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Cited by 210Heart Rate Variability and Autonomic ControlNon-Invasive Vital Sign MonitoringECG Monitoring and Analysis

Validity of the Empatica E4 Wristband to Measure Heart Rate Variability (HRV) Parameters: a Comparison to Electrocardiography (ECG)

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Schuurmans, Angela A. T., de Looff, Peter, Nijhof, Karin S., Rosada, Catarina, Scholte, Ron H. J., Popma, Arne, Otten, Roy·2020·Journal of Medical Systems
DOI 10.1007/s10916-020-01648-wPMC PMC7511462
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Abstract

Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables.

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  • The EMPATICA E4 wristband has demonstrated reliability and accuracy for HR and HRV research through comparisons with ECG.

    “The reliability and accuracy of EMPATICA E4 for research on HR and HRV have been previously demonstrated through comparisons with electrocardiography (ECG) measurements45.”

    From Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults (2021) · cites this paper as [45]

    The Conclusions report strong agreement with ECG-based VU-AMS recordings for mean HR and SDNN, supporting the E4’s potential for HR and HRV research while people are at rest. The Discussion reports significant differences for other HRV parameters and poor predictive value for RMSSD, so the unqualified claim of reliability and accuracy for HRV research overstates the findings. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Authors
Schuurmans, A. A. T., de Looff, P., Nijhof, K. S., Rosada, C., Scholte, R. H. J., Popma, A., & Otten, R.
Affiliations
  • Radboud University Nijmegen (NL)
  • De Bascule (NL)
Corresponding author
Schuurmans, Angela A. T.
ORCID
Venue
Journal of Medical Systems
Publisher
Springer Science and Business Media LLC
Published
2020-09-23
Volume
44
Issue
11
Pages
190-190
ISSN
  • 0148-5598 (ISSN-L)
  • 1573-689X
DOI
10.1007/s10916-020-01648-w
PMC
PMC7511462
OpenAlex
W3088371165
Cited by
210
References
10
Citations by year
2026: 37 · 2025: 39 · 2024: 44 · 2023: 35 · 2022: 32 · 2021: 22 · 2020: 1
FWCI
13.92
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Medical Systems (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • Research portal (Tilburg University) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Funders
  • Dr. Couvee Fonds (NA)
  • Innovatiefonds Zorgverzekeraars (NA)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
Keywords
Empatica E4, wristband, heart rate variability, wearable devices, device validation, electrocardiography comparison, SDNN, RMSSD, adolescents, residential care, trauma, autonomic nervous system
MeSH terms
Wearable Electronic Devices, Adolescent, Electrocardiography, Heart Rate, Humans, Electrocardiography, Ambulatory, Monitoring, Ambulatory

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