how they respond to the training
interest resides in the need to improve and individualize the design activities performed. This can be quantified by the athlete training
of training and exercise programs to maximize the improvements load. A framework proposed by Impellizzeri et al9 differentiated
in athletic performance and avoid overtraining and overreaching. between internal and external aspects of training load. The internal
Training prescriptions have been notionally based on the concept load refers to the more physiological aspects while the external load
of progressive overload since humans embarked in structured sport represents the activities (work) performed by the athlete. Adaptation
and physical activity. Early examples of training prescription2 gave is the consequence of the internal training load which is primarily
clear indications that a scientific approach to training was important determined by the external training load imposed on the athlete.9
not only to identify appropriate progression strategies3 but also to Over the last few years, numerous studies have been con-
individualize the training dose and maximize performance. Training ducted to improve our understanding of the implications of various
activities and/or exercise programs are designed with the aim of pro- training-load paradigms in various athletic cohorts,1 however despite
ducing stimuli capable of triggering various physiological responses the growing evidence in the usefulness of monitoring training
leading to improvements in the form and function of various biologi- activities, resistance is still perceived in some sporting communi-
cal systems. Early research by Selye4 on stress shaped the thinking ties. A recent review indicated,1that the reasons for the resistance
of modern approaches to training and exercise prescription5 and laid to conduct systematic training-monitoring activities can reside in
the foundations for a systematic approach to quantify and describe financial constraints, manpower limitations, lack of knowledge and/
adaptive responses to various exercise and training paradigms. It is or experience in specific training-monitoring activities, resistance
a well-accepted notion that training activities can alter homeostasis from the coaching staff and most of all the lack of guarantee that
and affect various physiological structures which respond to the training-monitoring interventions can improve the quality of training
training “stress” by trying to restore homeostasis. The net result of prescriptions. A recent PubMed Search (July 2016) identified 488
a well-designed progressive training program is an improvement in papers with the keywords training load monitoring. A more precise
the structure and function of the target physiological systems which analysis using keywords associated with various methods of training-
leads to improvements in human performance. However, the outcome load monitoring showed that a research bias exists toward methods
of a poorly designed and/or inappropriate progression in training can which are easily accessible/low cost (such as the session RPE and
result in impaired health and maladaptation,6 immunosuppression, similar methods) or with historical methods (lactate training load).
Recent research is mostly dominated by external load studies thanks
to the accessibility of inertial measurement systems (IMUs) which
Cardinale is with the Sports Physiology Dept, Aspire Academy, Doha, can be worn by athletes in training and/or competition. There is a lack
Qatar; University College London, UK; and University of St Mark & St of longitudinal studies employing internal-load measurements other
John, UK. Varley is with the Football Science and Performance Dept, Aspire than sRPE, possibly due to the cost-effectiveness and the invasiveness
Academy, Doha, Qatar, and the Inst of Sport, Exercise and Active Living, of measures necessary to quantify internal-load aspects. Considering
Victoria University, Melbourne, Australia. Address author correspondence the recent advances in wearable technologies for training-load moni-
to Marco Cardinale at marco.cardinale@aspire.qa. toring and the extensive array of commercially available tools, it is

S2-55
S2-56  Cardinale and Varley

important to understand the challenges and opportunities associated reason, it cannot be quantified with a single modality of assessment
with the various technologies. Therefore, the aims of this review are but should be approached holistically. While this is theoretically
to discuss the most-used wearable technologies and practices, pro- sound, a comprehensive quantification of internal training load is
vide some indications for new promising technologies, and provide impractical due to the limitation of current technology. In fact, a
simple evidence-based guidelines. holistic assessment would require athletes to wear multiple moni-
toring devices while training as well as to undergo invasive and
subjective measurements (see Figure 1). The implementation of too
Internal-Load Monitoring many devices/measurements may interfere with the athlete’s train-
The internal load experienced by an athlete can be defined as the ing activities and create challenges with regard to data collection.
summation of the physiological and psychological stimulation/ The ability to quantify internal load is of fundamental importance
stress imposed during training activities.9 Every form of exercise/ as it allows practitioners and coaches to quantify the implications of
training is characterized by specific physiological and psychologi- the external load and training prescriptions on various physiological
cal demands which vary not only with the “dose” of the activity systems. It also allows the personalization of training activities, as
(sets, repetitions, duration, etc) but also with the type (eg, strength well as the identification of potential health risks and maladapta-
training vs sport-specific training) of training performed. For this tions. Data should be analyzed for individual athletes to establish
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Figure 1 — Schematic diagram summarizing technologies to monitor internal training load.

