Research Topic: Real time athlete monitoring with particular focus on health and

performance success at upcoming Continental, Olympic and National Games.

State of the Art

A variety of wearable technologies can monitor, and integrate with data from other devices

and/or cloud services, to provide real time feedback [1-6]. In accordance with this trend,

employment and sporting rules and regulations are evolving to facilitate the use of wearable

devices [7, 8]. Despite the undoubted benefits of wearables, there are also well-founded

concerns regarding their implementation in high performance environments including: 1) the

lack of scientific evidence demonstrating the benefits of specific parameters in each context or

in isolation; 2) the quality of hardware and provided data; 3) information overload for sport

scientists and coaches; 4) challenges for the end user in integrating multiple data streams; 5)

data security and 6) exaggerated marketing claims [12-14]. It is imperative that wearable

devices using biological data for sport performance, safety or general health purposes, undergo

rigorous evaluation before being launched on the market [15-17]. The reality is that many

products are being promoted, but few follow a rigorous scientific development process. Product

launches typically come with wild claims, limited/no mention of reliability, validity or

sensitivity of measures. While “all-in-one” solutions are preferred, most products cannot be

integrated with data streams from multiple technologies and existing athlete management

systems. Nevertheless, these concerns should not be used to block the use of such technology.

The integration of accurate wearable sensors and real-time transmission of these data,

represents a unique opportunity to protect the health of athletes and enhance performance

during training and competition. The safety management of athletes was demonstrated in a

pilot implementation study by our research team, during the Tokyo 2020 Olympics [9]. The

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Tokyo 2020 Olympics was the first concerted effort involving academic and industry partners

to systematically implement real-time wearable solutions with user-friendly data presentation,

to protect the health of athletes competing in hot and humid environments. Specifically, we

developed a “hub” to aggregate a range of data feeds to assist athletes (8). For example, athletes

ingested a core temperature pill (eCelsius, BodyCap, Caen, France) prior to their event, to

monitor core temperature. Heart rate was measured either by a photoplethysmography sensor

in a wristband/smartwatch or via a standard telemetric heart rate monitor chest strap (Polar

Electro, Kempele, Finland). There were also numerous optional performance-orientated

metrics including stride and foot mechanics, foot dynamics and ground reaction forces, and

swimming analytics, that some athletes and coaches requested tracking of. For the first time

ever, this project enabled live-streaming of metrics throughout Olympic events, to key

stakeholders such as medical, broadcasting and coaching staff. Given this success, numerous

international sporting federations are now actively looking to utilise this monitoring technology

on a regular basis for both safety and promotional purposes (10).

Other pertinent recent technology examples by our team include the non-invasive, in situ

monitoring of sweating rate and sweat electrolyte losses [11], continuous lactate and glucose

monitoring that can track responses to specially-designed high performance drinks, and

augmented reality contact lenses used as a display that allows the athlete to be informed on

best performance strategies. Exploring the suitability of integrated wearable technologies

represents an opportunity for the Hong Kong Sports Institute (HKSI) to be at the forefront of

international scientific developments, and for Hong Kong athletes to directly benefit from these

advances, prior to other nations. Beyond the athlete safety considerations we have described,

having wearable technology with high levels of scientific precision enables the efficacy of

training interventions to be established in the field. For example, this permits a more discrete

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assessment of the effectiveness of heat or altitude adaptation in endurance sports such as

cycling, triathlon and rowing during competition. As athletes train, coaches and support staff

will be able to view live data and interpret these responses, enabling proactive modifications

to training where necessary. In competition, these technologies can also help to identify

sporting events where thermal strain may not be a primary determinant of fatigue, but still

compromises athlete’s performances relative to cooler environments. This has high relevance

within rowing, triathlon, athletics, fencing and rugby for major games throughout 2023-25,

which may influence preparation strategies undertaken in these sports. Another application of

the technology is the consideration of real-time responses to nutritional interventions, such as

high carbohydrate drinks or sports gels, which can be monitored on a regular basis in different

training scenarios, helping to develop optimal fueling strategies. Evidently, the technology is

wide-ranging and solutions will be tailored in accordance with the performance needs of

specific sports.

We propose a systematic project to develop this technology within the Hong Kong sporting

ecosystem, with particular focus on upcoming major games; Asian Games Hangzhou (2023),

Paris Olympics (2024) and National Games Guangdong/Hong Kong/Macau (2025). Through

collaboration with HKSI and elite coaches and athletes, we will develop this technology for

the benefit of athletes, athlete support staff, event organisers, international federations,

broadcasters, and medical personnel, starting in Hong Kong. This technological revolution in

sport science and medicine has the potential to transform how HKSI staff utilise technology in

specific circumstances; (i) athlete safety monitoring, (ii) training intensity monitoring (iii)

assessing the efficacy of generic and specific interventions such as specialist nutritional,

altitude and acclimation/acclimatisation interventions in ecologically valid environments i.e.

outside of the laboratory.

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Research goals

To demonstrate that real-time biometric technology can help HKSI and local sports federation

ensure the health and safety of its athletes across training and competitive scenarios. Secondly,

to revolutionise how athletes and support staff monitor training and evaluate specialist

performance interventions.

