Olatinwo et al.

J Wireless Com Network (2021) 2021:60

https://doi.org/10.1186/s13638-021-01919-1

REVIEW Open Access

Towards achieving efficient MAC protocols

for WBAN‑enabled IoT technology: a review
Damilola D. Olatinwo1, Adnan M. Abu‑Mahfouz1,2* and Gerhard P. Hancke1,3

*Correspondence:
a.abumahfouz@ieee.org Abstract
1
Department of Electrical, Internet of things (IoT) is a concept that is currently gaining a lot of popularity as a
Electronic and Computer
Engineering, University result of its potential to be incorporated into many heterogeneous systems. Because of
of Pretoria, Pretoria 0001, its diversity, integrating IoT is conceivable in almost all fields, including the healthcare
South Africa sector. For instance, a promising technology in the healthcare sector known as wireless
Full list of author information
is available at the end of the body area network (WBAN) could be integrated with the IoT to enhance its productiv‑
article ity. However, in order to guarantee the optimization of the operation of the healthcare
applications facilitated by the WBAN-enabled IoT technology, there must be enough
support from all the different protocol stack layers so as to satisfy the critical quality-
of-service (QoS) requirements of the WBAN systems. Consequently, the medium
access control (MAC) protocol has recently been gaining lots of attention in the area
of WBANs due to its ability to manage and coordinate when a shared communica‑
tion channel can be accessed. For the purpose of achieving efficient MAC protocols
for WBAN-enabled IoT technology, this paper investigates some key MAC protocols
that could be exploited in WBANs based on their characteristics, service specifications,
technical issues such as energy wastage issues, and possible technical solutions were
provided to enhance energy efficiency, channel utilization, data transmission rate, and
dealy rate. Also, these MAC protocols were grouped and compared based on short-
and long-range communication standards. Following this, future directions and open
research issues are pointed out.
Keywords: IoT, 5G technology, Energy efficiency, Communication standards, WBAN,
MAC protocols

1 Introduction
To improve the quality-of-life, a wireless body area network (WBAN) has been specifi-
cally designed for healthcare monitoring [1]. The agenda of this type of wireless network
is to provide health related services that targets the general well-being of humans by reg-
ularly monitoring critical vital signs, including the heartbeat, respiration, temperature,
and blood pressure, collecting specialized signals, like the electromyography (EMG),
electroencephalogram (EEG), and electrocardiogram (ECG), and reporting the obtained
measurements remotely to dedicated physicians and hospitals via communication tech-
nologies, reducing hospital visits in a cost-effective manner, and minimizing the rate of
hospitalization. As an internet communication paradigm, the internet of things (IoT)

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Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 2 of 47

technology has gained a lot of attention recently in the academia sphere as well as indus-
try because of its ability to be applied to various wireless systems and seamlessly con-
nect various types of devices, such as actuators, sensors, medical devices, and vehicles
together over the internet to achieve the critical tasks of different wireless networks, like
WBAN applications, pervasively. IoT technologies can be fused with WBANs to form
a WBAN-enabled IoT technology for enhanced functionalities and new use cases [1].
Such systems are not only suitable for healthcare monitoring, but also have capabilities
to autonomously carry out process control and decision-making functions with or with-
out any human intervention [2]. These systems consist of intelligent, miniature size, and
low-power IoT biosensor devices which are positioned inside, around or worn on the
human body to monitor, diagnose, and treat patients that suffers from chronic diseases,
including cancer, diabetes, obesity, myocardial infraction, stroke, and other forms of dis-
eases, in a seamless manner, as well as communicate sensory health data to healthcare
providers, including designated hospitals [1–3], through access point (AP) or base sta-
tion (BS) nodes in the body area.
Because of the aforementioned unique properties, the WBAN-enabled IoT technol-
ogy must be well supported in terms of energy efficiency and/or long lifetime require-
ment, reasonable latency, efficient channel bandwidth utilization, long communication
coverage, low power utilization, pervasiveness, low-cost deployment, and sufficient
throughput to efficiently drive these systems as a result of inherent resource scarcity
issues related them. Given that the biosensor devices in these systems have limited bat-
tery power resources since they mostly use batteries [4], and the energy expended during
health data communications is always huge and expensive compared to other activi-
ties, then, it will be reasonable and advantageous to reduce the power consumption due
to data communications through pragmatic means, including medium access control
(MAC) mechanisms and/or power control mechanisms. For insight into data communi-
cations in WBAN systems, an illustration is provided in Fig. 1.
Because of the MAC layer energy consumption and/or energy wastage associated
issues when biosensor devices try to access the communication channel, this study is
focused on addressing the concerns of the MAC layer that are associated with the
WBAN systems, and seeking the design of good MAC protocols that are characterized

Fig. 1 An illustration of data transmissions in a WBAN system

Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 3 of 47

by efficiency, low energy consumption, reliability, time sensitivity, low latency, reason-
able data transfer rate, as well as low hardware implementation cost [4].
Currently, the investigation and design of efficient MAC protocols for WBAN systems
are active research areas in the healthcare research sphere [5, 6]. The design of efficient
MAC protocols for WBANs is a promising adventure that would be highly helpful to
optimally control how the biosensor devices access the communication channel, and
improve the allocation of the WBAN system scarce network resources, including time
slots, power, spectrum and/or channel. Hence, this study reviews some MAC protocols
that could be exploited in WBANs and those designed specifically for the WBAN sys-
tems. The main contributions of this research work are highlighted as follows:

• General overview of wireless MAC protocols that can be exploited in the WBANs.
• Exploration of MAC protocols that are specific to WBANs.
• Identification of suitable MAC protocols by exploring their characteristics, service
specifications, technical issues such as energy wastage issues, and possible solutions.
• Identification of relevant communication technologies in line with the WBAN IoT-
related MAC protocols.
• Investigation and comparison of different MAC protocols based on short- and long-
range standards in relation to energy efficiency, health data transmission rate, radio
access techniques, and delay rate.
• Provision of insights into relevant MAC protocols, including their energy consump-
tion, issues, and energy saving mechanisms.
• Presentation of recommendations and future directions.

To authors’ best knowledge, this research study is the first to investigate and compare
WBAN system MAC protocols based on short- and long-range coverage area with focus
on energy consumption issues, channel access techniques, transmission efficiency, and
latency. Additionally, this study was able to highlight the protocols used by different
communication standards, their energy consumption, energy saving mechanisms, and
related issues. The remaining parts of this study are structured as follows. Section 2 pre-
sents a review of some existing survey papers for comparison purposes. MAC proto-
col requirements for WBAN-enabled IoT technology are presented in Sect. 3. Section 4
discuss the general overview of some MAC protocols in communication systems and
WBAN-enabled IoT technology. Short- and long-range MAC protocols are presented
in Sect. 5. Open research problems as well as future directions are presented in Sect. 6,
while Sect. 7 concludes this study.

2 Related survey paper

Due to the scarceness of energy resources in wireless communication systems, such as
the WBAN systems, research interest has recently been drawn toward exploiting effi-
cient channel access protocols to address the energy consumption problem without
compromising the application stringent quality of service (QoS) requirements, like reli-
ability, delay-rate, and throughput. As an example, the authors of [7] focused on identi-
fying the research challenges associated with the design of hybrid MAC protocols that
are based on the IEEE 802.15.6 standard which falls under the category of short-range
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 4 of 47

communication technologies for exploitation in WBANs. Unlike this work, we focused

on MAC protocols for both short- and long-range communication standards for the
WBAN systems. Another example is [8], authors presented a research work on WBAN
for e-health with a major focus on the MAC protocols challenges and a context-aware
design was introduced to achieve an efficient and a reliable network. Their discussions
were based on the IEEE wireless standards that include the IEEE 802.15.4 and IEEE
802.15.6. In contrast to [8], we presented a study that focuses on efficient MAC proto-
cols that can be exploited in the WBAN systems by putting into consideration their ser-
vice requirements and technical challenges related to energy efficiency. Additionally, we
investigate as well as compare different MAC protocols based on short- and long-range
communication standards and related issues, including energy wastage like collisions,
idle listening, as well as radio access techniques, energy saving mechanisms, health data
transmission rate, delay rate, and transmission efficiency.
In [9], authors presented a survey on the existing MAC protocols used in WBAN
with focus on the requirements, sources of energy wastage, and classification. Also,
they briefly discussed the IEEE 802.15.4 and IEEE 802.15.4 wireless standards MAC pro-
tocols. Different from [9], we investigated the use of 5G IoT radio standards and tech-
nologies, such as the eMTC and NB-IoT MAC protocols in WBAN systems for energy
efficiency. Furthermore, in our study, we grouped different MAC protocols based on
short and long range so as to know the optimal MAC protocol(s) to employ when con-
sidering the design of a WBAN-enabled IoT healthcare system for different use cases by
comparing the MAC protocols that falls into each group and also outlining their weak-
nesses and strengths.
A survey was carried out on MAC protocols in [10], and the authors considered some
sources of energy wastage, design requirements, and the advantages and disadvantages
of the MAC protocols. Since the work in [10] did not consider the grouping of MAC
protocols according to their communication coverage, this limitation consequently cre-
ates a context for a new survey, so we presented a study that is different from [10] which
classifies MAC protocols into short- and long-range coverage, and also the exploita-
tion of 5G IoT radio standards and technologies MAC protocols which can be used to
achieve energy efficiency in a WBAN system was introduced. The authors of [11] pre-
sented a study on the existing MAC protocols designed for WBANs with focus on their
salient characteristics and sources of energy wastage. The only wireless standard consid-
ered here was IEEE 802.15.4. The authors of [12] reviewed MAC protocols for WBANs,
and they considered the design objectives of the IEEE 802.15.6 and IEEE 802.15.4 based
MAC superframe structures. Also, the design goals of various multiple access (MA)
schemes and their challenges were discussed. In [13], four different MAC protocols that
include Medical MAC (MedMAC), energy efficient MAC, BodyMAC, and low duty
cycle MAC were investigated. Sources of energy wastage and some important MAC
protocol requirements were also discussed. Authors of [14] investigated some energy-
aware MAC protocols with their optimization methods, and they also analyzed and
compared the path loss for WBASN communications. Different from what were done
in [11–14], we presented a study that focuses on achieving efficient MAC protocols that
can be exploited in WBAN systems by putting into consideration their service require-
ments and technical challenges related to energy wastage. In addition, we investigated
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 5 of 47

and compared different MAC protocols based on short- and long-range standards with
focus on radio access techniques and issues related to energy wastage. In [15], a survey
based on the MAC protocols used in wireless sensor networks (WSNs) was presented,
and the survey focused on the two major categories of the generic MAC protocols that
include the contention and scheduled based MAC protocols. The survey investigated
some short-range wireless MAC protocol standards that could be employed in WSNs,
such as the IEEE 802.11, IEEE 802.15.4, and Bluetooth. Since the survey investigated in
[15] is limited to the short-range wireless standards, we therefore explored the investi-
gation of various MAC protocols applicable to long-range communication networking,
including the new 5G IoT radio standards.
The focus of the survey in [16] was on both short- and long-range MAC protocols
for IoT, but not for WBAN systems. Also, the considered MAC protocols were classi-
fied and compared based on energy consumption, transmission power, advantages, and
disadvantages. To complement [16], this new study focused on an IoT-enabled WBAN
healthcare system, and we also introduced the exploration of 5G IoT radio standards
and technologies MAC protocols in IoT-enabled WBAN healthcare systems to improve
energy efficiency, latency, and throughput network performances. Also, efficient WBAN
MAC protocol service requirements and technical challenges are discussed in this study.
Furthermore, different from [16], we present a general overview of MAC protocols used
in wireless communication systems and MAC protocols that are specific to WBANs.
For the purpose of comparison, the surveyed related papers and this study are summa-
rized and compared in Table 1.

3 MAC protocol requirements for WBAN‑enabled IoT technology

The analysis of MAC protocol requirements is an inseparable part of the WBAN-ena-
bled IoT technology, and hence, this necessitates a quick review of WBAN-enabled IoT
technology MAC protocol requirements. Consequently, this section presents some of
the key design requirements to be considered in the development and deployment of
a MAC protocol for WBAN-enabled IoT healthcare systems. Examples include energy
efficiency, latency, reliability, fairness, low complexity, and throughput performance
metrics. These parameters are discussed in the next subsections.

Table 1 Comparison of related survey work on short- and long-range MAC protocols for WBAN
systems
Survey on MAC Short-range MAC Concept of long-range MAC Concept of 5G-enabled MAC
protocols (Reference) protocols protocols for WBAN systems protocols in WBAN systems

✓
✓
[7] × ×

✓
[8] × ×

✓
[9] × ×

✓
[10] × ×

✓
[11] × ×

✓
[12] × ×

✓
[13] × ×

✓
[14] × ×

✓ ✓
[15] × ×
[16] ×
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 6 of 47

3.1 Energy efficiency
Energy efficiency is an important requirement to consider when designing a WBAN-
enabled IoT MAC protocol, and this requirement focusses on how the energy resources
of biosensor devices could be efficiently utilized. A major way by which biosensor
devices consume energy is during the channel access process. The energy wasted during
this process may be significant due to the likelihood of collisions [17, 18] and biosensor
devices being battery powered devices may not be able to afford such energy, and hence,
for efficient utilization of energy, the usage of energy by the biosensors when trying to
access the channel should be minimized through the design of energy-aware MAC pro-
tocols that can help to optimize energy during health data communication by reducing
the control overhead messages, minimizing the possibility of collisions, optimally allo-
cating channel resources, and by switching the radio into a low power sleep mode when
the channel is busy. Also, MAC protocol design for WBAN-enabled IoT should cater
for optimizing the level at which energy is being dissipated to prevent energy wastage
since the electromagnetic waves radiated by the biosensor devices at high energy levels
may damage patients’ body and tissue [19]. This means that, the rate at which energy is
absorbed by the body must not exceed the specific absorption rate (SAR) given that a
WBAN-enabled IoT technology is a special network that is body focused [19].

