Google Pixel Watch 5: AI and Health at the Heart of Innovation

Google Pixel Watch 5: AI and Health at the Heart of Innovation

The Google Pixel Watch 5 does not focus on hardware. While it features a new satin pyrite case finish, a few new strap colors, and a special Steph Curry edition, the real improvements lie under the hood. It boasts a slightly faster Qualcomm processor and a small increase in battery capacity. The price has also risen by $50 compared to last year, as the Pixel Watch 5 is not immune to RAMageddon — no one is. Otherwise, it would be easy to think that this watch hasn't really changed. The major updates this year are primarily software-based.

This is hardly surprising, given Google's launch of Fitbit Air in May. After seeing a few demonstrations of the Pixel Watch 5, it is clear that this year's refresh deepens the themes of AI and proactive health that Google introduced earlier this year.

Health and fitness features make up the majority of the updates, but Gemini on the wrist benefits from a few key enhancements. You can now use it offline for simple tasks like starting timers and launching apps. (However, I noticed during my demonstration that it was noticeably slower in offline mode.) Gemini will also be more proactive in its suggestions. For example, a message asking for my availability prompted the option to check Google Calendar from my wrist. Additionally, a new icon on the watch face displays real-time information for items like timers, Uber arrival times, and workout sessions. Meanwhile, pinch and wrist movement features were integrated via a software update for Pixel Watches in December, but they are now much more embedded in the user interface with WearOS 7.

There are few reasons for owners of Pixel Watch 3 or 4 to upgrade. Most of the new health software updates will be backward compatible.

You can also use AI to generate watch faces. I created a face featuring "plump cats and a stylish font." It wasn't quite that. The plump cats were not characters but rather clock numbers shaped like well-fed cats. It's a somewhat gimmicky way to integrate the Nano Banana model onto the watch… but if you like it, it works.

New Health Features

The most innovative update is the Respiratory Emergency Detection. This is an extension of last year's Pulse Loss feature. When the watch detects a severe drop in blood oxygen saturation (i.e., SpO2), it triggers a call to emergency services and your designated emergency contacts. (A sudden drop in SpO2 can indicate that you are having difficulty breathing.) To minimize false positives, the watch uses a combination of heart rate, motion, and altitude sensors. Although I couldn't see this feature in action, I was told during my demonstration that it would not activate until SpO2 dropped to around 83% — so a significant decrease — for an extended period. It also deactivates once the watch determines that you have slept for 30 minutes to avoid false alarms related to low SpO2 due to sleep apnea or sleeping on your side. This feature is not intended for individuals with pre-existing or chronic respiratory conditions; it is designed to signal acute cases where a person may have stopped breathing. It will be available on Pixel Watch 4 and 5 in Europe at launch and is awaiting FDA approval in the United States.

Another less critical feature is that the Pixel Watch (and Fitbit Air) will also track nighttime breathing quality and provide monthly updates. The idea is to see how your daily trends impact respiratory health at night over a longer period.

Other Health Features

Two other health features are Blood Pressure Trends and Insulin Resistance Trends. First: neither of these features is diagnostic. Both are wellness features intended to function as "check engine" warnings, requiring a minimum of one week of data and signaling monthly trends. They will not be available at the launch of the Pixel Watch 5; their rollout is currently planned for September. That said, these features will also be available on the Pixel Watch 3 or later, as well as on the Fitbit Air.

With Blood Pressure Trends, the watch will monitor blood flow using the optical heart rate sensor, as well as motion sensors. This data is integrated into an AI model to estimate the shape and speed of pulse waves traveling beneath the skin to approximate whether your blood pressure tends to increase or decrease. (There will be no direct systolic or diastolic measurements.)

While we have seen other players in the wearable sector like Apple and Whoop tackle blood pressure information, Google's attempt to detect insulin resistance non-invasively is entirely new. Insulin resistance describes a condition in which your body does not efficiently metabolize food. The pancreas must produce more insulin to use blood glucose, and if left untreated, it often leads to fatigue, stubborn weight gain, and ultimately, type 2 diabetes. This feature would passively estimate whether your insulin resistance tends to increase or decrease month after month based on signals such as heart rate, sleep quality, and daily movements. To validate the algorithm, Google claims to have tested it against blood samples and published its results in a peer-reviewed study in Nature.

Again, this is not non-invasive blood glucose monitoring. Like Blood Pressure Trends, there are no direct readings involved, and it is not a screening feature for diabetes. It simply serves to signal when your lifestyle trends indicate sustained metabolic stress over a month. That said, I have written extensively about the ten-year process to obtain a diagnosis of insulin resistance. It can remain asymptomatic for several years, may not appear in routine metabolic tests, and a traditional diagnosis involves convincing doctors to test insulin and fasting glucose through blood samples. We will need to see how this feature works in real life, but it could have a huge impact if it performs well.

Fitness Features

Google is not neglecting the fitness side either. Fitbit and Pixel Watch users have complained for years about questionable GPS maps for outdoor activities, especially in urban areas. Last year, Google introduced dual-frequency GPS. This year, it boldly claims that the Pixel Watch 5 will outperform the Garmin Fenix 8 and the Apple Watch Ultra 3 by using satellite data and weather station data, as well as 3D building models from Google Maps, to "correct" GPS data in post-processing using AI.

Google is also introducing AI-generated strength training plans on the wrist. This feature is already available with Google Health Premium, but the difference is that you no longer need your phone to log repetitions or move to the next exercise. At least, from my demonstration, this seems to be an obvious and smart move given the renewed focus on strength training in the era of GLP-1.

All these health updates are intended to feed the AI coach of the Google Health app (which requires a subscription to Google Health Premium). As I mentioned in my review of the Fitbit Air, Google's AI coach is the best of the bunch — but it's a remarkably low bar at the moment. Health AI remains a work in progress, and Google's coach is no exception — but so far, these updates are a clever mix of potentially useful and intelligent features to build a long-term health AI roadmap.

The Google Pixel Watch 5 is available for pre-order starting today and will go on sale on August 20. The special Steph Curry edition will be available in stores on September 3.