This project is proposed to be conducted in preparation and during the Asian Games in

Hangzhou, China (Sep 23, 2023 – Oct 8, 2023). Subsequently, in close partnership with

personnel at HKSI, the most appropriate sensors for future events will be identified, and then

routinely implemented in training. For example, additional biometrics to existing core and skin

temperatures, heart rate and gait data. This may include; sweat rate and composition (sensors

to collect sweat data will become available in late 2023) and continuous lactate and glucose

monitoring. Throughout the training cycle prior to the Paris Olympic Games, this technology

will then be routinely used in training and competition by Hong Kong athletes, to understand

individual needs during training, as well as their responses to performance enhancing

interventions in the field. It is in envisaged that in the lead up to the National Games 2025,

such technology will be ubiquitous across Tier A & B sports in HKSI.

Methods

In the weeks prior to the during the Asian Games in Hangzhou (Sep 23, 2023 – Oct 8, 2023),

coaches/relevant personnel at the HKSI will be invited, with their respective athletes/teams to

participate in this research project, following ethical committee approval. Given the proximity

to the Asian Games, there will be minimal contact with the athletes and no disruption to the

planned preparation/performance of the athletes. This is possible due to the use of extremely

user-friendly but very sophisticated technology developed during the Covid-19 pandemic. As

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such, coaches/relevant personnel at the HKSI will engage with willing athletes, and following

consent, will provide them with all necessary technology as early as possible to allow sufficient

time for familiarisation.

Athletes may choose real-time transmission of their data or offline recording. The athletes will

wear a small bracelet and a smart watch with a bespoke application which will transmit the

data collected wirelessly through cellular connectivity to the mission control room via the

Cloud. Cellular connectivity will be achieved using local/international e-SIMs depending on

the use case. For core body temperature assessment athletes will be required to swallow a

temperature pill (eCelsius, BodyCap, Caen, France) six-hours prior to training or their event

(or the night before depending on race start time). To ensure athletes, coaches and medical staff

are well familiarised with the temperature pills examples will be made available to athletes in

the weeks prior to the event. Participating athletes will also have access to any of the following

parameters being monitored: Heart rate using a telemetric heart rate monitor chest strap (H10

Polar Electro Oy, Kempele, Finland) or the inbuilt smart watch sensor. Skin temperature using

a temperature pill (eCelsius, BodyCap, Caen, France) with its electronics “flattened” to ensure

the thermistor remains in contact with the skin at all times, positioned on the athlete with a

standard heart rate strap. New parameters will be introduced depending on needs and

technological developments. Exciting pipeline developments include the monitoring of core

body temperature without the need to ingest a temperature pill, heart rate (and ECG) without

the need of a restricted chest strap, the monitoring of sweating rate and sweat electrolyte losses,

continuous glucose and lactate monitoring, and augmented reality contact lenses used as a

display that allows the athlete to be informed on best performance strategies without the need

of a smart watch/band.

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Where necessary, environmental parameters such as Wet Bulb Globe Temperature (WBGT)

will also be monitored and recorded (Kestrel 4400, Nielsen-Kellerman, Boothwyn, USA),

including the placing of weather stations along the training or competition course(s). Kestrel

devices are linked by Bluetooth to the real-time monitoring system via a bespoke cellular

wireless transmitter that allows the ambient conditions monitored by the Kestrel to be displayed

in real-time on a dashboard to the research team via the Cloud. The app developed for Tokyo

2020 and used for this research provides a live data feed of air and land surface temperature

together with relative humidity without the need of sensors. This technological innovation is

especially important in regions where weather station networks are absent. This digital

approach permits seamless transition to any global location, provision of ambient conditions

for each athlete, and endless possibilities to scale up to include more parameters such as

forecast of upcoming ambient conditions, UV index and air quality indices.

Following Asian Games 2023, collaborative meetings will be held with HKSI and relevant

sports, to discuss findings and plan monitoring priorities for the Paris 2024 cycle. Athletes and

coaches will therefore have access to this technology throughout their training calendar and

will be supported in its use to monitor training effectiveness and performance interventions.

An added advantage of this approach is that training data may be compared against a robust,

competition dataset collected during Hangzhou 2023.

The significance of this research

A high level of scientific rigour by reputable scientists, practitioners and key stakeholder

organisations, is a key attribute to this proposal. The integration of accurate wearable sensors

and real-time transmission of data represents a unique opportunity to protect the health of

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athletes during training and competition, as will be demonstrated in this pilot research. These

data will subsequently directly inform training preparation for future major games.

This focus on technology and implementation during major competition is intended to

encourage further innovations enabling future monitoring of a much wider spectrum of data in

real-time, aiming to understand performance as well as being used as a preventative

telemedicine tool for athletes and potentially the wider population in the future. The use of

such technology along with other wearable technology transmitting numerous types of data in

real time, will undoubtedly become the norm at major sporting events as international sporting

federations seek to make their sport more interesting and accessible to wider audiences.

Implementing technology will enable HKSI to fully utilise HK summertime, as a 'super-

strength' for athlete preparation, whilst placing HKSI at the forefront of technology that will

be widely applied in trail, road and endurance races across Asia. This research will help

futureproof HKSI and participating sports federations, allowing easy assessment of

performance innovations, while at the same time ensuring the health and safety of their

competing athletes.

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