3.2 Throughput
Throughput can be regarded as the successful delivery rate of a health packet over a
communication channel. The system throughput aggregate is the total amount of data
rates successfully transmitted from all the biosensor devices to the destination device,
i.e., from a sender to a receiver, in a WBAN-enabled IoT network [1, 20]. Because of the
scarcity of the communication channel resources and several biosensor devices wishing
to access the channel concurrently, collision and/or time wastage issues may be encoun-
tered during the exchange of messages. These issues may affect the system achievable
throughput, hence, they need to be optimally addressed using efficient MAC protocols.
It is important to mention that the throughput requirements are always related to a
specific WBAN use case and should be high enough to cater for an application’s need
and large number of biosensor devices. Moreover, in a WBAN-enabled IoT technology,
various factors that include delay-rate, control overhead, collision avoidance, and the
utilization of channel may affect the efficiency of the throughput performance. Conse-
quently, these issues need to be carefully considered when designing a MAC protocol for
WBAN-enabled IoT applications for efficient health data communications.

3.3 Latency
Latency is a measure of the rate of delay which is a function of the time it will take a
sent health packet from a biosensor device to be successfully received at the destina-
tion device. For critical healthcare systems, like WBAN-enabled IoT, the latency is an
important requirement that ascertains how effective is the service provided by such sys-
tems. Since WBAN-enabled IoT is a health-focused system, then, health information
about patients, especially chronic and critical health conditions, need to be timely and
reliably communicated to the appropriate healthcare quarters for prompt actions. Note
that, the offered traffic load of the network is a critical underlying factor for timely and
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 7 of 47

reliable health data transmission as a very high traffic load may results in a network con-
gestion which causes delay to health data transmission. Likewise, the choice of MAC
protocol may also influence the speed of health data communication since it determines
the channel access. In the case of WBAN-enabled IoT technology that can only toler-
ate little or no delay [21], the delay experienced by the biosensor devices while trying to
access the channel should be very minimal, and this may vary from WBAN-enabled IoT
use cases. But then, the general bound on latency for a non-real time traffic is 250 ms,
while that of a real time traffic is around 10 ms in practice. Hence, the design of MAC
protocols for WBAN-enabled IoT technology must support the required latency bound
of each WBAN-enabled IoT use case and minimize delays in accessing the channel.

3.4 Fairness
Fairness can be described as the ability of various biosensor devices, applications, or
users to be able to have equal access to a shared communication channel. Fairness is
regarded as an important performance metric in the conventional data and voice
networks. It is the minimum number of packets that are transmitted by each biosen-
sor device in relation to the maximum number of packets that are transmitted by any
of the biosensor devices in a network. However, in a WBAN-enabled IoT, a biosensor
device in a specific time may have more health packets to communicate compared to
other biosensor devices and thereby access the communication channel more than the
others. Hence, instead of treating individual biosensor device equally, the success of the
system is measured by their performance as a whole and each biosensor device fairness
becomes unnecessary. To achieve this, the Jain fairness equation can be applied [22].
Due to the heterogeneous nature of WBAN-enabled IoT technology, MAC resource
allocation should not always be fair since priorities may be assigned to some biosensor
devices, like life critical medical biosensor devices, which may have higher transmission
priority than the non-medical devices, during data transmissions.

3.5 Reliability
Health packet delivery reliability is another crucial design goal for a WBAN-enabled IoT
technology. The guarantee of a successful health packet delivery could be ensured by
avoiding overloading biosensor devices with health data, detecting and recovering from
health packet drops, and by carefully selecting error-free links. Moreover, there is a typi-
cal tradeoff between the overhead traffic control and the reliability level, for instance, per
health packet acknowledgment can minimize the recovery time, but constrains its scope
at the expense of a high traffic control that may increase energy utilization, increase one-
way delay, as well as reduce the link bandwidth effectiveness. Also, the MAC protocol
can impact the reliability of health data transfer. For a reasonable reliability, a level above
90% is typically required for a WBAN-enabled IoT technology packet reception rate.

3.6 Low complexity
Another important performance metric that is related to energy efficiency is the neces-
sity for a low complexity operation in WBAN-enabled IoT technology. The reason
for this is that such systems are expected to be affordable and simple. Since these sys-
tems consist of limited energy biosensor devices, they cannot support computational
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 8 of 47

operations that are costly, including complex algorithm. Because of this, low complexity
MAC algorithms that provide channel access to the biosensor devices at a low-cost will
play a vital role in enhancing the performance of WBAN-enabled IoT technology con-
sidering its resource constrained nature.

4 General overview of MAC protocols used in wireless communications

and WBAN‑enabled IoT technology
4.1 WBAN IoT and general wireless communication systems
A WBAN IoT is a human-focused type of wireless communication system employed in
the sphere of healthcare monitoring to collect a patient’s health data and send such data
to medical physicians in remote locations through a computer network [2]. On the other
hand, a general wireless communication system is a type of wireless network deployed
in an application domain other than healthcare for data communication purposes. An
example of a typical general wireless communication system includes a wireless sensor
network (WSN). It is important to mention that a WBAN IoT is different from other
types of wireless communication systems in terms of application focus, requirements,
and characteristics. For example, a WBAN IoT focuses more on quality-of-service (QoS)
requirements like energy efficiency, latency, data rate, network heterogeneity, and reli-
ability, while a general wireless communication system like WSN focuses more on power
conservation [23]. Also, both WBAN IoT and WSNs are differentiated in terms of the
employed sensor type and environment. For instance, WBAN IoT environment is typi-
cally highly dynamic in nature as the patient wearing a WBAN IoT is mobile, while a
WSN environment is typically static in nature since most of the application areas of a
WSN is stationary. These differences have orchestrated the need for different QoS con-
siderations in the MAC designs for both WBAN IoT and WSN.

4.2 General overview of MAC protocols in wireless communication systems

The MAC layer is an important building block in the wireless communication systems’
protocol stack model which comes immediately after the PHY layer. It is used to man-
age the allocation of the communication channel. For example, the MAC layer of the
WBAN-enabled IoT technology is responsible for managing and controlling the times
when a set of biosensor devices can access a shared communication channel for com-
munication purposes, and its channel resource allocation process may be optimized to
satisfy the stringent network QoS requirements of WBAN-enabled IoT technology in
terms of energy efficiency, throughput, fairness, and latency [11]. For this purpose, an
efficient MAC protocol for WBAN-enabled IoT technology should be aware of differ-
ent WBAN QoS requirements and capable of supporting various health data types, such
as an emergency health data, normal health data, continuous health data, periodic, and
bursty health data without compromising the QoS requirements of the application. Fur-
thermore, a good MAC protocol must be energy efficient because of the energy resource
scarceness issue related to wireless communication systems such as the WBAN-enabled
IoT technology. Note, the major energy wastage issues often experienced by the biosen-
sor devices when accessing the channel for communication purposes are collisions and
idle listening. Therefore, these issues must be addressed for a WBAN-enabled IoT tech-
nology to be energy efficient.
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 9 of 47

Additionally, due to the ad hoc means by which biosensor devices gain access to the
radio channel, there are two major problems they mostly experience that causes colli-
sions, latency, and channel under-utilization. The problems are the hidden-terminal
problem and exposed-terminal problem. A hidden-terminal problem is experienced
when two biosensor devices sense a channel to be free due to their inability to prop-
erly hear each other, unlike an AP which is fully aware of all the network devices, and
simultaneously transmit their individual sensory health data to an AP. This problem
often leads to collisions. To resolve this issue, a biosensor device needs to first accu-
rately listen to the communication channel to identify when it is in a busy or idle mode
before sending its health packet. An exposed-terminal problem occurs when a biosensor
device that wish to access the channel mistakenly sense that there is an ongoing trans-
mission and therefore denied an access to the channel or needlessly differs its transmis-
sion. The hidden-terminal problem wastes energy resources through collisions, while the
exposed-terminal problem causes delay, time-resource wastage, and inefficient channel
utilization or bandwidth resources under-utilization.
To deal with the various MAC layer related issues that may potentially waste the net-
work resources, insights into different MAC protocols are essential. Because of this, this
study classifies the existing MAC protocols into four major categories that include the
contention-free, contention-based, hybrid MAC, and the MAC protocols that are spe-
cific to WBANs in Fig. 2, and a general overview of these protocols and their suitability
for WBAN-enabled IoT technology are presented in this section since they are funda-
mental to developing new protocols.

4.2.1 Contention‑free MAC protocols

This section briefly presents the primary details about the contention-free MAC
protocols for insights into their operation. The contention-free MAC protocols are
regarded as schemes that could coordinate the communication between the biosensor
devices in the context of a WBAN-enabled IoT technology in a well-ordered manner.
In this category, the available communication channel is shared between several bio-
sensor devices using a scheduling method to circumvent collisions, and the biosensor
devices will not need to compete with one another before accessing a communication
channel [24]. With this type of schedule, the protocols attempt to minimize energy
utilization by organizing the biosensor devices in a common scheduling manner. This

Fig. 2 Classification of MAC schemes for the WBAN-enabled IoT technology

Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 10 of 47

help the protocols to clarify the biosensor devices that should access the communica-
tion channel at any period of time, thereby, avoiding unnecessary idle listening, over-
hearing, and collisions.
The contention-free schemes may be classified into two main groups, including the
fixed assignment and dynamic (or demand) protocols [24], and are discussed in the
subsequent subsections.

4.2.1.1 Fixed assignment protocols The protocols in this group divides the avail-
able resources among the biosensor devices in the context of a WBAN-enabled IoT
technology so that the assigned resources are in long term, i.e., the assignment is for
longer durations. An individual biosensor device exclusively utilizes its allocated radio
resources without having to compete with other biosensor devices. Examples of the
protocols in this category are the time-division multiple access (TDMA), frequency-
division multiple access (FDMA), and the code-division multiple access (CDMA). The
FDMA works by dividing radio spectrum into frequency sub-bands, while each fre-
quency sub-band is separated by a guard band to prevent interference among adjacent
channels, and allocated to each individual biosensor device in a WBAN-enabled IoT
technology. The allocated band is large enough to take in the signal spectral transmis-
sions to be broadcasted [24] and may enhance the throughput and latency perfor-
mance of a network. The spectral efficiency of the FDMA scheme can be determined
using (1) according to [28] as:

Cs Tc
ηs = ≤1 (1)
SB

where ηS is the spectral efficiency, Cs is the channel spacing, Tc represents the total num-
ber of the channels’ traffic, and Sn represents the bandwidth of the system.
Unfortunately, the FDMA protocol suffers from bandwidth wastage issue because of
the guard band provision and the capability of each biosensor device to have a dedicated
frequency band. Other potential issues include lack of support for biosensor devices
with heavy traffic, scalability concern, high-cost hardware implementation issue. Unlike
the FDMA, the TDMA protocol allows biosensor devices to share a single communica-
tion channel without any form of interference. It achieves this by dividing the communi-
cation channel into different time slots and allocate a particular time slot to an individual
biosensor device at a specific time. Consequently, each biosensor device transmission is
scheduled via a controller (such as a central AP) and their achieved in a round robin
scheduling manner. It is crucial to mention that the TDMA protocol can operate either
as a narrowband or a wideband TDMA system. In the narrowband TDMA, spectral effi-
ciency can be calculated in (2) given by [28] as:
  
(τ Ts ) UB UN
ηS = (2)
Tfr Sn

where τ is the time slot duration, Ts is the time slot number in a frame, Tfr is the frame
duration, UB denotes the user’s bandwidth in a given time slot, and UN denotes the num-
ber of users in the system sharing a time slot. While, the spectral efficiency of the wide-
band TDMA can be expressed in (3) as:
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 11 of 47

τ Ts
ηS = (3)
Tfr

This protocol requires a less energy since a biosensor device is only in an active state
when it is scheduled to send or receive a health packet, thus conserving its energy when
not in an active state. The biosensor devices in a TDMA system often remains in a sleep
mode when the slot is not active, thus circumventing the energy wastage issue related to
an idle state and overhearing [25]. Also, there are no collision and retransmission issues
in a TDMA protocol. As a consequence, a TDMA protocol supports energy efficiency
and can be applied to WBAN-enabled IoT technology. This protocol has been exploited
in WBAN systems, and some good examples are [26, 27]. In CDMA, multiple biosen-
sor devices can be enabled to transmit their health packets concurrently with a mini-
mal interference. This could be achieved by providing a unique code to each biosensor
device to separate their transmissions. Because of the CDMA transmission nature, it
employs a forward error correction (FEC) method to recuperate from any possible inter-
ference experienced between the biosensor at the receiver [28]. Some major issues with
CDMA are delay, interference, and channel allocation issue. Hence, this protocol may
be regarded as energy efficient and may not be a good candidate for WBAN-enabled
IoT technology. But then, the constraints of these protocols could be improved upon by
combining the protocols together.
Summary of the fixed assignment MAC protocols
Among the reviewed fixed assignment protocols, most research works have employed
the TDMA scheme compared to the CDMA and the FDMA schemes due to the poten-
tials of the schemes, i.e., CDMA and FDMA, to increase the energy requirement and the
implementation cost of the biosensor devices. Also, in general, the fixed assignment pro-
tocols are considered to be disadvantageous because of their inability to reassign slots
that belongs to one biosensor device to other biosensor devices if they are not needed
in each time frame. Another disadvantage of the fixed assignment protocol approaches
if considered for the WBAN-enabled IoT technology is that the generation of schedules
for the entire system may be a demanding task, and this could make schedules to require
constant modifications each time the traffic features in the network changes or network
topology changes. For the purpose of clarity, Table 2 presents a qualitative analysis of the
TDMA, FDMA, and CDMA protocols.

