Accuracy of wrist-worn heart rate monitors
Open accessAbstract
Accuracy of Wrist-Worn Heart Rate MonitorsWrist-worn fitness and heart rate (HR) monitors are popular.1,2 While the accuracy of chest strap, electrode-based HR monitors has been confirmed, 3,4 the accuracy of wrist-worn, optically based HR monitors is uncertain.5,6 Assessment of the monitors' accuracy is important for individuals who use them to guide their physical activity and for physicians to whom these individuals report HR readings.The objective of this study was to assess the accuracy of 4 popular wrist-worn HR monitors under conditions of varying physical exertion.Methods | This study recruited 50 healthy adults.The mean (SD) age was 37 (11.3)years; the mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 23.5 (3.1); 28 participants were women (58%), and 7 participants were African American (14%).Exclusion criteria included cardiovascular disease, pacemakers, and treatment with heart rhythm medications.The protocol was approved by the Cleveland Clinic institutional review board.Participants provided written informed consent.Participants wore standard electrocardiographic limb leads and a Polar H7 chest strap monitor secured tightly to ensure skin contact.Each participant was randomly assigned to wear 2 different wrist-worn HR monitors placed tightly above the ulnar styloid.Four wrist-worn monitors were assessed: Fitbit Charge HR (Fitbit), Apple Watch (Apple), Mio Alpha (Mio Global), and Basis Peak (Basis).Heart rate was assessed with the participant on a treadmill at rest and at 2 mph, 3 mph, 4 mph, 5 mph, and 6 mph.Participants exercised at each setting for 3 minutes to achieve a steady state; HR was recorded instantaneously at the 3-minute point.After completion of the treadmill protocol, HR was recorded at 30, 60, and 90 seconds' recovery.
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The Polar H7 uses an ECG-based sensor technique with medical grade accuracy.
“The Polar H7 [17] is a chest strap recording heart beats and interbeat-intervals, using an electrocardiograph (ECG) based sensor technique with medical grade accuracy [83].”
From Sensing Interruptibility in the Office: A Field Study on the Use of Biometric and Computer Interaction Sensors (2018) · cites this paper as [83]
The Methods passage (page unavailable) identifies the Polar H7 as a chest-strap monitor, and the table reports 0.99 concordance with electrocardiogram-measured heart rate. The paper describes chest-strap monitors as electrode-based, but does not explicitly establish the Polar H7’s sensor technique or designate its accuracy as “medical grade.” (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe actigraphy-based sleep tracker has proven to be most accurate when collecting measurements at rest.
“The tracker has proven to be most accurate when collecting measurements at rest [34,35].”
From Reduced cognitive function during a heat wave among residents of non-air-conditioned buildings: An observational study of young adults in the summer of 2016 (2018) · cites this paper as [34]
The Discussion (provided as passage [3] under Abstract; page not given) says wrist-worn heart-rate monitors were generally most accurate at rest. The paper assessed heart-rate readings, not the accuracy of an actigraphy-based sleep tracker or its sleep measurements. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe two devices showed reasonable accuracy in HR and EE estimations under certain exercise conditions.
“Similar to previous studies [13,28,30-32], we found reasonable accuracy in HR and EE estimations for these 2 devices under certain exercise conditions.”
From Accuracy of Wrist-Worn Activity Monitors During Common Daily Physical Activities and Types of Structured Exercise: Evaluation Study (2018) · cites this paper as [28]
The Results and Discussion (Abstract; page unavailable) report that wrist-worn monitors’ HR accuracy varied with exercise intensity and was generally best at rest, supporting only the qualified HR portion. The study assessed four monitors, not the citing authors’ two devices, and our copy reports no evaluation of energy-expenditure (EE) accuracy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBecause the Fitbit samples at a coarser rate, it cannot measure heart rate variability.
“While the Fitbit's coarser sampling granularity does not allow measuring HRV [83] and tends to overestimate sleep duration, it has a high intra-device reliability [60]”
From Sensing Interruptibility in the Office: A Field Study on the Use of Biometric and Computer Interaction Sensors (2018) · cites this paper as [83]
The Methods passage (page not provided) describes recording Fitbit heart-rate readings at set points during a treadmill test. The Discussion passage (page not provided) says continuous assessment was not feasible with all devices, but neither passage identifies Fitbit’s sampling rate or addresses whether it can measure heart rate variability. Searches for HRV and sampling granularity found no passage establishing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredOther studies have used suboptimal reference methods, such as chest straps or pulse oximeters, which themselves have a degree of error varying between 0 and 40 bpm when compared to electrocardiograms.