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Training-Monitoring Technology   S2-57

meaningful changes in the observed parameters and their biological monitoring. For this reason, we believe that hopefully with further
implications to provide meaningful feedback to the coaching staff. technological developments making such measurements cheaper,
more accessible, and less invasive, as well as providing opportuni-
Cardiovascular and Respiratory Measurements ties for rapid feedback, could be an area of research and applica-
tion which might shed more light on the implications of various
The quantification of heart-rate responses to training is possibly training regimens on adaptation. Recent advancements in various
the earliest example of quantification of internal load. After the “omics” suggest the possibility of gathering more information on
invention of electrocardiography at the start of the 20th century,10 biological responses to exercise activities from relatively small
heart rate has been able to be detected while exercising since the blood,23 sweat,24 and/or urine samples.25 However, such methods
1980s thanks to the development of wrist-worn heart-rate moni- are still impractical in the applied setting due to the laboratory
tors (HRMs) communicating with chest bands.11 Over the years, equipment and expertise necessary to process the samples. Future
numerous studies have been conducted to assess the validity and implementations of such techniques will become reality in sport
reliability of these devices and the overall conclusion is that HRMs when simple analytical processes and accessible equipment are
using chest electrodes can be both valid and reliable during physi- extensively available. Wearable solutions are also developing at
cally and mentally challenging tasks (for a review see Achten and a very fast rate. The feasibility of equipping human skin with
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Jeukendrup10). The use of HRMs has allowed the development of ultrathin devices has been recently demonstrated by the pioneering
various training-load indices to quantify the cardiovascular load work of a few laboratories.26,27 Recent validation work has shown
experienced by the athletes in training and competition. Most of promising results of epidermal sensors in quantifying biological
the training-load indices used make assumptions related to the parameters in vivo while performing exercise activities28 suggesting
linear relationship identified between heart rate and V̇O2 during that it is not far-fetched to imagine a future of wearable sensing
incremental tests and identify intensity zones and time spent in capable of improving our understanding of how the body reacts to
each zone expressed as a percentage of maximum heart rate and various exercise stimuli. In general, until cheaper and less invasive
various possibilities exist to quantify training load using such technologies and methods become available, our understanding
approaches.12 Recently, further developments in technology has of the biological responses to training will remain limited with
seen promising alternatives to chest belts. Lightweight wrist pho- fewer chances to affect day-to-day activities of sport scientists
toplethysmography is gathering momentum, albeit with mixed and coaches. Therefore, at the moment, practitioners should use
results with regards to accuracy/validity,13,14 and it could become biochemical markers of training-load monitoring with caution
a valid alternative provided that specific algorithms are imple- taking into account the limitations, the biological and individual
mented to account for motion artifacts so as to reduce the mean variability and the fact that many parameters currently quantified
error of detection below 3%.15 Smart textiles also offer promising in the field can be affected by many variables.
solutions with textile sensors capable of high accuracy in various
activities.16,17 This shows that more and possibly better options Neuromuscular Parameters
will be available soon for assessing the implications of training
on cardiorespiratory parameters. The assessment of neuromuscular parameters of training load
Near-infrared spectroscopy (NIRS) is nowadays a well- has been somewhat limited by the available technology. Recent
accepted technology to assess muscle oxygenation in vivo, and developments include sporting garments with embedded electro-
our previous research18,19 together with studies conducted by myographic (EMG) sensors capable of quantifying muscle activity
others (for a review of this methodology see Ferrari et al20) sug- during exercise.29 Furthermore, epidermal solutions26 suggest that
gest that this technology could be implemented successfully in muscle activity of athletes in training could be monitored routinely
most sports, including aquatic sports.21 While the market seems and accurately. Surface EMG data of athletes and nonathletes in
to be showing an increase in portable NIRS devices, only few competition30 or training have been recently published, but to
present some form of validation to date. Recent developments in the author’s knowledge there is no longitudinal study presenting
miniaturizing and embedding the devices in sporting garments22 internal load assessments using this technique. The same holds
suggest that this modality of internal training-load quantification true for electroencephalographic measurements and galvanic skin
not only has merit but also could have extended applications in the responses observed during training. This is mostly due to the
near future. impractical use of such technologies in the sporting setting due
to the bulky equipment, as well as the prohibitive costs. For this
Humoral Parameters reason, despite the fact that in many coaching communities there
are common references to “neuromuscular load” it is virtually
A large amount of research has been conducted examining a range impossible at this moment to quantify this aspect. However, it is
of biochemical, hormonal, and immunological markers able to possible to assess the effect of training acutely and chronically
characterize the acute and chronic responses to various exercise using various tests which assess the function of the neuromuscu-
and training paradigms. It is beyond the scope of this article to lar system such as dynamometric measurements, reaction time,
conduct a comprehensive review of the literature in this area; electroencephalography (EEG) responses, vertical jumps, and
however, it is important to state that it would represent a dangerous other proxy measures of neuromuscular function. As for humoral
reductionist approach to identify only 1 marker able to quantify parameters, technology in this domain is developing very quickly,
some aspects of internal training load. Recent reviews1,7 have and we have examples of EEG measurements during static sporting
looked at different approaches and they all conclude that more activities like shooting.31 Considering the potential for EEG to pro-
research is needed. However, the limitations of implementing such vide more information about the implications of training activities
measurements reside in the invasiveness of the measurements, the on the brain,32 it is hoped that better wearable devices and more
cost-effectiveness of determining humoral responses to training accurate signal filtering approaches will be developed to be able
and the difficulty in performing some meaningful longitudinal to quantify neuromuscular load in different sports.