4.2.1.2 Demand/dynamic assignment protocols The protocols in this group exclusively

assigns the available resources including the radio channels to the biosensor devices
in a short-term form. Technically, the main aim of the demand assignment protocols

Table 2 Qualitative analysis of TDMA, FDMA, and CDMA protocols [25–28]

Parameters TDMA FDMA CDMA

Energy efficiency High Low Low

Latency Moderate Moderate Moderate
Throughput Moderate Low Moderate
Reliability High Moderate Moderate
Channel utilization Moderate Low High
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 12 of 47

is to enhance the utilization of the radio channel by assigning the channel to the com-
peting biosensor devices in an optimal or near-optimal manner. Compared to the fixed
assignment techniques that may exclusively allocate channel to the biosensor devices of
a WBAN-enabled IoT network in a pre-determined manner without considering their
communication requirements such as the size of the health packet. The demand assign-
ment techniques on the other hand disregard the biosensor devices that are in an idle
state and only put into consideration the biosensor devices that are prepared to transmit
their health packets. It is worthy of note to mention that in the existing literature the
dynamic assignment protocols proposed are mainly based on a TDMA approach and
mostly focus on adapting slots number or reallocation of slots based on the number of the
biosensor devices that are active as well as their traffic intensity [29].
The demand assignment schemes could be grouped into two main classes including
the distributed and the centralized schemes. In the centralized protocols, the biosensor
devices broadcast requests for the allocation of a bandwidth to a central device and the
request may be either accepted or rejected. However, depending on the protocol charac-
teristics, the necessity to request an access to the radio channel may cause a delay in the
transmission of the health packets. Moreover, a logical control medium apart from the
health packet channel may be needed by the competing biosensor devices to dynami-
cally request for an access to the radio channel. For the distributed protocols examples
are the token-passing and the reserved-based methods. In the token-passing protocols,
controllers are needed to pass a polling request to one another in a round-robin man-
ner through a special small frame known as a token. The token is rotated between the
biosensor devices and is arranged in a logical ring on the topmost part of a broadcast
channel. The controller is only allowed to send a health packet when it has a token. An
example of a WBAN system that adopted this protocol is [30] where the authors con-
sidered a token-based dynamic MAC protocol for a WBAN system. The reserved-based
method allows fixed time slots to be employed for a future access reservation to a radio
channel. For instance, a biosensor device may indicate its wish to send a health packet by
switching a reservation bit in a static location [21]. An example of a research wok on a
reservation-based dynamic method is [31].
Summary of the demand/dynamic assignment MAC protocols
The demand/dynamic assignment protocols are examples of the contention-free tech-
niques where the radio channel is assigned to a biosensor device on demand, unlike the
fixed assignment protocols that is on a fixed basis. The main aim of the demand assign-
ment protocol is to enhance the radio channel utilization through the assignment of the
radio channel capacity to competing biosensor devices in an optimal or near-optimal
manner. The protocols in this group technically uses a network control scheme to grant
the competing biosensor devices access to the radio channel. Moreover, a logical control
radio channel, apart from the health packet radio channel could be required by the com-
peting biosensor devices to request access to the radio channel.

4.2.2 Contention‑based MAC protocols

The contention-based MAC protocols are types of schemes that allows many biosensor
devices to contend with one another in an uncoordinated way to gain an access to a radio
channel. Unlike the contention-free protocols, they do not depend on a transmission
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 13 of 47

schedule, but rather employs some other methods, like the contention-based algorithms,
to resolve the contention issue that may potentially arise. The contention-based proto-
cols seem to be promising because of their advantages in contrast to the contention-free
protocols according to [32]. For instance, the contention-based techniques are flexible,
robust and simple, they do not require the channel state information to be shared, main-
tained, or saved, and therefore enables them to quickly adapt to the changes in the traf-
fic characteristics or the changes in a WBAN-enabled IoT network topologies, and also,
they do not require too much infrastructure support such as a clock for synchronization
purposes. However, the aforementioned advantages of the contention-based protocols
over the contention-free protocols typically come with a weakness at the expense of col-
lision due to the fact that a biosensor device may use a trial and error method for access-
ing the radio channel when attempting to send a health packet. The devices can also
experience an unfairness problem in channel access. The common examples of the pro-
tocols that falls under this category are referred to as the random access protocols such
as the CSMA and the ALOHA protocols.
The ALOHA was designed to typically allow each transmitter, i.e., biosensor device,
in a communication system, like WBAN-enabled IoT technology, to transmit its health
packet without controlling the transmission. It utilizes an acknowledgement or a
retransmission policy to handle a possible collision problem. This protocol has two var-
iants, namely the pure ALOHA protocol and the slotted ALOHA protocol. In a pure
ALOHA protocol, whenever a biosensor device has a new health packet to send, it sim-
ply transmits the health packet immediately. Afterward, a biosensor device finds out by
listening to the channel if the transmission was successfully received at the receiver, such
as an AP, or has experienced a collision. In order to detect if there is a collision or not,
the receiver will have to send an acknowledgement message for a successfully received
health packet, while the transmitter considers the absence of a non-acknowledgement
message as an indication that a collision has occurred. Considering a transmission sce-
nario, according to [33], packets can be generated using a Poisson distribution, the prob-
ability of the Poisson arrivals of the packets can be expressed in (4) as:

( × t)m × e−×t
Pm (t) = , m = 0, 1, 2, . . . (4)
m!

where m is the arrivals of packets generated in a finite time arrival interval t , and  is the
arrival rate. Additionally, the probability that a packet is successfully transmitted is the
probability that there are no extra packets transmission in the vulnerable time. A vul-
nerable time in pure ALOHA implies the time in which no transmission is expected to
occur so as to avert a collision. In pure ALOHA, a vulnerable time is expressed in (5) as:

VT = 2 × Tpk (5)

where VT is the vulnerable time and Tpk is packet transmission time. Since the probabil-
ity of a successful transmission would imply that there is no arrival of packets during the
vulnerable period, i.e., no occurrence of a collision, then the probability of a successful
packet ( Psuccess) transmission is defined in (6) as:
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 14 of 47

Psuccess = G × exp−2G (6)

where G is the offered traffic. If a collision eventually occurs, then the transmitter back-
off for some random period of time. The back-off time is regarded as the time required
for a transmitter involved in a collision to wait before trying to resend the health packet
again [33, 34]. Some issues associated with the pure ALOHA protocol are energy effi-
ciency, channel utilization, and throughput [35, 36].
To improve upon this protocol, a slotted ALOHA protocol was introduced in 1972
by Roberts [37]. Unlike the pure ALOHA protocol, the slotted ALOHA does not
allow the transmission of health packets whenever a biosensor device has a health
packet to transmit. Instead, a biosensor device that wants to transmit a health packet
has to wait till the beginning of a time slot. The available time resource is divided into
time slots, and each slot is sufficient enough to accommodate the maximum length
of a health packet. In addition, the biosensor devices are synchronized in such a way
that each biosensor device knows the beginning of the slots, such a synchronization
is achieved through an additional overhead. The possibility of a collision occurrence
may also be envisaged in the slotted ALOHA protocol when two biosensor devices
attempt to transmit their health packets at the start of a time slot [38, 39]. Also, the
vulnerable time is lowered by half compared to the pure ALOHA and is given in (7)
as:

VT = Tpk (7)

While, the probability of a successful packet transmission in slotted ALOHA is

expressed in (8) as:

Psuccess = G × exp−G (8)

The CSMA protocol utilizes a carrier sensing (CS) method for assigning an idle
channel to biosensor devices in a CSMA-based WBAN-enabled IoT technology
[40]. In this protocol, a biosensor device that wish to transmit senses the carrier, i.e.,
channel, to know if there is an ongoing transmission so as to minimize the issue of
collision. Therefore, vulnerable time in the CSMA protocol is equal to the propaga-
tion time. If the biosensor device found the channel to be busy, it will either wait or
reschedule its health packet transfer process based on an amount of period that is
determined by the used algorithm [41]. But then, if the channel is found idle, the bio-
sensor device starts its transmission immediately. This protocol typically suffers from
two major problems, including the hidden-terminal and exposed-terminal problems.
These problems are promoters of collisions, time-resource wastage, and inefficient
channel utilization.
Currently, there are different variants of the CSMA scheme available in literature to
provide possible solutions in a situation where a transmission channel is found busy,
and the examples of such variants are the non-persistent CSMA, the 1-persistent
CSMA, and the p-persistent CSMA [41–43]. Considering a transmission scenario,
according to [41–43], the throughput efficiency of a non-persistent and a 1-persistent
CSMA can be calculated using (9) and (10) respectively as:
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 15 of 47

G exp−aG
S= (9)
G(1 + 2a) + exp−aG

Gexp−G x(1 + G)
S= (10)
G + exp−G

where G is the packet load and a is the propagation normalized delay.

Because of the collision concern related to the CSMA protocol, the evolution of a
CSMA protocol with a collision avoidance (CA), i.e., CSMA/CA, is a promising proto-
col [44]. In a CSMA/CA protocol, a biosensor device that is ready to transmit its health
packets first listens to the radio channel to ensure it is free before transmission would
take place. If the radio channel is found idle, the health packet would be transmitted, else
the biosensor device will back-off for a random period of time and later listens again to
know if the channel is idle. Note, depending on the back-off algorithm employed, if the
channel is free when back-off counter gets to zero (i.e., 0), then the biosensor sends its
health packets, but if the channel is busy when the back-off counter gets to 0, then the
back-off is reset again and this process is repeated continuously until the channel is free
[45]. It is noteworthy to mention that the CSMA/CA protocol prevents a collision from
happening before transmission by first sending a request to send (RTS) message to the
AP, and the AP responds back with a clear to send (CTS) message. Afterward, health
packet transmission can commence, and if an acknowledgment message is not received
from the AP after transmission, the biosensor device assumes the occurrence of a col-
lision and try to resend the health packet again until an acknowledgement message is
received [44].
Summary of the contention-based MAC protocols for WBAN-enabled IoT
In practice, the slotted ALOHA protocol has been established to have a maximum
throughput efficiency of about 37% compared to the pure ALOHA protocol which has
a maximum throughput efficiency of about 18% when G = 1, and is also energy efficient
[39]. Consequently, the slotted ALOHA protocol is envisaged to be a promising candi-
date that can be explored as an energy efficient MAC protocol in WBAN-enabled IoT
technology. However, the exploitation of this protocol requires a careful design due to
the inherent collision issue related to the protocol. While, the 1-persistent CSMA has
a maximum throughput efficiency of about 50% and the non-persistent CSMA has a
maximum throughput efficiency of about 90% when G = 1 [44]. As a consequence, the
CSMA protocols are more promising for a potential utilization in WBAN-enabled IoT
technology compared to the ALOHA protocols. However, because of the contending
nature of these protocols for channel utilization, they typically suffer from latency, reli-
ability, and energy efficiency issues. These concerns make them to be disadvantageous in
WBAN-enabled IoT technology, but then, their shortcomings can be carefully optimized
to make them productive. For the purpose of clarity, a qualitative analysis of the pure
ALOHA, slotted ALOHA, and the CSMA protocols are presented in Table 3.
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 16 of 47

Table 3 Qualitative analysis of pure ALOHA, slotted ALOHA, and CSMA protocols [39–45]
Parameters Pure ALOHA Slotted ALOHA CSMA (1-persistent
& non-persistent)

Energy efficiency Moderate High Low

Latency Moderate Moderate High at light loads
Throughput Low Moderate High
Reliability Low Moderate Moderate
Channel utilization High Moderate Moderate

4.2.3 Hybrid MAC protocols

Hybrid MAC protocols are formed as a result of combining or mixing the contention-
free MAC protocols and the contention-based MAC protocols together. The conten-
tion-based protocols have the ability to adapt to changing network easily and they are
also suitable for low load networks compared to the contention-free protocols, while
the contention-free protocols are slightly suitable in terms of channel utilization at high
loads. For this reason, harnessing the benefits of these two classes of protocols so as to
off-set their limitations is important [46]. As a consequence, hybrid MAC protocols are
potential methods for developing efficient MAC protocols for WBAN-enabled IoT tech-
nology. The idea of mixing protocols together has been explored and applied to WBANs
in literature, good examples are [4, 47, 48]. In [4], a hybrid MAC protocol was pro-
posed by mixing the CSMA/CA and the TDMA protocols (i.e., CSMA/CA-TDMA) to
improve the energy efficiency of WBAN biosensor devices as well as extend their lifes-
pan. For the purpose of evaluation, the protocol was compared with the Quasi-Sleep-
Preempt-Supported (QS-PS) and the channel-aware polling-based MAC protocols using
9 biosensors, a guard time interval of 0.00003 s, a transmission rate of 5 Mbps, and a
transmission probability of 0.8. The result of the simulation is presented in Fig. 3.
From Fig. 3, we noticed that the more the biosensors in the network were increased
from 3, 5, 7 to 9 biosensors, the more the energy consumed for the three MAC proto-
cols. However, the CSMA/CA-TDMA protocol was observed to be more energy efficient
compared to the other protocols. For example, when the network was simulated with
5 transmitting biosensors, the energy consumed using the CSMA/CA-TDMA proto-
col was about 236 mJ, while about 259 mJ and 245 mJ energy were consumed using the
QS-PS and the CPMAC protocols, respectively. This implies that the CSMA/CA-TDMA
was able to achieve about 15% energy reduction than the QS-PS and about 10% energy
reduction than the CPMAC. These improvements could be attributed to the hybrid
method employed, i.e., combining the advantages of the CSMA/CA and the TDMA
protocol as well as the division of the biosensors into different states, for instance, the
awaiting orders state. In addition, a significant amount of energy was saved by allocating
most of the overhead transmission at the personal station. However, the scalability of
the system still remains a concern. The authors of [47] presented a hybrid multi-channel
MAC (HMC-MAC) protocol for WBANs by mixing the CSMA/CA and TDMA pro-
tocols to mitigate the likelihood of inter-WBAN interference, i.e., collisions. The pro-
posed protocol enabled multiple transmissions concurrently on different radio channels
which resulted to a high throughput with a low energy consumption as well as a reduced
collision occurence with the help of a channel selection scheme. For the purpose of
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 17 of 47