“other studies have used suboptimal reference methods, such as the chest straps45–47 or pulse oximeters48, which themselves have a degree of error (varying between 0 and 40 bpm when compared to ECGs44).”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
Some studies have used the gold-standard reference method of electrocardiogram, which directly measures heart rate via electrical impulses from the heart and is used for clinical accuracy.
“Although some studies have attempted to address wearable HR accuracy using the gold-standard reference method of ECG, which directly measures HR via electrical impulses from the heart and is used for clinical accuracy38–44”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
The Apple Watch has slightly greater accuracy than Fitbit devices (Apple Watch: −1.3 bpm, Fitbit: −9.3 bpm).
“with the Apple Watch having slightly greater accuracy than Fitbit devices (Apple Watch: −1.3 bpm, Fitbit: −9.3 bpm42–44)”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
On average, wearables slightly and negligibly underestimate absolute heart rate (−0.9 to −7.2 bpm) compared with gold-standard electrocardiogram.
“Current research verifying wearables to the gold-standard ECG, which uses electrodes to directly measure cardiac muscular contractions from electrical activity of the heart, have shown that on average wearables slightly and negligibly underestimate (−0.9 to −7.2 bpm) absolute HR40,41,44,52”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
Apple Watch has lower mean difference standard deviation and higher agreement with electrocardiogram than Fitbit devices.
“lower mean difference standard deviation43, and higher agreement with ECG than Fitbit devices39,44.”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
Larger wrist circumference has been shown to be associated with reduced heart rate accuracy, although these outcomes have not been found in all studies.
“Larger wrist circumference has been shown to be associated with reduced HR accuracy42, although these outcomes have not been found in all studies44,46.”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
Higher body mass index, which likely covaries with larger wrist circumference, has been shown to be associated with reduced heart rate accuracy, although these outcomes have not been found in all studies.
“Higher body mass index, which likely covaries with larger wrist circumference as described above, has been shown to be associated with reduced HR accuracy42,62, although again these outcomes have not been found in all studies44,46.”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
Wearable devices are more accurate during rest and low intensity exercise compared to higher intensity exercise, when they can begin to deviate more from ECG recordings.
“a substantial amount of research showing that wearable devices are more accurate during rest and low intensity exercise when compared to higher intensity exercise, when wearable devices can begin to deviate more from ECG recordings38,39,44,46,70–73”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [44]
Wrist-worn heart rate monitors, including the Apple Watch, have variable accuracy compared with electrocardiogram measurement.
“Variable accuracy for wrist-worn heart rate monitors, including the Apple Watch, compared with electrocardiogram measurement has also been noted previously in brief comparisons of bouts of exercise [56].”
From Wearable technology for high-frequency cognitive and mood assessment in major depressive disorder: longitudinal observational study (2019) · cites this paper as [56]
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- Authors
- Wang, R., Blackburn, G., Desai, M., Phelan, D., Gillinov, L., Houghtaling, P., & Gillinov, M.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Gillinov, Marc
- Venue
- JAMA Cardiology
- Publisher
- American Medical Association (AMA)
- Published
- 2017-01-01
- Volume
- 2
- Issue
- 1
- Pages
- 104
- ISSN
- 2380-6583 (ISSN-L)
- OpenAlex
- W2530450109
- Cited by
- 386
- References
- 6
- Citations by year
- 2026: 16 · 2025: 31 · 2024: 29 · 2023: 32 · 2022: 43 · 2021: 40 · 2020: 52 · 2019: 59 · 2018: 57 · 2017: 25 · 2016: 1
- FWCI
- 22.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cleveland Clinic
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- heart rate accuracy, wearable activity trackers, treadmill exercise, exercise intensity, heart rate recovery, Apple Watch
- MeSH terms
- Adult, Heart Rate, Humans, Middle Aged, Wrist, Electrocardiography, Ambulatory, Healthy Volunteers
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