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S2-58  Cardinale and Varley

External-Load Monitoring substantially change the velocity output and are not reported by
all manufacturers. External-load metrics arising from distance and
External training load can be defined as the work completed by the velocity data include the distance covered within specific speed
athlete, measured independently of their internal characteristics. thresholds and/or the number of discrete efforts that occur within
External-load measures can include duration, speed, distance cov- a specific speed threshold (ie, number of sprints). Researchers and
ered, body load, acceleration, metabolic power, and sport-specific practitioners often focus on total distance and the distance covered
movements such as balls thrown or tackles performed. The ability at high speeds as this is thought to be the most demanding and
to objectively quantify external training load is essential in athlete important movement undertaken by the athlete. However, high-
monitoring as it allows practitioners to evaluate the effectiveness speed running should not be interpreted as high-intensity activity
of a training program or intervention, minimize the risk of athlete as this is not a complete reflection of the external load imposed
injury,33 design individual training programs that reflect competi- on the athlete.40 High-intensity activities can also include jumps,
tion demands,34 and allow the athlete to maintain and optimize accelerations, decelerations, changes of direction, and tackles.41
performance.35
Athlete monitoring should be conducted at an individual level Acceleration
to identify meaningful changes in external load. Therefore, it is
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important to understand the accuracy and reliability of the devices Acceleration is more energetically demanding than constant-
used to measure external load as this will allow practitioners to velocity movement.41,42 During a maximal 5-second sprint from
determine the athlete’s day-to-day variation in these measures and a static start 50% of the total work is achieved within the first 1.5
confidently determine meaningful changes in load. seconds and a peak power output 40% greater than the average
power output is obtained after only ~0.5 second.42 Thus, from a
Global Positioning Systems standing start the hardest work is likely performed before the sprint
threshold is reached. Further, performing an acceleration from a
In elite sport, wearable technology such as global positioning low velocity can match or even exceed the power output required to
system (GPS) devices and inertial sensors such as accelerometers, maintain a higher constant velocity,41 Thus accelerating is not only
magnetometers, and gyroscopes are commonly used to monitor a metabolically demanding task, but one that does not need to occur
the external load of the athletes during training and competition.35 at a high velocity to be challenging. This suggests that if external
GPS devices measure position, velocity, and acceleration, the load is quantified based only on distance and speed measures it is
data of which are processed using various algorithms and filters likely that the true high-intensity work undertaken by athletes will
to provide a range of metrics that can be used to quantify external be underestimated.
load.36 Accelerometers have been used to quantify movement for Acceleration is derived from GPS velocity data. There are two
over a decade, with accelerometers now commonplace in technolo- primary levels of data processing when calculating acceleration.
gies such as smartphones, wearable fitness devices, and individual The first is the time interval over which acceleration is derived from
inertial sensors. Accelerometers provide a measure of acceleration the velocity data. Using a longer time interval will result in aver-
which can be used to estimate overall external load imposed on the age acceleration which has a smoothing effect on the acceleration
body.37 This may provide a more representative value of overall data. The second level of processing applies smoothing filters to the
muscular peripheral load than velocity and distance based metrics as already calculated acceleration data. Any errors in velocity data are
it incorporates external load from collisions, foot impact, and other magnified when acceleration is derived therefore, acceleration data
movements that are not accounted for when using GPS. Almost all can often be substantially filtered. As with velocity data, the filter
GPS devices used in sport contain a triaxial accelerometer. Devices techniques vary depending on the manufacturer. As acceleration
may also contain a magnetometer and/or gyroscope which measure filters are applied to previously filtered velocity, data differences
direction and orientation, and angular movement respectively.38 Data in filtering techniques can substantially affect the acceleration
from these additional sensors can be integrated to calculate advanced measures reported. This has been observed when GPS data were
movement patterns and be used to quantify load in indoor sports. processed before and after a software update resulting in a substan-
tial reduction in the number of accelerations detected following
Distance and Velocity Measures the update.43 Although filtering techniques were not reported, it is
likely that changes in the data-filtering techniques contributed to
Total distance is the most common measure of external load using these differences. Typically, the number of acceleration efforts or
wearable technology. This measure is provided using GPS data the distance covered in specific acceleration thresholds are used as
and can be calculated either by positional differentiation or as the external load measures. However, caution is needed when interpret-
integral of Doppler-shift velocity. Although not all manufacturers ing this data given the limitations of current technology.44
disclose their chosen method, 2 prominent GPS manufacturers
(Catapult Sports and GPSports) use positional differentiation to Accelerometer-Derived Measures
calculate distance. Often the distance covered is reported according
to specific speed thresholds and it is common to see a threshold for Accelerometers can provide an external load measure of physical
low-speed running, high-speed running, and sprinting.6 The GPS activity that may overcome the limitations of GPS based metrics.
device calculates velocity either derived from the change in distance This measure quantifies the overall load on the body indicating
(determined by positional differentiation) over time or using the the total stress resulting from acceleration, deceleration, change of
Doppler-shift method. As Doppler-shift appears to provide greater direction, collisions and foot impacts.35 Manufacturers may have
precision and less error,39 this method is commonly used by manu- slight variations in how this load is calculated; however, it is typi-
facturers. Raw GPS velocity data may be further processed using cally the sum of acceleration in all 3 planes of movement measured
filtering techniques (eg, median or exponential filters), which will using a triaxial accelerometer. An example is the metric PlayerLoad
vary based on the manufacturer. Different filtering techniques can used by Catapult, which is the square root of the sum of the squared