Fig. 3 Energy versus number of biosensors

performance comparison in terms of energy efficiency, the HMC-MAC was compared

with a traditional multi-channel MAC protocol (MC-MAC) using a total number of 10
biosensors that are classified into high priority (HP) and low priority (LP) per WBAN
with an arrival rate of 10 packets/secs and a data rate of 250kbps. The outcome of the
simulation is presented in Fig. 4.
We realized from Fig. 4 that the HMC-MAC protocol is advantageous in the context of
energy savings. For example, when 3 WBAN systems were considered, we noticed that the
HMC-MAC with HP has a total energy consumption of about 10 J, while the MC-MAC
with HP has about 60 J and the HMC-MAC with LP has a total energy consumption of
about 150 J, while the MC-MAC with LP has 200 J. This is indicative that the HMC-MAC
with HP was able to achieve a 25% reduction in energy consumption than the MC-MAC
with HP. This improvement was as a result of the channel selection algorithm that was
introduced to prevent the occurrence of collisions among neighboring WBANs, thereby
improved energy efficiency. Also, the authors of [48] considered a hybrid MAC protocol
for WBANs by combining the CSMA/CA and TDMA protocols to mitigate collisions
issue. The proposed protocol enabled multiple transmissions concurrently on different
radio channels which resulted to a high throughput as well as a reduced collision with the
help of a channel selection scheme.
However, in the literature, it is vital to note that there are some limitations that could
be attributed to a hybrid MAC protocol, for instance the scalability issue and message
control overhead concern. A hybrid MAC protocol scalability issue can be improved
by exploiting a hybrid protocol based on the CDMA or FDMA protocol, but then, the
major limitation of the FDMA is the expensive hardware as well as that of the CDMA
in terms of complex operations. Also, power control requirement is another limitation
of these protocols. Thus, in the context of WBAN-enabled IoT technology, the TDMA
based hybrid MAC protocols have promising potentials compared to that of the FDMA
and CDMA protocols. Because of this, a work carried out in [49] combines the TDMA
and FDMA protocols to offer two channels when transferring packets from the devices
to an AP. The combination of the TDMA and FDMA protocols was used to minimize
energy utilization with a collision-free packet transmission.
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 18 of 47

Fig. 4 Total energy consumption

4.2.4 WBAN‑specific MAC protocols

The MAC protocols that falls under this category are designed to address the specific
requirements of the WBAN communication systems. At present, there are a number
of MAC protocols proposed in literature for WBANs, for insights into these protocols,
this study has considered some of the state-of-the-art MAC protocols that specifically
targets WBANs. Examples are the BodyMAC protocol, the Heartbeat-driven MAC pro-
tocol, the Medical MAC (MedMAC) protocol, the battery-aware TDMA protocol, the
priority-guaranteed MAC protocol, and so on. Also, this study covers the advantages
and disadvantages of these prominent MAC protocols, as well the protocols are dis-
cussed with focus on how to address energy inefficiency that could be caused by issues
like idle listening, collision, and packet overhead. All these are considered in the subse-
quent subsections.

4.2.4.1 BodyMAC protocol The BodyMAC protocol is one of the prominent protocols
that have been specifically designed for WBAN use cases [50], and is based on a TDMA
approach. The BodyMAC protocol has its channel bounded by the superframe structure
of the TDMA with UL and DL sub-frames. The essence of this protocol is to optimize the
power consumption of WBANs. Because of this, the BodyMAC protocol provides a flex-
ible bandwidth allotment to enhance energy efficiency through the reduction of packet
collisions, transmission time, packet overhead, as well as the reduction of idle listening.
This protocol works in a way that the biosensor devices go into a sleep mode when not
active, i.e., when they have no data to transmit, and this help to conserve the battery
power resource.
Note, the MAC frame structure of the BodyMAC is divided into three segments,
namely the beacon, DL, and the UL. The beacon period is responsible for the MAC
layer synchronization and also describes the MAC frame structure. The DL segment
is reserved for communication from the AP to the biosensor devices to accommodate
on-demand traffic. The UL segment is used for the communication from the biosen-
sor devices to the AP. It has two phases that include the contention access phase (CAP)
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 19 of 47

which employs the CSMA/CA scheme and the contention-free phase (CFP) as shown in
Fig. 5 [50].
In the CAP process, the biosensor devices contend for the transmission of control
packets to the AP for guaranteed time slots (GTS), and in the CFP process, the AP is
responsible for controlling the allocation of the GST to the biosensor devices in order to
prevent a collision occurrence. It is important to mention that the communication in the
CFP is helpful in improving energy efficiency. But then, for the UL segment in the CAP,
the CSMA/CA protocol employed results to a high energy consumption because of the
collision issue and the clear channel assessment (CCA). Also note that the MAC layer
synchronization mode of this protocol is energy expensive as a significant amount of
energy is expended for the exchange of beacon signals [13].
For performance evaluation purposes, simulation investigations were performed on
the BodyMAC protocol, the IEEE 802.15.4 MAC protocol, and the CSMA/CA protocol
with 24 biosensors and a data rate of 8 kbps in the context of energy conservation and
the obtained simulation results are presented in Fig. 6 [50].
From Fig. 6, we could deduce that the BodyMAC has a less energy consumption
level when compared with the CSMA/CA and the IEEE 802.15.4 MAC protocols. For
instance, when time was set to 16 s, the energy consumed by each biosensor was about
0.5 J, 0.17 J, and 0.14 J when the CSMA/CA, IEEE 802.15.4, and BodyMAC protocols
were applied, respectively. This reveals that the BodyMAC protocol is advantageous
in terms of energy savings and has performance gains of about 36% and 18% over the
CSMA/CA and the IEEE 802.15.4 MAC protocols respectively. These improvements are
due to the exploitation of a sleep mode mechanism which helped the biosensors to be
in an active mode only when they have packets to send unlike the CSMA/CA protocol
where the biosensors will have to be in an idle mode before they can send their packets,
while the IEEE 802.15.4 MAC employed the GTS which may waste the energy of the bio-
sensors when they are inactive. But then, packet collision issue still remains a concern.

4.2.4.2 Heartbeat‑driven protocol The heartbeat-driven protocol is another important

protocol that was developed for WBAN applications to improve energy efficiency in [51].
The heartbeat-driven protocol is also based on a TDMA protocol and was designed for
WBANs to use the heartbeat rhythm information to perform synchronization instead
of a beacon. Heartbeat rhythms are natural phenomenon in the body of every human
being and is observable in different bio-signals. It allocates dedicated slots time to each
individual biosensor device in order to guarantee a collision-free data transmission. It is
worthy of note to mention that the heartbeat-driven protocol is aimed at improving the

Fig. 5 A typical BodyMAC frame structure

Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 20 of 47

energy efficiency of the biosensor devices by avoiding the need for a periodic synchro-
nization. The consequence of this is that, time synchronization can be achieved through
the heartbeat rhythm without turning on their radios for the reception of periodic timing
messages from a centralized controller so that the time synchronization energy cost can
be eliminated as well as prolong the network lifespan. The protocol proposed in [51] for
body sensor networks use a synchronization recovery policy with two resynchronization
methods. The simulation results of [51] revealed that the heartbeat MAC protocol has
the potential of prolonging the network lifetime. However, this solution has a high energy
consumption and high delay rate problems which could make it unsuitable in emergency
conditions [13].

4.2.4.3 MedMAC protocol In literature, a MedMAC protocol has been proposed for
WBANs to reduce energy consumption and improve the channel access method [52].
The MedMAC adopts a TDMA scheme for allocating time slots for transmission to the
biosensor devices. The allocated time slots vary in length and also based on the biosen-
sor devices requirements. As shown in Fig. 7, the MedMAC protocol employed a multi-
superframe structure that uses beacons for synchronization purposes [52].
Additionally, for communication with low data, network initialization, and emer-
gency traffic, an optimum contention period is used. Also, the MedMAC employed a
unique GST for each biosensor device to prevent a collision occurrence. The MedMAC
was compared with the IEEE 802.15.4 MAC in [52] to investigate its energy consump-
tion performance. To this end, simulations were carried out by grouping the biosensor
devices into class 0 and class 1 applications. The biosensor devices in class 0 contains
3 devices and are used for monitoring health/fitness, including temperature, pulse, and
respiration. While, an EEG system with 24 biosensors was considered in class 1 with a
latency of < 250 ms and a bit rate of 250kbps. Figure 8 shows the simulation results of the
energy consumed by the 24 EEG biosensors.
We noticed from Fig. 8 that as the number of the biosensors increases the energy
consumed by each of the biosensors also increase when the IEEE 802.15.4 MAC
protocol was applied, but when the MedMAC protocol was applied there was no

Fig. 6 Energy consumption versus time

Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 21 of 47

variation in the energy consumed by each of the biosensors as they increase. For
example, when there are 4, 8, and 12 biosensors in the EEG system the average energy
consumption using the IEEE 802.15.4 was around 5 mW, 9 mW, and 13 mW respec-
tively, while that of the MedMAC was about 0.1 mW and did not vary as the num-
ber of the biosensor increases. This indicates that the MedMAC was able to achieve
about 10% energy consumption reduction than the IEEE 802.15.4. This improve-
ment was due to the dedicated time-slot that was allocated to each of the biosen-
sors for transmission and this helped to prevent collisions occurrence unlike the IEEE
802.15.4 MAC that employed the CSMA/CA protocol to reduce the number of colli-
sions. But then, collisions may be experienced in the retransmission of the packets by
the biosensors in a CSMA/CA network, resulting into energy wastage. On the other
hand, the MedMAC only provide support for a low data traffic and this could make
it unsuitable for modern WBANs especially for the implantable and wearable sensors
which requires a high data rate.

4.2.4.4 Battery‑aware TDMA protocol A battery-aware TDMA protocol is another

protocol designed to improve the WBAN’s network lifetime by employing a cross-layer
method [53]. This protocol operates like the IEEE 802.15.4 beacon mode where the
biosensor devices have to periodically listen to the beacons from the AP, i.e., the coor-
dinator. The design of this protocol incorporates several factors, including the battery
electrochemical properties, the packet queuing features, and the time-varying wireless
fading channel. This protocol exploits the time-axis region to partition its operation
processes into three parts, namely the inactive period, active slot time, and the bea-
con slot [53]. In order to support the various WBAN application requirements, the
frame length is adaptive and could be changed. At the beginning of the beacon phase,
a periodic wakeup scheme was introduced to prevent the biosensor devices from an
unnecessary idle listening. In addition, a dedicated slot time Ts is allocated to each bio-
sensor device for data transmission in the active phase after it receives a beacon. For
the inactive phase, the biosensor devices go into a sleep mode in order to save energy.
The battery-aware TDMA protocol prolongs the lifespan of the biosensor devices and
the GTS allocated to each biosensor device enhances packet delivery in a timely man-
ner and improves reliability. The limitations of this solution include the inability to
hold or retain packets in the buffer for long which could result to a high rate of packet

Fig. 7 A multi-superframe structure for medical MAC protocol

Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 22 of 47

Fig. 8 Average energy consumption versus number of biosensors

drop and a high delay rate. Also, it lacks support for mechanisms that accommodates
any emergency data [13].

4.2.4.5 Priority‑guaranteed MAC protocol Note, a superframe structure performs a

major role in the development of a MAC protocol. As a consequence, the priority-guar-
anteed protocol employed a new superframe structure. Here, the time-axis is composed
of the inactive and the active phases. The active phase is divided into five sections in
order to accommodate different types of data flow that include a control-channel AC1, a
control-channel AC2, a beacon, a time slot reserved for bursty traffic (TSRB), and a time
slot for periodic traffic (TSRP). The AC1 as well as the AC2 are used for the UL control
of processes, for instance, the control of life-threating medical applications by AC1, and
the consumer electronics by AC2. It is important to emphasize that the AC1 and AC2
uses the randomized ALOHA for the TSRB and TSRP processes as shown in Fig. 9 [54].
The TSRB and TSRP are the two reserved time slots for bursty and periodic data
respectively. Beacon is used for the biosensor devices synchronization. In addition, the
priority-guaranteed protocol is a TDMA based scheme which assigns the GTS to the
biosensor devices for the communication of data within the TSRB and TSRP.
The priority-guaranteed MAC in [54] was proposed to meet different service require-
ments such as energy efficiency, network reliability, and low latency access for medical
applications as well as cater for the high data rate service requirement for the non-medi-
cal (consumer electronics) applications in a WBAN system. The performance of the pro-
tocol was studied by comparing it with the IEEE 802.15.4 protocol in terms of energy
efficiency. Simulation parameters such as a physical data rate of 250 kbps, a frame length
of 61.44 ms, and a traffic arrival rate () of 1 and 20 were assumed. For a detailed com-
parison, two performance measures such as the average energy consumption per kb and
the mean node energy consumption were used to evaluate the protocols. The simulation
results obtained are shown in Figs. 10 and 11.
From Figs. 10 and 11, we observed that the priority-guaranteed protocol is advanta-
geous in the context of energy savings than the IEEE802.15.4 protocol when compared
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 23 of 47

using the same traffic arrival rate. For instance, in Fig. 10, when there are 12 nodes in
the system and setting  = 1 and 20, we noticed that the average energy consumed
per kb is about 0.80 µJ and 0.39 µJ respectively when the IEEE 802.15.4 protocol was
applied, while that of the priority-guaranteed protocol has an average energy consump-
tion of about 0.76 µJ and 0.25 µJ, respectively. This implies that the energy consumed by
the nodes was saved by approximately 16% and 50% under low and heavy traffic load,
respectively, using the priority-guaranteed protocol. Also, from Fig. 11, we observed that
the priority-guaranteed protocol was able to save up to about 10% and 20% energy under
low and heavy traffic load respectively due to the exploitation of the data channel and
the control channel separation, which helped the data channel to be free from collision
occurrence. However, there are some drawbacks that could be attributed to this proto-
col, for instance, the complexity of its superframe structure and the inability to adapt to
emergency traffic.
Summary of the WBAN-specific MAC protocols
This section compares the WBAN-specific MAC protocols in Table 4 based on some
critical requirements of WBAN-enabled IoT technology using qualitative analysis.

