Google’s Pixel Watch 5 dives deeper into AI and health

The $399 Google Pixel Watch 5 isn’t about the hardware. Sure, there’s a new satin pyrite case finish, a few new strap colors, and a Steph Curry Special Edition. Under the hood, there’s a slightly faster Qualcomm processor and an itty-bitty battery bump. There’s a $50 price hike from last year, too, because the Pixel Watch 5 isn’t immune to RAMageddon — none of us are. Otherwise, no one would blame you for looking at this watch and thinking absolutely nothing’s changed. That’s because the big updates this year are all software-based.

This isn’t a huge surprise considering Google’s Fitbit Air launch in May. And after seeing some Pixel Watch 5 demos, it’s clear this year’s refresh is furthering the AI and proactive health themes that Google introduced earlier this year.

Health and fitness features account for the bulk of the updates, but Gemini on the wrist gets a few key improvements. You can now use it offline for simple tasks like starting timers and launching apps. (Though I noticed in my demo it was notably slower when doing this offline.) Gemini will also be more proactive in making suggestions. One example I saw: a text asking for my availability brought up the option to check Google Calendar from the wrist. Likewise, there’s now an icon right on the watchface that surfaces real-time information for things like timers, Uber ETAs, and workouts. Meanwhile, the pinchy pinch and wrist-flick features came via a software update to Pixel Watches in December, but they’re much more fully integrated into the UI with WearOS 7.

You can also use AI to generate watchfaces. I created a watchface featuring “fat cats and an elegant font.” It didn’t quite do that. The fat cats weren’t characters, so much as pleasantly plump, cat-shaped clock numbers. It’s a gimmicky way to shoehorn the Nano Banana model onto the watch… but if that’s your thing, it works.

Now for the health stuff. The most novel update is Breathing Emergency Detection. It’s an extension of last year’s Loss of Pulse feature. When the watch detects a severe drop in blood oxygen saturation (aka SpO2), it’ll trigger a call to emergency services and your designated emergency contacts. (A sudden drop in SpO2 may indicate you’re struggling to breathe.) To minimize false positives, the watch uses a combination of heart rate, motion, and altitude sensors. While I didn’t get to see the feature in action, I was told at my demo that the feature won’t kick in unless SpO2 drops to roughly 83 percent — so a significant decrease — for an extended period. It also disables once the watch determines you’ve been asleep for 30 minutes to mitigate false alarms linked to low SpO2 from sleep apnea or side sleeping. The feature also isn’t intended to be used by people with preexisting or chronic respiratory conditions; it’s more for flagging acute instances where a person may have stopped breathing. It’ll be available on both the Pixel Watch 4 and 5 in Europe at launch, and is pending clearance from the FDA in the US.

A less high-stakes feature is that the Pixel Watch (and Fitbit Air) will also track nightly sleep breathing quality and provide monthly updates. The idea is to see how your daily trends impact respiratory health at night over a longer time frame.

Two other health features are Blood Pressure Trends and Insulin Resistance Trends. First and foremost: Neither of these is diagnostic. Both are wellness features intended to function as “check engine light”-type warnings, require a minimum of a week’s worth of data, and flag trends monthly. They won’t be available right when the Pixel Watch 5 launches; rollout is currently scheduled for September. That said, these features will also come to the Pixel Watch 3 or later, as well as the Fitbit Air.

With Blood Pressure Trends, the watch will monitor blood flow using the optical heart rate sensor, as well as motion sensors. That data gets fed into an AI model to estimate the shape and speed of pulse waves traveling under the skin to approximate whether your blood pressure is trending higher or lower. (There will be no direct systolic or diastolic measurements.)

While we’ve seen other wearable players like Apple and Whoop tackle blood pressure insights, Google’s attempt at non-invasive insulin resistance detection is brand spanking new. Insulin resistance describes a condition in which your body doesn’t metabolize food effectively. The pancreas has to produce more insulin to utilize blood glucose, and untreated, it often leads to fatigue, stubborn weight gain, and eventually, Type 2 diabetes. This feature would passively estimate whether your insulin resistance is trending higher or lower month to month based on signals like heart rhythm, sleep quality, and daily movements. To validate the algorithm, Google says it tested the algorithm against blood draws and published its findings in a peer-reviewed study in Nature.

Again, this is not noninvasive blood glucose monitoring. As with Blood Pressure Trends, there are no direct readings involved, and this isn’t a screening feature for diabetes. It’s just flagging when your lifestyle trends indicate sustained metabolic stress over a monthlong period. Even so, I’ve spilled a ton of ink on the decadelong process for me to get diagnosed with insulin resistance. It can remain asymptomatic for several years, it may not show up in routine metabolic tests, and a traditional diagnosis involves nagging doctors to test fasting insulin and glucose via blood draws. We’ll have to see how this feature works in real life, but it’s potentially huge if it works well.

That’s health. Google isn’t slacking on the fitness front either. Fitbit and Pixel Watch users have griped for years over dubious GPS maps from outdoor activities, especially in urban areas. Last year, Google introduced dual-frequency GPS. This year, it’s making the bold claim that the Pixel Watch 5 will outperform the Garmin Fenix 8 and Apple Watch Ultra 3 by utilizing satellite and weather station data, as well as 3D models of buildings from Google Maps, to “correct” GPS data using AI in post-processing. Shots fired.

Google is also bringing AI-generated strength training plans to the wrist. This feature is already available with Google Health Premium, but the difference is that you no longer need the phone to log reps or move on to the next exercise. At least based on my demo, this seems like an obvious and smart move given the renewed emphasis on strength training in the GLP-1 era.

All of these health updates are meant to feed into the Google Health app’s AI coach (which requires a Google Health Premium subscription). As I wrote in my Fitbit Air review, Google’s AI coach is the best of the lot — but that is a remarkably low bar at the moment. AI health remains a work in progress, and Google’s coach is no exception — but so far these updates are a savvy mix of potentially helpful and smart for building a long-term AI health roadmap.

The Google Pixel Watch 5 is available for preorder starting today and arrives on shelves August 20th. The Steph Curry Special Edition will hit shelves September 3rd.