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instantaneous rate of change in acceleration in the x, y, and z axes it is unclear how wearing multiple devices may affect GPS signal
divided by 100.37 These load measures are described in arbitrary quality and accelerometer results may vary when placed in differ-
units therefore, reliability is more easily determined than validity. ent locations. While interunit reliability appears to have improved
While GPS measures are reliant on the quality of the satellite signal, it is recommended that the same device be used on a given athlete
these load measures are calculated purely from accelerometer data when monitoring training load to minimize intraunit variability.51
and can therefore be collected indoors or in areas with poor signal The validation of the accelerometers measure of Player Load is
quality (eg, indoor or high-walled stadiums). Research that has used problematic as it represents an arbitrary unit, however its reliability
PlayerLoad measures to quantify external load during training has has been assessed under laboratory and field conditions.37 When
found it to have a strong relationship with total distance covered.45 using a hydraulic universal testing machine to oscillate devices at
It has been suggested that practitioners could use PlayerLoad mea- specified acceleration ranges, devices showed strong interunit and
sures as a surrogate for measures of total distance when GPS is not intraunit reliability (CV of <1.10%) for Player Load.37 Similarly in
available (ie, indoors).45 Accelerometer external-load values are of field conditions (Australian Football match), devices were shown to
an individual nature; therefore, when monitoring athletes practitio- have strong interunit reliability (CV of 1.94%) for Player Load.37
ners should compare within-athlete changes rather than between. Validity and reliability of wearable technology are improving
with technological developments. As validation research is often
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Validity and Reliability conducted externally after the release of new technology, practi-
tioners are likely to be using the devices before this information is
Given the expanding number of wearable devices available for available. Unfortunately, validation is required with each new device
sports, understanding their reliability and validity is essential to release or upgrade, and following any changes to data processing
inform training practice. Decisions around athlete training may which may occur after firmware or software updates. The ability
be based on small fluctuations in training load; thus, precision is to monitor athletes requires identifying changes within athlete load
extremely important to differentiate between real change and mea- measures over time. Thus practitioners are recommended to ensure
surement error.47 As manufacturer validation is rarely performed, consistency in data collection, processing, and analysis where pos-
external validation is necessary for each device and device metric sible. For this reason, practitioners may wish to delay device and
to understand the error so that correct assumptions can be made system upgrades until the end of the season. If retrospective data
regarding changes in load variables. A substantial number of studies can be reprocessed this can provide comparable data for each new
have assessed the validity and reliability of wearable technology for season. This consistency will enhance the reliability of external-load
their use in sport. This has been extensively reviewed elsewhere,46 metrics used to assess athletes.
so this section will summarize the findings.
The validity of GPS devices for measuring distance and velocity
appear to improve with a higher sampling frequency.44,48 Improve- Use of Load Monitoring in Sport Settings
ments may also be due to advances in chipset technology and signal
processing algorithms. Regardless of the sampling frequency, accu- A large amount of the external-load research is descriptive, detailing
racy has been shown to be reduced at higher velocities.48 However, and comparing external load in different circumstances (eg, during
validation studies have often used protocols that involve running training and competition). The benefit of these studies is that they