5 Overview of short‑ and long‑range MAC protocols for WBAN‑enabled IoT

technology
5.1 Short‑range technologies and standards
The short-range MAC protocols of the short-range standards provide a channel access
to various network elements, like the biosensor devices, deployed in a body area for
communication purposes at the MAC layer over a short distance. The energy spent by
the biosensor devices during the channel access process is a major source of energy
consumption apart from the energy consumed by the radio transmitter of a biosensor
device. Consequently, insight into different short-range MAC protocols, such as IEEE
802.15.4, IEEE 802.15.6, Bluetooth, Wi-Fi, and ETSI SmartBAN, their underlying energy
wastage issues, like idle listening and collisions, and their energy consumption require-
ment and/or power saving mechanisms, like power control and sleep scheduling, is
essential since these factors may impact the performance of a WBAN-enabled IoT tech-
nology in terms of energy efficiency, throughput, latency, channel utilization efficiency,
and reliability.

Fig. 9 A priority-guaranteed MAC superframe structure

Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 24 of 47

Fig. 10 Average energy consumed versus number of nodes

Fig. 11 Mean node energy consumption against the number of nodes

5.1.1 IEEE 802.15.4 standard

The IEEE 802.15.4 standard is a complement of the IEEE 802 wireless specifications.
It is also described as a low-rate wireless personal area network (LR-WPAN) protocol
that operates either on the 2.4 GHz, 915 MHz, or the 868 MHz frequency bands. The
main aim of the IEEE 802.15.4 short-range protocol is to provide a low power, low cost,
and low packet rate. It also provides support for the wireless connectivity of different
types of applications such as medical applications, that include the pervasive and ubiq-
uitous healthcare monitoring systems, home and industrial applications. It is a stand-
ard adopted by the ZigBee Alliance and 6LoWPAN for WPAN compliant systems, and
defines the PHY and MAC protocol layers for IEEE 802.15.4 systems. The PHY layer
defines the network interface parameters, components, as well as their operations. In
order to support the MAC layer operations, the PHY layer incorporates several fea-
tures that can help in energy saving, these include the link quality indicator (LQI), CCA,
and receiver energy detection (RED) techniques [55]. Being a short-range standard, an
IEEE 802.15.4-enabled biosensor device can achieve about 100 m communication cov-
erage based on the PHY protocol layer specification and the spectrum employed for
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 25 of 47

a geographical area [56]. The MAC protocol layer is responsible for handling network
association, disassociation, and controls access to the radio channel that can be realized
by two different methods of operation which include the non-beacon and the beacon
modes. The non-beacon mode of IEEE 802.15.4 MAC requires the exploitation of the
unslotted CSMA/CA technique to perform all transmissions. While, the beacon mode
of IEEE 802.15.4 MAC employs the slotted CSMA/CA technique with a superframe
structure. [57, 58]. The superframe structure contains both active and inactive parts. The
active part include the CAP, beacon period, and CFP. The inactive part is employed to
put the biosensor devices in a sleep state. In the CAP of the active part, the biosensor
devices contend for transmission chance on the slotted CSMA/CA protocol. The beacon
period is employed to periodically send beacon/control packets by the AP to the bio-
sensor devices for superframe and synchronization definition. The CFP is used by the
biosensor devices to request for guarantee time slots (GTSs) for applications that are
time-critical. According to [59, 60], the power consumption of the IEEE 802.15.4 stand-
ard is typically ≤ 50 mW. The usage of this standard has been explored and applied to
WBANs, and a good example is [61]. The authors of [61] considered the extension of
the function of the IEEE 802.15.4 standard superframe structure for WBANs to cater
for emergency slot and polling access periods. Also, in the proposed solution, a two-hop
network was configured to accommodate different kinds of devices putting into consid-
eration the in-body and the on-body communication situations. However, the limitation
of this standard could be attributed to its inability to cater for a time-sensitive communi-
cation since it operates in the CSMA/CA access mode which waste energy due to issues
like idle listening and collisions These issues may make a biosensor device to spend
excess energy than what is required for data packets. Another limitation is it inability
to provide a full support for the WBAN-enabled IoT QoS requirements [62]. In order to
address these limitations, a few number of protocols have recently been proposed in the
literature which are not IEEE 802.15.4 based.

5.1.2 IEEE 802.15.6 standard

The IEEE 802.15.6 standard describes a MAC layer which provides support for different
PHY layers, like the ultra-wideband (UWB), human body communication (HBC), and
the narrowband (NB) layers. The UWB is employed to operate in two different frequency
bands that include a low and a high band. The low band is made up of three channels

Table 4 Qualitative analysis of WBAN-specific MAC protocols [10, 13]

MAC protocols Energy efficiency Latency Throughput Channel Reliability Priority access
utilization
efficiency

BodyMAC Moderate Moderate Moderate High Low Low

Heartbeat driven Moderate High Moderate Moderate Moderate Low
MedMAC Moderate High Low Moderate Low Moderate
Battery-aware High High Moderate Moderate Moderate Low
TDMA
Priority-guaran‑ High Moderate Moderate Moderate Moderate Moderate
teed
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 26 of 47

with a mandatory channel of 7 [63]. The NB controls data communication over a net-
work as well as the activation and deactivation of a WBAN radio transceiver, and is also
responsible for clearing channel assessment. The HBC make use of the body as a com-
munication medium for transmitting electrical signals, and also utilizes and/or support a
frequency band that ranges from 5 to 50 MHz. The IEEE 802.15.6 is regarded as the first
international WBAN standard [64]. In the IEEE 802.15.6, the biosensor devices may be
classified into one hop which support a star topology or two-hop that support a mesh
topology [65]. The operation of a WBAN that is controlled by a hub or a single coordina-
tor must have a hub and many biosensor devices that ranges from 0 to nMaxWBANSize,
where nMaxWBANSize stands for the maximum WBAN biosensor devices. While, in a
two-hop WBAN, a relay-capable biosensor device can be employed to exchange packet
frames between a biosensor device and the hub. Additionally, the IEEE 802.15.6 stand-
ard separate the channel or time axis into superframes or a beacon period of the same
length. Each individual superframe is composed of a number of assigned slots that are
exploited for packet transmission.
Moreover, the IEEE 802.15.6 standard employs three communication modes that
include a beacon mode with a superframe structure, a non-beacon mode with a super-
frame structure, and a non-beacon mode without a superframe structure [66]. Also, the
IEEE 802.15.6 standard supports three types of access schemes, such as a random access
scheme, unscheduled and improvised access scheme (contention-less access), and sched-
uled-polling access scheme (contention-based and contention-free access) [67]. In the
random access scheme, depending on the PHY layer, a hub may exploit either a CSMA/
CA or a slotted ALOHA protocol [68]. The hub consider the CSMA/CA protocol for NB
PHY layer and a slotted ALOHA protocol is considered for the UWB PHY layer. In the
improvised and the unscheduled access scheme, the hub can employ a make-up access
to transfer post or poll command without pre-reservation or a prior notification in the
non-beacon with superframe structure or the beacon mode [69]. The scheduled access
scheme is exploited to achieve a scheduled bi-link, DL, and UL allocations and a sched-
uled polling access scheme is utilized for the posted and polled allocation. A compari-
son and analysis of the IEEE 802.15.6 as well as the IEEE 802.15.4 MAC layer standards
were carried out in [70]. Another work is [71] where authors proposed an architecture
that uses the IEEE 802.15.6 standard, sensor nodes were attached to the body of differ-
ent workers in an underground scenario to measure temperature, humidity, gas concen-
tration air flow, and so on. The performance of the system proposed was evaluated in
the context of energy consumption, throughput, and delay. Their analysis revealed that
the standard is a reliable communication network that can help to achieve a reliable and
reasonable quality of service in tunnels and underground environments. However, the
standard does not cater for QoS priority architecture which can accommodate all kinds
of traffic at the biosensor device side, like the normal and emergency traffic, and at the
coordinator side, like the on-demand and normal traffic. Also, since it employs either a
CSMA/CA or a slotted ALOHA protocol, energy wastage may be experienced due to
potential collisions and idle listening issues. To address these, authors of [72] proposed
a transmit energy control mechanism that can adapt to body channel variations, enables
constant energy conservation, and prolong the biosensor devices battery lifespan. Note,
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 27 of 47

the power transmission requirement of the IEEE 802.15.6 standard is approximately 1

mW at a distance of 1 m [60, 73].

5.1.3 Bluetooth/IEEE 802.15.1
The Bluetooth technology is defined as a WPAN IEEE 802.15.1 standard whose main
objective is to allow wireless communications between a number of biosensor devices
over a short range. The primary medium access control scheme in the Bluetooth tech-
nology is a centralized TDMA based scheme [74]. The Bluetooth technology consists
of a baseband layer that carries out the Bluetooth’s PHY as well as the Bluetooth’s MAC
processing [16]. The baseband layer as defined by Bluetooth operates on an unlicensed
Industrial Scientific and Medical (ISM) frequency band of 2.4 GHz. Additionally, the
Bluetooth PHY layer transmission method is based on a frequency hopping spread spec-
trum (FHSS). Typically, there are 79 radio frequency channels with 1 MHz spacing, how-
ever some countries allow the use of 23 channels only.
It is important to mention that the communication in a Bluetooth network is based
on a master-to-slave approach where a set of biosensor devices that shares a common
communication medium is called a piconet. Each of the piconet is composed of a master
biosensor device which helps to control the access to the radio channel and a maximum
of seven slaves’ biosensor devices. While a group of piconets forms a scatternet [75].
Moreover, gaining access to the radio channel is controlled through the use of a slotted
time-division duplex (TDD) technique in such a way that the master biosensor device
employs a polling protocol to assign time slots to the slave biosensor devices [76]. The
exploitation of this standard in WBAN has been considered in literature, for instance
[77], where an investigation on the usage of Bluetooth for an on-body transmission was
considered.
For the purpose of energy consumption optimization, the Bluetooth defines four dif-
ferent operational states, including the active state, hold state, sniff state, and park state
[24]. The active state allows the master to schedule the health packet transmission based
on the traffic demands of different slaves. The sniff state aims to minimize the duty cycle
of a slave biosensor device sensing activity. The hold state allows a slave biosensor device
to go into a sleep mode for a particular time, i.e., the hold time, and when this time
expires, the slave biosensor device can then return to an active state. Likewise, the slave
biosensor device remains in the sleep mode for an indefinite time in the park state, while
the master biosensor device wakes the slave for it to enter into the active state. The Blue-
tooth technology has a transmission power that ranges from -20 dBm to 20 dBm, i.e.,
0.01 mW to 100 mW, and a receiver sensitivity of about -70 dBm to -82 dBm depending
on the physical layer employed [78]. Additionally, the Bluetooth technology was devel-
oped to provide a low operational cost, low latency, and a high data rate transmission.
Due to the mentioned characteristics, the Bluetooth technology could be employed in
a WBAN-enabled IoT technology that requires a high data transmission, but then, this
may incur a high energy dissipation cost [79]. Also, since Bluetooth is based on a TDMA
scheme, then more energy is required for synchronization. Other limitations of the clas-
sic Bluetooth include inadequate standby modes, limited connecting devices, and a slow
start-up time. These drawbacks resulted to a new version of the Bluetooth technology
which is referred to as the Bluetooth low energy (BLE) or Bluetooth 4.0. The BLE was
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 28 of 47

proposed by the Bluetooth Special Interest Group (BSIG) and this group was responsible
for the development of the Bluetooth technologies as well as the design of its technical
specifications. The BLE technology is mostly employed in devices that only transmits
data in a periodic manner and this technically makes it to go to sleep when inactive,
that is, when there are no data to transmit. Furthermore, the BLE may achieve energy
efficiency by employing low energy chipsets. These chipsets help to realize an ultra-low-
power utilization at different operation modes, including the transmit, receive, as well as
the idle modes. It also integrates energy saving mechanism, including adaptive and low
duty cycling methods.

5.1.4 Wireless Fidelity (Wi‑Fi)/IEEE 802.11

The evolution of the IEEE 802.11 standards, i.e., the IEEE 802.11 a/b/g/n/ah is merged
together to form the Wi-Fi technology. This technology was designed to cater for
the applications that demand high data transmission rate. Wi-Fi complaint devices
could operate on the unlicensed ISM frequency bands of 5 and 2.4 GHz at a high data
transmission rate that spans between 11—54 Mbps. The high data rate transmission
of a Wi-Fi technology could be attributed to its ability to utilize various efficient cod-
ing techniques. It also has the ability to cover a communication range of more than
100 m. Note that, this technology is an internet-enabled solution which could be used
to provide an internet connectivity in WBANs. Wi-Fi is also considered advantageous
over other communication technologies in the short communication range category
in terms of high speed and high data transmission rate [80]. It is worth noting that
the CSMA/CA protocol is mostly employed as the channel access mechanism in the
IEEE 802.11 standard [81]. Similarly, the IEEE 802.11 comprises of two channel access
methods that include the distributed coordinator function (DCF) and the point coor-
dinator function (PCF). The DCF is a fully distributed protocol, while the PCF is a
centralized protocol [82]. The DCF access the channel through the CSMA protocol
with an immediate MAC level acknowledgment and employs an RTS or CTS optional
exchange method. To improve the efficiency of this protocol in WBANs context, a
research work was carried out in [83] to improve the power saving technique of the
DCF IEEE 802.11 in order to enhance its energy efficiency. In the PCF, an AP pro-
vides a distributed access, which contains a contention period and contention-free
period access, to the channel using a polling method [84]. It is worthy of note that
Wi-Fi could either be in a doze mode or wake-up mode. In the doze mode, the bio-
sensor devices cannot transmit or receive any data. The doze mode is technically use
for power consumption optimization. Similarly, the Wi-Fi technology can support
two major power management mechanisms, including the power save (PS) and active
mode (AM) [85, 86]. However, since the IEEE 802.11 standard uses the CSMA/CA
based protocols, then, its ability to fully satisfy the WBAN-enabled IoT QoS require-
ments remain an issue since the protocol cannot easily scale as the size of the network
devices is increased. Another concern is energy wastage due to control overhead
packets, idle listening, and collisions. The power consumption of Wi-Fi standard is
typically around 800 mW [60].
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 29 of 47

The exploitation of this standard has been considered in a WBAN context, an exam-
ple is [87]. The authors of [87] proposed a scheme for a mobile Wi-Fi to enable the
connectivity of a WBAN system.

5.1.5 ETSI SmartBAN
A technical committee was established by the European Telecommunications Stand-
ards Institute (ESTI) in March 2013 to propose a smart body area network (SmartBAN)
standard defined as the ETSI SmartBAN. This standard could be regarded as a simple,
low-power communication, and low complexity system, which enables a wireless con-
nection between biosensor devices and a hub. It exploits a multiple-radio technique to
connect biosensor devices by exploiting the existing radio standards, and operates on
the frequency band of 2.48 GHz. The aim of the SmartBAN is to define an European
standard for BAN with focus on some applications, like health care, leisure, sports, well-
ness, and so on. The main features of this protocol include the ability to access a chan-
nel with ease, data transfer reliability, minimal listening period, and ability to provide an
additional control message for biosensor devices with low duty cycle [88]. Also, there
is a provision for a multi-user channel access (MCA) mode which enables a high prior-
ity message transmission, for example, the emergency packets. Furthermore, the MCA
helps to achieve a low latency for time-sensitive use cases. On the contrary, the afore-
mentioned features are only specific to SmartBAN, and therefore could not provide
support to other WBAN standards, for example, the IEEE 802.15.6 standard. Note, the
MAC protocol of the SmartBAN is divided into two access channels, namely the con-
trol channel and the data channel. The control channel is used for controlling traffic,
the transmission of control messages, and network initialization, while the data chan-
nel is used for transmitting data [3]. In addition, the data transmission has an inter-bea-
con interval which is divided into three major components, namely the inactive period,
scheduled access period (SAP), and control and management period (CMP). Note, each
period is also divided into different slots of time with the same length. The CMP is based
on the slotted ALOHA scheme and is used for data and control transmission. The SAP
is majorly for transmitting data and is based on the TDMA scheme which helps to pre-
vent a collision occurrence. An overview of the ESTI SmartBAN MAC protocol was car-
ried out in [89]. As with channel and/or time slot resource pre-allocation protocols, slot
wastage and control overhead are potential related issues with this standard.

5.2 Long‑range technologies and standards

The long-range MAC protocols of the long-range standards allow biosensor devices and
base station nodes to access a radio channel for data exchange purposes over a long dis-
tance. Since biosensor devices are mostly battery powered devices that could not afford
to waste energy on channel access, then, insight into the operation of the long-range
MAC protocols of the long-range standards will assist in improving the productivity and
performance of WBAN-enabled IoT technology. To achieve this, the low-power wide
area network standards are considered in this section.
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 30 of 47

5.2.1 Low‑power wide area networks (LPWANs)

The LPWAN technologies can be classified into two groups, namely the non-cellular
LPWAN technologies and cellular LPWAN technologies. The examples of the non-cel-
lular LPWAN technologies are LoRa Alliance, SigFox, and so on. These technologies use
proprietary solutions for connectivity, while the cellular LPWAN technologies are new
standards, for example, the NB-IoT and eMTC (LTE Cat-M1), and they are regraded as
the major foundational building blocks of the 5G technologies. These new standards are
promising since 5G networks promise to offer high data rate transmission, better reli-
ability, as well as a high bandwidth unlike the classical cellular technologies that was not
originally designed for WBAN use cases. The identified standards are considered in the
following sub-sections under two categories.

6 (a) Non‑cellular LPWAN technologies

(i) LoRa alliance

LoRa alliance is based on two main components, including LoRa and LoRaWAN [90].
LoRa is associated with the PHY layer and operates on the unlicensed ISM band and
also employ a chirp spread spectrum (CSS) modulation scheme with a data rate of about
300 bps – 50 kbps. LoRaWAN on the other hand, is related with MAC layer and uses
the pure ALOHA protocol to enable a UL communication in a star topology [4]. It is
important to point out that LoRaWAN is designed majorly for low energy consump-
tion devices, like biosensors. Also, the LoRaWAN protocol categorizes LoRa biosensor
devices in the context of a WBAN-enabled IoT into three major operation modes which
enables a trade-off between the energy requirement, latency, and DL communication.
These operation modes include the class A, B, and C. Basically, a LoRa-enabled biosen-
sor device is mostly designed as a class A device with a power saving capability, except
in some cases in which it could be specifically designed to function in the Class B or the
Class C mode. The Class A is regarded as being the most energy efficient class, with a
high latency, and offers a DL communication only for a small slot after a UL commu-
nication. It has two receive windows. Hence this class may be considered suitable for
the WBAN-enabled IoT technology since the DL would only need to acknowledge the
delivery of the health data, except that latency will be an issue. Class B support biosensor
devices that have a moderate latency requirement and consumes less power with multi-
ple scheduled DL slots. While, Class C supports devices with the lowest latency require-
ment with continuous open receive windows at the expense of more power cost compare
to the Class A and B [91, 92]. Typically, the energy consumption of this standard is
around ≤ 50 mA for data transmission, 10 mA to ≤ 40 mA for reception, and ≤ 0.01 mA
for the sleep mode [3]. However, since the LoRaWAN protocol defines the pure ALOHA
scheme as the channel access protocol for classes A, B, and C, then, the collision prob-
lem remains a major constraint. Despite the different operation modes available, colli-
sions are still inevitable. Another serious concern is idle listening.

(ii) SIGFOX

The Sigfox standard employs an ultra-narrow band (UNB) technology and supports
a frequency band of 868 MHz in Europe and 915 MHz in the US and a maximum
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 31 of 47

throughput of about 100 bps resulting into an ultra-low-power consumption and a low
noise level. At the MAC layer, the UNB technology is based on the ALOHA protocol
medium access (MA) technique known as the random frequency and TDMA (RFT-
DMA) protocol. This protocol enables an active biosensor device to randomly access the
channel in frequency and time and has no MA collision control approach as well as no
prior awareness of the channel occupancy [93]. The RFTDMA protocol helps to achieve
a low energy consumption due to the fact that the biosensor devices do not have to sense
the channel before transmitting their data. Additionally, the frequencies used for trans-
mission are randomly chosen in a continuous interval. On the contrary, the limitation
of this protocol is the chances of collision occurrence which could be attributed to the
simultaneous packet transmissions. The UL transmission power of the Sigfox technology
depends on global regions which varies from around 14 dBm to 22 dBm (25 mW–158
mW), while the DL transmission power varies from around 26 dBm to 36 dBm, i.e., 500
mW–4 W, in Europe and United states, respectively. As a consequence, the Sigfox tech-
nology uses two power saving mechanisms, including the power saving mode (PSM) and
discontinuous reception (DRX) [94]. It is important to point out that in a Sigfox system,
a Sigfox-enabled biosensor device does not need to be awake at a particular instance for
synchronization, i.e., it is an asynchronous technology. Also, biosensor devices are in the
transmission mode when communicating their data and in the sleep mode in between
transmissions. Furthermore, the Sigfox technology uses an inter-transmission period in
which a biosensor device could be in an idle state [92], due to this idle state, energy may
be wasted.

6.1 Cellular LPWAN 5G IoT radio technologies

One of the major limitations of the existing communication standards often employed
in WBAN-enabled IoT healthcare systems is the limited bandwidth constraint required
to efficiently monitor patients’ health conditions and report sensory data in a real-time
fashion. To address this limitation, the new 5G standards are promising candidates to
improve the bandwidth limitation confronted by the WBAN-enabled IoT technology.
While most of the existing technology MAC protocols are leveraged on some adapta-
tions to meet some of the various requirements of the WBAN-enabled IoT services,
like wide communication coverage, energy efficiency, cost-effectiveness, low delay rate,
timely and reliable packet delivery. Fortunately, the 5G technology MAC protocols are
envisaged to meet the WBAN-enabled IoT requirements. Additionally, the 5G technolo-
gies are also envisioned to provide high data rates, high bandwidth, and also introduce
a transport network structure in their architecture so as to offer a sustainable packet
communication through the use of a self-backhauling mechanism [95]. Note that the 5G
communication systems have self-organizing capabilities that may be exploited through
the selection of suitable and available spectrum blocks for backhauling purposes, and
this would be an essential feature for offering a high spectrum frequency radio access.
Also, according to [96], the 5G communication systems are supported by several
medium access mechanisms. The multiple medium access mechanisms include the
non-orthogonal multiple access (NOMA), orthogonal frequency-division multiplexing
(OFDM), sparse code multiple access (SCMA), coded access reservation, coded slotted
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 32 of 47

ALOHA, filter bank multicarrier offset QAM (FBMA-OQAM), interleave division mul-
tiple access (IDMA), coded random access, and universal filter OFDM (UF-OFDM). For
insight into 5G technologies, the fundamental technologies are discussed in the next
sub-sections.

(i) Enhanced machine-type communication (eMTC)

The enhanced machine-type communication (eMTC) technology is also known as the

long term evolution category M1, i.e., LTE Cat-M1 technology. The eMTC technology was
developed to provide packet reliability, device identification, low complexity, and security
[97]. The eMTC was designed according to the 3GPP specifications so as to realize a low-
power consumption as well as extend the existing communication technology coverage.
The 3GPP design aim for the eMTC communication technology was to provide suitable
MAC and PHY connections for the eMTC networks as well as optimize the communi-
cation access technology, support flexible bandwidth deployment, increase spectral effi-
ciency, reduce delay, support high throughput rate, and reduce idle time [98]. The eMTC
networks are regarded as a multicarrier network that spreads radio resources in the fre-
quency domain and in the time domain by employing a frequency-division duplex (FDD)
method and a single carrier (SC-FDMA) mechanism as well as a TDD method and an
orthogonal frequency-division multiple access (OFDMA) scheme for UL and DL health
packet transmissions, respectively. For the UL health packet transmission, there is only
a single physical UL control channel (PUCCH) which conveys information that include
the channel quantity information (CQI), the transmission confirmations, and the schedul-
ing requests. Also, a physical random channel (PRACH) method is employed to estimate
the arrival period of the UL message as well as to initiate a connection between the base
station and the terminal [99]. Note that the eMTC-based biosensor devices can support
a multiple input multiple output (MIMO) data communication and thereby allowing the
base station to send various data streams concurrently over the same carrier [100].
Typically, the MAC layer exists in the universal equipment (UE) as well as the
evolved Node-B (ENB) and is a component of the eMTC air interface control and user
planes [101]. The radio access network protocol in eMTC is the evolved universal ter-
restrial radio access network (E-UTRAN). Basically, the main functions and services
of the MAC protocol include multiplexing/de-multiplexing of the service data units
(SDUS) of MAC which belongs to a single or several logic channels into or form a
transport block (TB) carried to and from the PHY layer on the transport channels,
report scheduling information, correct error through hybrid automatic repeat request
(HARQ), handling priority between the LCs and the UEs centered on dynamic sched-
uling and so on [102]. Furthermore, the eMTC MAC protocol employs scheduling
mechanisms in order to schedule health packet transmissions so as to guarantee
health packet successful transmission in the context of the WBAN-enabled IoT to
provide a promising achievable throughput, and a spectrum efficient transmission of
the health packets.
Generally speaking, the power wastage of a biosensor-enabled eMTC device could
be attributed to the periodic listening of paging signals and measuring of the link qual-
ity. While, the energy consumption due to data transmission is insignificant of the
total energy consumed. Consequently, the eMTC exploits two power management
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 33 of 47