trials commencing from a static start when assessing high velocity. provide methods to quantify and analyze external load; however,
In studies that have isolated the acceleration and high-velocity- there is limited ability to generalize or compare results as they are
running phases, GPS accuracy is reduced as the rate of acceleration dependent on the training program and athletes/team participating
(change in velocity) increases.44,49 For example, GPS was found in the research.
to have a lower coefficient of variation for measuring running at Practitioners have a variety of external-load metrics at their
constant high speeds (5–8 m/s) compared with low constant speeds disposal when monitoring athletes. The way in which these metrics
(1–3 m/s), 3% versus 8%, respectively.44 Similarly, validity is shown can assist practitioners in optimizing their training plan can vary
to improve over trials of longer distances, where the acceleration with each metric. Information regarding the body load of an ath-
phase is relatively diminished over the trial.50 This would explain lete can provide a holistic representation of the stress imposed on
the increased errors for movements that require rapid changes in the athlete, however, it is difficult to design specific training drills
velocity such as change-of-direction movement and short explosive based on this metric. External-load measures relating to distances
actions. As distance and velocity are calculated independently and covered at specific speeds may be more appropriate as they provide
are subject to filtering it is important that each measure and the practitioners with tangible metrics that can be used to plan what the
associated analysis technique from the GPS is validated appropri- athletes will actually do in the training program. Similarly, when
ately. For example, velocity calculated via Doppler shift has shown using external load to indicate fatigue, velocity and distance based
a higher level of accuracy and lower error than velocity calculated measures are unlikely to completely represent the stress on the body,
via positional differentiation.39 so body load and/or acceleration metrics should also be included.
Of primary importance when monitoring athlete load is the It is impractical to suggest that practitioners use all metrics for
reliability of the monitoring device as this will allow practitioners each component of the training plan and their decision should be
to identify meaningful changes in external load. Individuals may based on their understanding of the metric and if it can be used in
respond differently to a given training load; therefore, an individual- a practical way to support their training goals.
ized approach to athlete monitoring is important.1 Higher sampling A number of studies have explored the relationship between
frequencies and improvements in technology have been found to training and injury (for review see Drew et al52). External-load
improve reliability in a similar way to validity.44,51 The intraunit metrics are often quantified as both acute (7 d) and chronic (eg,
reliability of velocity and distance at any given velocity is difficult to last 4 wk) and as a ratio of the 2.33 The actual load metric used
accurately determine as it requires participants to perform multiple varies between studies however, total distance appears to be the
trials at the exact same speed. Interunit reliability is also difficult as most common. Both high and low external loads are associated

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S2-60  Cardinale and Varley

with injury risk, with suggestions that there may be an optimum to internal and external training loads in different athletic
load threshold for individual athletes.53 It may be that a low exter- cohorts.
nal load results in athletes being underprepared for the training or • Although a wide range of metrics are available, practitioners
competition demands whereas chronically high loads may impose should limit their use to those that they understand and that can
too much stress on the body. There is a strong theory that in some affect their training program.
sports the interplay between acute and chronic external load may
be the most important consideration for athlete monitoring with
spikes in acute load associated with a higher injury risk.54 Regard- References
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