mechanisms for prolonging the battery lifespan of biosensor devices, these mechanisms
include the PSM and DRX. In practice, the PSM is used to enable biosensor devices to
turn off energy consuming functionalities for the purpose of saving energy. While, the
DRX works by providing a support to a biosensor device by reaching an agreement on
how to manage data communication during the data reception period with the network,
thereby enabling a biosensor device to keep its receiving functionality off to save energy.
In addition, the eMTC was developed to support a transmission power of either 23 dBm
or 20 dBm [103].
(ii) Narrowband-internet of things (NB-IoT)
The NB-IoT technology can as well be referred to as the LTE Cat-NB1 and is
designed to extensively reuse the architectural design of the LTE networks [104]. This
technology may support most of the key requirements for data communication in a
WBAN-enabled IoT remote healthcare monitoring system that include low-power
dissipation, low complexity, and long-distance communication. The NB-IoT tech-
nology employs a single-carrier SC-FDMA scheme for the UL transmission and the
OFDMA for the DL transmission. Based on the SC-FDMA scheme, multiple access
is made possible to biosensor devices by allocating different sets of overlapping-free
subcarriers. Moreover, the NB-IoT may provide two types of transmissions for the
health packets communication in the context of WBAN-enabled IoT technology, they
include the single-tone and multi-tone transmissions. The multi-tone transmission is
centered on the SC-FDMA with 0.5 ms slot, 15 kHz sub-carrier spacing and 1 ms sub-
frame as the same as the LTE networks. While, the single-tone transmission makes
use of 3.75 kHz with 2 ms slot period and 15 kHz sub-carriers spacing for UL trans-
mission [105]. Additionally, the UL of the NB-IoT contains two physical mediums,
i.e., channels that include the narrowband physical UL shared channel (NPUSCH)
and narrowband physical RACH (NPRACH). There are two distinct formats in the
NPUSCH channel, the first format is utilized when loading an UL packet and has a
peak block size of about 1000 bits [106], and the second format employs a repeat code
for correcting errors as well as a signal HARQ for NPUSCH recognition. Just like the
eMTC technology, the NB-IoT has a maximum power transmission of about 20 dBm
or 23 dBm [103]. However, periodic listening to paging signals and the channel qual-
ity measurement functions performed by the NB-IoT-enabled biosensor devices are
the major sources of energy consumption of this technology. To optimize the energy
consumption of this technology, two power saving mechanisms could be employed
by the NB-IoT technology, which are the PSM and the DRX. This standard may suffer
from collisions when multiple biosensor devices simultaneously request access to the
channel resources because of the likelihood of false alarm, inaccurate channel estima-
tion and channel detection issues related to the NPRACH [107].
Summary of short- and long-range MAC protocols for WBAN-enabled IoT
technology
The summary and the comparison of both the short- and the long-range MAC proto-
cols for WBAN-enabled IoT technology with focus on communication coverage, energy
efficiency, data delay rate, transmission rate, power consumption, access methods,
advantages, and limitations are provided in Table 5.
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 34 of 47

7 Discussion on open‑ended research problems and future directions

for WBAN‑enabled IoT technology’s MAC protocols
This section presents key discussions on the open-ended research problems associated
with the WBAN-enabled IoT technology’s MAC protocols as well as future directions
for improving the productivity of these systems. The design of energy efficient MAC
protocols is a pragmatic idea for improving the network efficiency of WBAN-enabled
IoT technology. Currently, the design of MAC protocols is an active research area in the
domain of WBANs as the existing ones have not fully catered for the efficiency require-
ments of WBAN systems, while some are presently at their infancy stage. As an exam-
ple, the new communication technologies are still in need of new novel MAC protocols
that can be suitably adapted into the WBAN-enabled IoT technology for enhancing
their efficiency, for instance energy utilization optimization and delay optimization. As
a consequence, this study has put forward some recommendations for future research
directions that can help to improve the efficiency of the MAC protocols that target
WBAN-enabled IoT technology.
(1) Exploring and exploiting hybrid methods for WBAN-enabled IoT MAC
protocols
The hybrid method is an interesting concept that can be employed to combine the
strengths of different MAC protocols in the categories of contention-free and conten-
tion-based MAC protocols to improve the QoS performance of WBAN-enabled IoT. But
then, exploiting this concept often results into performance trade-off issues that requires
novel ideas to increase the performance efficiency of hybrid MAC protocols. For exam-
ple, the combination of both TDMA and slotted ALOHA MAC protocols is a potential
hybrid MAC protocol. However, when the TDMA and slotted ALOHA are integrated
into a WBAN-enabled IoT to provide channel access to the biosensor devices, where
the TDMA protocol is employed as a transmission mechanism and the slotted ALOHA
protocol is employed as a contention mechanism, there will be likelihood of a collision
occurrence when two biosensors transmit their packets at the same time-slot during the
contention period as well as performance trade-off between the contention time and the
transmission time. Addressing these issues are key to developing efficient hybrid MAC
protocols for WBAN-enabled IoT. To address these issues, interesting future research
directions include the design of modified slotted ALOHA protocol to minimize colli-
sions by employing techniques from graph and tree theories and balancing the trade-
off issue between the contention time and the transmission time using techniques from
operations research.
(2) Addressing the channel access issues of LoRaWAN MAC in WBAN-enabled
IoT
LoRaWAN is a potential communication protocol that can be integrated into the
WBAN-enabled IoT technology to improve QoS performance, however, there is a need
to address the channel access issues related to the LoRaWAN MAC. The LoRaWAN
MAC is based on the ALOHA channel access scheme and provides a channel access to
the network devices in a random manner [108]. Consequently, the LoRaWAN MAC ena-
bles devices to randomly select an uplink channel to send their data without the consid-
eration of any other transmission, leading to collisions between several transmissions
Table 5 Comparison of short- and long-range MAC protocol for WBAN-enabled IoT technology
Parameters Short-range communication standards and technologies Long-range communication systems
IEEE 802.15.4 IEEE 802.15.6 Bluetooth Wi-Fi ETSI SmartBAN Non-cellular technologies Cellular technologies

5G IoT radio standards and

Olatinwo et al. J Wireless Com Network

technologies
Sigfox LoRa alliance eMTC NB-IoT

Communication Less than 100 m About 2 m–10 m 10 m -100 m About 1 km Less than 1.5 m Urban:50 km Urban: 5 km Rural: Rural: 15 km Rural: 35 km Urban:
coverage Rural: 50 km 15 km 8 km
Radio access Non-beacon: NB PHY layer: TDMA CSMA/CA CMP: slotted UNB: ALOHA- LoRaWAN based UL: SC-FDMA DL: UL: SC-FDMA DL:
(2021) 2021:60

technique unslotted CSMA/CA, UWB ALOHA SAP: based RFTDMA on Pure ALOHA OFDMA OFDMA
CSMA/CA, PHY layer: slot‑ TDMA
beacon: slotted ted Aloha
CSMA/CA
Energy require‑ Very low Moderately low Low High Low Low Low Low Low
ment
Health packet 10—250 kbps 10 Mbps 1 Mbps Less than 54 Less than 100 100 bps 50 kbps 1 Mbps UL: 160 – 200 kbps
transmission Mbps kbps DL: 160 – 250
rate kbps
Data delay rate Low Very low Low Low Less than 125 ms 10 s 10 s 150 ms Less than 10 s
Network/Topol‑ WPAN/star, mesh, WPAN/star WPAN/star, picon‑ WLAN/star Star network Star network Star network Star network Star network
ogy tree net, scatternet
Power consump‑ Approximately Approximately Transmission Approximately - UL: 14 to 22 dBm Transmission Transmission Transmission
tion less than or 1 mW at a dis‑ power: -20 to equal to 800 DL: 26 to 36 power: less power: 23 or 20 power: 23 or 20
equal to 50 mW tance of 1 m 20 dBm mW dBm than or equal to dBm dBm
50 mA Recep‑
tion power: less
than or equal to
10 – 40 mA
Strength Make best use of Reliable Operational cost Internet connec‑ Reliable in the Energy efficient Energy efficient Energy efficient, Energy efficient,
battery lifetime is cost-effective tivity support context of and low opera‑ and low opera‑ offer a fast as offer a fast as
multi-path tional cost tional cost well as a reliable well as a reliable
interference network network
Page 35 of 47
Table 5 (continued)
Parameters Short-range communication standards and technologies Long-range communication systems
IEEE 802.15.4 IEEE 802.15.6 Bluetooth Wi-Fi ETSI SmartBAN Non-cellular technologies Cellular technologies

5G IoT radio standards and

Olatinwo et al. J Wireless Com Network

technologies
Sigfox LoRa alliance eMTC NB-IoT

Limitations Limited coverage, Limited coverage, Limited coverage, Energy wastage Limited coverage, Low health Interference Limited capacity High operational
Lack support for Collision prob‑ Lack support problem caused Slot wastage packet capabil‑ issue, Collision of the network, cost due to the
time-sensitive lems due to its for real-time by control and control ity, Reliability problems, Idle Waste power use of licensed
(2021) 2021:60

communica‑ channel access health-data overhead overhead issues issue, Interfer‑ listening issue resources due spectrum and
tions because methods, i.e., transmissions packets, Limited ence issue, to periodic high mainte‑
of its CSMA/CA CSMA/CA or coverage, Energy wastage listening to nance, high
access mode slotted ALOHA, Scalability issue, issue due to paging mes‑ chances of
exploitation, Suffers from Idle listening idle listening of sages and link collision during
Energy wastage idle listening concern, Colli‑ biosensors in measurement multiple channel
due to idle problem sion problem the inter-trans‑ access request
listening and mission period by biosen‑
collisions sor devices
because of the
inefficiency of
NPRACH channel
access method
Page 36 of 47
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 37 of 47

due to simultaneous channel utilization. This collision issue is envisaged to be an under-

lying problem in a WBAN-enabled IoT in terms of QoS performance, energy efficiency
and delays for example. For the LoRaWAN technology to be successfully integrated into
the WBAN-enabled IoT for better QoS performance, further research is needed to be
conducted on this.
(3) Addressing the NB-IoT technology channel access issues in WBAN-enabled
IoT
NB-IoT is a promising technology that can be combined with WBAN-enabled IoT
to improve QoS performance, but then, the channel access mode of this technology
causes a serious performance issue that calls for more research intervention. For
example, when multiple devices request for the uplink channel resources simultane-
ously to send their data, there may be collisions between several transmitting devices
due to various factors like inaccurate channel estimation, inefficient channel detec-
tion, and false alarm, and the consequences of the collisions are retransmissions and
power wastage issue. Currently, the collisions issue still remain a serious limitation
to the deployment of NB-IoT in WBAN-enabled IoT. Hence, there is a need for more
investigations on the design of new techniques on efficient channel estimation and
accurate channel detection to deal with the collisions issue and to advance the NB-
IoT for WBAN-enabled IoT.
(4) Supporting heterogeneous and variable health data traffic in WBAN-ena-
bled IoT
Because of the various heterogeneous biosensor devices and varying delay and
throughput requirements associated with the WBAN-enabled IoT, such a technology
is required to take into consideration and support heterogeneous traffic and variable
traffic. For this purpose, research on the design and development of heterogeneous
traffic-aware and variable traffic-aware MAC for WBAN-enabled IoT technology is
very critical to dynamically allocate channel resources in response to the health data
traffic.
(5) Development of optimized clustering techniques for WBAN-enabled IoT
MAC protocols
Battery power conservation, increasing network lifetime, and scalability are impor-
tant factors to be taken into account when designing MAC protocols for WBAN-ena-
bled IoT to make them sustainable and support more biosensor devices. To address
this, the exploitation of clustering technique is a promising future research direction
to reduce the power path cost of the biosensor devices when communicating with the
AP. For examples, the use of clustering technique makes it possible to group biosen-
sor devices into several clusters with cluster heads and the biosensor sensor devices
in each cluster communicates directly with their respective cluster heads instead of
expending more power on communicating directly with the AP. Also, the use of clus-
tering technique can help to achieve a more scalable MAC protocol for WBAN-ena-
bled IoT.
(6) Developing efficient wake-up-enabled MAC protocols for WBAN-enabled
IoT
Because of the significant amount of power consumed by the biosensor devices dur-
ing the active state, it will be reasonable to combine a passive wake-up radio with the
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 38 of 47

main radio in the biosensor devices to allow the main radio to be in a sleep state and
to circumvent the power wastage issue due to the unnecessary idle listening of the
main radio. In this case, the wake-up radios are enabled to monitor the environment
and to listen to the request from the AP [109, 110]. The usage of passive wake-up
radios are useful to increase energy efficiency and to reduce collisions by switching
on only the biosensor devices that need to either receive or transmit packets at a
wake-up tone message request from the global wake-up radio in the AP. This wake-up
tone signals are coordinated by the MAC protocol and are broadcasted on a different
channel other than the one used by the biosensor devices for health data communica-
tion purposes to avoid collisions between the wake-up tone messages and health data
packets. The use of a passive wake-up radio will be advantageous in WBAN-enabled
IoT settings since it is a low-cost device and harvest its power from the incoming
wake-up tone signal. Also, it requires a very low power compared to the conventional
duty cycling techniques A passive wake-up radio can use about 50 µW energy and
this makes it a promising candidate for the WBAN-enabled IoT technology [30, 109].
However, the current MAC protocols employed to wake up the biosensor devices
from a sleep mode are still not efficient and could be further improved on to reduce
the delays associated with harvesting power and transitioning from the sleep mode to
the active mode when sending critical health data in emergency cases.
(7) Developing efficient time-based MAC protocols for WBAN-enabled IoT
technology
As a result of the power wastage issues related to the existing MAC protocols
designed for WBANs because of collisions, idle listening, and overhearing issues as
well as the transitions that occurs between the different operation modes (i.e., active,
sleep, idle), the usage of the channel resources by the biosensor devices may be effi-
ciently timed by researching, designing, and developing novel time-based channel
access MAC protocols that are suitable for deployment in WBAN-enabled IoT. Also,
the investigation of a time-based channel access MAC protocol can improve delay
prediction and minimize health packet drops because of buffer overflow or inter-
ference constraints. However, addressing the above-highlighted issues through the
researching of time-based channel access MAC protocols may increase the network
overheads. To deal with the likely incurred overheads, another focus of research is to
consider the idea of a reservation-based request along with simplified heuristic tech-
niques to handle the complexity of the channel access scheduling.
(8) Design of priority access MAC protocols for WBAN-enabled IoT critical
data
Due to the varying traffic load or the characteristics of the biosensor devices in the
WBAN-enabled IoT technology, there are still much room for the extension of the
current MAC protocols so as to provide an improved and efficient priority support for
the WBAN-enabled IoT applications, especially the medical applications with time
critical data and other requirements. Such priorities could be classified into normal
data, periodic data, and critical data, i.e., emergency data and data delay requirement.
As an example, some WBAN-enabled IoT applications are delay intolerant, while
some are delay tolerant such as the non-medical applications. Since life is involved,
critical health data with stringent data delay requirements, typically needs to be
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 39 of 47

reported as soon as possible to the designated remote healthcare providers in less

than a second, then, the provision of prompt access to the communication medium
for such critical health data must be highly prioritized [111]. Unlike the other health
data which are less critical. In addition, the energy resource can be efficiently used
by introducing a priority differentiation approach. For this reason, by utilizing a ran-
dom function, the radio channel access may be controlled with the help of allocating
priorities to the biosensor devices or the channel links to the destinations. While, the
biosensor devices with the highest priority may be allowed to access the channel first.
In the area of priority access MAC protocol, some efforts have been intensified,
for example [112, 113], while at the same time some short-range standards, like the
IEEE 802.15.4, IEEE 802.15.6, and ETSI SmartBAN, may provide priority access and/
or high-priority messaging support, however, since the WBAN-enabled IoT technol-
ogy will potentially rely on the IoT technologies that have capabilities for transmitting
a few number of data packets because of their low-power features, the investigation
of energy efficient and priority access aware MAC protocols deserve more research
attention and is currently regarded as an active area of research.
(9) Investigation of new low duty cycling techniques for WBAN-enabled IoT
MAC protocols
The duty cycling technique is an energy saving scheme [17] that may be integrated into
the WBAN-enabled IoT MAC protocols for optimizing the way the biosensor devices
access the radio channel. The basic concept of a low duty cycle technique is to minimize
the time a biosensor device spends on idle listening or overhearing needless activities
going on in the radio channel by putting the biosensor device in a sleep mode [114].
Duty cycle can be determined by the ratio of the idle listening time length to the wake-
up time length and this helps to determine the duration a biosensor device spends in the
idle listening period. A duty cycling protocol can be grouped into two categories that
include the fixed duty cycle and the adaptive duty cycle. An example of a protocol that
employs the fixed duty cycle idea, i.e., they make use of fixed length of time, is the sen-
sor-MAC (S-MAC) protocol. While, the examples of the adaptive duty cycle protocols
are the wireless sensor MAC (WiseMAC) and the T-MAC, which adaptively determines
the sleep and the wake time of a biosensor device. Typically, the adaptive duty cycling
techniques are considered to be more effective in conserving energy than the fixed duty
cycling technique [115, 116]. Other examples of the duty cycle MAC protocols include
the energy adaptive clustering hierarchy, power aware cluster TDMA (PACT), and
ALOHA with preamble sampling [117]. However, the need to improve the energy effi-
ciency and latency QoS performance of the existing techniques is still an active area of
research in the WBAN research domain.
(10) Development of traffic and topology adaptive MAC protocols for WBAN-
enabled IoT
To improve the energy efficiency of a WBAN-enabled IoT technology, MAC proto-
cols can be optimized to adjust to the traffic condition changes and the network topol-
ogy changes. But then, adaptability to changes typically could result to an increase in
the computational complexity of a protocol including other disadvantages that may
make the biosensor devices to expend more energy resources. In the area of traffic
adaptive MAC protocol development, some efforts have been intensified in [118, 119],
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 40 of 47

however, further investigations are required because of the unique challenges posed by
the WABN-enabled IoT technology. Thus, the development of traffic and topology adap-
tive MAC protocols that captures the effect of topology and traffic changes is still an
active research issue that requires more attention for improved energy efficiency in the
WBAN-enabled IoT technology.
(11) Developing MAC protocols that support fading and mobility management
for WBAN-enabled IoT technology
Because of the mobile characteristics of the WBAN-enabled IoT biomedical devices
and the dynamic nature of the environment of this technology, there is a need to take the
issue of mobility management into consideration as this affects the total performance
of a WBAN-enabled IoT technology because of the shadowing, diffraction, and the
reflection of body effect in a typical fading wireless channel [120]. To address this open
research problem, an interesting future research direction will be to research, design
and develop novel WBAN-enabled IoT MAC protocols that takes fading and mobility
management into consideration to guarantee the reliability QoS performance of this
technology.
(12) Investigation of QoS support-based MAC protocols for WBAN-enabled IoT
technology
WBAN-enabled IoT health data could be classified into ordinary health data, critical
health data, delay in-tolerant health data, and reliability sensitive health data. As a result,
these health data types require a guaranteed and dedicated QoS so as to transmit their
health data with little or no delay or packet loss. Therefore, there is still much room for
researchers to explore and develop efficient QoS sensitive MAC schemes that are aware
of throughput, delay, path loss requirements, and so on. Also, since path loss issue in
the WBAN-enabled IoT could be as a result of patient’s different postural movement
including swimming, walking, standing, lying-down and so on, hence further research
on improving the existing routing and MAC protocols need to be intensified so as to fur-
ther address the problems that are associated with the path loss issue.
(13) Design of low-complexity MAC protocols for WBAN-enabled IoT
Typically, the centralized and the distributed access schemes are used in centralized
and distributed WBAN networks respectively, for resource allocation purposes such
as channel access. For the realization of this purpose, a central AP and the biosensor
devices employs control signals for the exchange of useful information in the centralized
networks, while the exchange of control signals exists between the distributed APs and
the biosensor devices in the distributed networks. Note, the signaling overhead involved
in the centralized networks often requires a huge amount of energy as the biosensor
expends more energy for exchanging control signals compared to the distributed net-
works. Unfortunately, the biosensor devices in the WBAN-enabled IoT technology are
low-power in nature and could not afford to spend energy unreasonably. To deal with
the potential huge burden of the centralized networks on the biosensor devices, the
investigation of low-complexity distributed MAC algorithms are active open research
problems to maximize the network resources as well as improving the network utility
gains. In addition, most of the existing MAC protocols are computationally expensive,
therefore, further research on modifying and advancing the current versions of these
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 41 of 47

protocols is very crucial to obtain more suitable protocols for the WBAN-enabled IoT
technology.
(14) Improving WBAN-enabled IoT technology spectrum/channel efficiency and
access strategies
As new wireless communication system paradigms would technically require higher
spectrum usage as well as the ability to handle some data hungry devices, and since the
conventional spectrum allocation strategies causes spectrum scarcity, hence, new strate-
gies and protocols need to be designed so as to achieve an efficient spectrum utiliza-
tion [6]. It is important to emphasize that MAC protocols are responsible for identifying
available spectrum, scheduling of network resources such as time slots, and coordina-
tion of heterogeneous systems as well as users’ coexistence [4]. In addition, WBAN-
enabled IoT technology are often confronted with issues like delay, energy inefficiency,
and spectrum scarcity problems since they are mostly deployed on the unlicensed over-
crowded spectrum which are also used by other wireless networks since it is easily and
freely accessible. In order to circumvent most of these issues, an appealing solution is
to adopt a cognitive radio (CR) technology [121, 122]. However, one problem with a CR
based WBAN-enabled IoT technology is that the biosensor devices can only access the
spectrum to communicate their health data in an opportunistic manner to avoid causing
interference to the signals of the licensed primary users. To deal with this problem in the
context of WBAN-enabled IoT, considering the time-critical nature of its health data,
efficient CR-based MAC protocols are needed to be investigated.
(15) Design of efficient retransmission policies and error correction schemes for
WBAN-enabled IoT technology
Based on the review carried out on hybrid MAC protocols in this study, it is appar-
ent that most protocols in this category exploits the CSMA/CA scheme making colli-
sion occurrences inherent as a result of frequent data retransmission which could lead
to energy wastage. To address this issue, i.e., the frequent data retransmissions, an error
correction technique could be employed and this could help to achieve a better energy
utilization process. Similarly, another approach to tackle the frequent data retransmis-
sion problem is by minimizing collisions through changing the contention window
ranges, by applying an additive increase and multiplicative algorithm and by modifying
the superframe periods in line with the application requirements. For instance, authors
of [123, 124] proposed the use of a hybrid automatic repeat request policy to address
retransmission issue. As a consequence, further research could still be conducted on
designing a cooperative and energy efficient retransmission policy.
(16) Addressing co-existence issue in WBAN-enabled IoT technology
A WBAN-enabled IoT technology may encounter a co-existence issue since it co-exist
together with other general wireless communication systems on the same frequency
bands in the unlicensed overcrowded spectrum [125]. The co-existence issue may poten-
tially subject the WBAN-enabled IoT technology to critical interference problems that
could degrade its performances in terms of delay due to collisions as well as energy wast-
age due to retransmissions. Hence, interference mitigation or avoidance access proto-
cols that are interference aware needs to be investigated, developed and incorporated
into the WBAN-enabled IoT technology. In this matter, MAC protocols should take into
consideration the collaborative and cooperative co-existence with other various WBAN
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 42 of 47

systems and the general wireless communication systems. In addition, ideas like time
and frequency spacing, standards modification, and code diversity could be further
investigated to mitigate interference issues in WBAN-enabled IoT.
(17) Enhancing the authentication security of WBAN-enabled IoT technology via
the exploitation of new authentication schemes
IoT authentication security is a key requirement of WBAN-enabled IoT technol-
ogy due to the possibility of security vulnerabilities (e.g., authentication vulnerability)
from attacks [126–129]. Such a security measure helps to guard against any unauthor-
ized disclosure of a patient’s health data to the attackers [130]. However, the conven-
tional cryptographic security mechanisms like AES, ECC, and RSA, including other new
authentication mechanisms employed for authentication security are not efficient for
WBAN-enabled IoT technology, biosensor devices, and users owing to the fact that such
security mechanisms are resource demanding [8], and the biosensor devices in health-
care applications are resource-limited devices, hence, these devices may be unable to
afford significant resources, including power and memory for security authentication
purposes [126, 127]. To this end, there is a need to investigate and develop efficient and
lightweight authentication schemes for achieving IoT authentication security in WBAN-
enabled IoT technology.

8 Conclusion
To improve the quality of life as well as achieve the future visions of diagnostics, timely
detection, treatment, and prevention of diseases through advanced technologies, wire-
less body area networks (WBANs) fused with the internet of things technologies (IoT) are
powerful and promising solutions. But then, these technologies have posed several unique
challenges due to different resource scarcity issues related to communication networks.
Also, to efficiently drive these technologies, there must be efficient network support in
place, especially at the medium access control (MAC) layer. Because of these requirements,
this paper has considered the analysis of WBAN-enabled IoT technology MAC protocol
requirements and major issues related to the MAC layer, investigation of the potential
MAC strategies that are applicable to WBAN-enabled IoT technology for improving com-
munication quality and supporting critical QoS requirements, summary of the existing
WBAN-specific MAC protocols, communication standards for WBAN and their under-
lying constraints. Based on these, future directions and open research issues have been
pointed out to improve the productivity and wide deployment of these technologies.

Abbreviations
AM: active mode; AP: access point; BLE: bluetooth low energy; BS: base station; BSIG: bluetooth special interest group;
CA: collision avoidance; CA-MAC: context-aware medium access protocol; CAP: contention access phase; CCA​: clear
channel assessment; CDMA: code-division multiple access; CFP: contention-free phase; CSMA: CS: Carrier sensing
multiple access; CTS: clear to send; DL: downlink; ECG: electrocardiogram; EEG: electroencephalogram; EMG: electro‑
myography; ESTI: European Telecommunications Standards Institute; FDMA: frequency-division multiple access; FEC:
forward error correction; GTS: guaranteed time slot; IoT: internet of things; LR-WPAN: low-rate wireless personal area
network; LQI: link quality indicator; MAC: medium access control; MedMAC: Medical Medium Access Protocol; PS: power
save; QoS: quality of service; RED: receiver energy detection; RTS: request to send; SmartBAN: smart body area network;
TDMA: time-division multiple access; Ts: dedicated slot time; TSRB: time slot reserved for bursty traffic; TSRP: time slot for
periodic traffic; UL: uplink; UWB: ultra-wideband; WBAN: wireless body area network; WSNs: wireless sensor networks.

Acknowledgements
This research work was supported by the Council for Scientific and Industrial Research, Pretoria, South Africa.
Olatinwo et al. J Wireless Com Network (2021) 2021:60 Page 43 of 47

Authors’ contributions
All the authors have equally contributed to the review of this article. Conceptualization, D.D.O. and A.A.; resources, D.D.O.,
A.A. and G.H.; investigation and writing–original draft preparation, D.D.O. and A.A.; writing–review and editing, D.D.O.,
A.A., and G.H.; visualization, D.D.O., A.A. and G.H.; supervision, A.A. and G.H.; project administration, D.D.O. and A.A.; fund
acquisition, A.A. All authors read and approved the final manuscript.

Funding
This research was supported by the Council for Scientific and Industrial Research, Pretoria, South Africa, through the
Smart Networks collaboration initiative and IoT-Factory Program (Funded by the Department of Science and Innovation
(DSI), South Africa). The APC was funded by the CSIR.

Availability of data and materials

The authors declare that the data and materials in this manuscript are available.

Competing interests
The authors declare no competing of interest.

Author details
1
Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria 0001, South Africa.
2
Council for Scientific and Industrial Research (CSIR), Pretoria 0184, South Africa. 3 Department of Computer Science, City
University of Hong Kong, Kowloon Tong, Hong Kong.

Received: 6 July 2020 Accepted: 4 February 2021

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