Validity of wrist-worn photoplethysmography devices to measure heart rate: a systematic review and meta-analysis
Abstract
Heart rate (HR), when combined with accelerometry, can dramatically improve estimates of energy expenditure and sleep. Advancements in technology, via the development and introduction of small, low-cost photoplethysmography devices embedded within wrist-worn consumer wearables, have made the collection of heart rate (HR) under free-living conditions more feasible. This systematic review and meta-analysis compared the validity of wrist-worn HR estimates to a criterion measure of HR (electrocardiography ECG or chest strap). Searches of PubMed/Medline, Web of Science, EBSCOhost, PsycINFO, and EMBASE resulted in a total of 44 articles representing 738 effect sizes across 15 different brands. Multi-level random effects meta-analyses resulted in a small mean difference (beats per min, bpm) of -0.40 bpm (95 confidence interval (CI) -1.64 to 0.83) during sleep, -0.01 bpm (-0.02 to 0.00) during rest, -0.51 bpm (-1.60 to 0.58) during treadmill activities (walking to running), while the mean difference was larger during resistance training (-7.26 bpm, -10.46 to -4.07) and cycling (-4.55 bpm, -7.24 to -1.87). Mean difference increased by 3 bpm (2.5 to 3.5) per 10 bpm increase of HR for resistance training. Wrist-worn devices that measure HR demonstrate acceptable validity compared to a criterion measure of HR for most common activities.
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Exercise-based heart rate monitoring was most affected by skin-tone bias, while resting heart rate accuracy was generally preserved.
“When stratified by outcomes, exercise-based heart rate monitoring was most affected by skin-tone bias, while resting heart rate accuracy was generally preserved [12-14].”
From Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring (2025) · cites this paper as [14]
In recent years, the quality and accuracy of wearables have improved.
“In recent years, the quality and accuracy of wearables have improved [7,8], resulting in more clinically approved certifications [9].”
From The impact of wearable technologies in health research: scoping review (2022) · cites this paper as [8]
Numerous reviews and studies have investigated validation and accuracy of specific affordable wearables compared to gold standard measurements or in meta-analysis.
“Numerous reviews and studies have investigated validation and accuracy, particularly for specific affordable wearables, comparing these to the gold standard measurements [21] or comparing evidence in a meta-analysis [8].”
From The impact of wearable technologies in health research: scoping review (2022) · cites this paper as [8]
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- Authors
- Zhang, Y., Weaver, R. G., Armstrong, B., Burkart, S., Zhang, S., & Beets, M. W.
- Affiliations
- University of South Carolina (US)
- Nanjing Medical University (CN)
- Corresponding author
- Zhang, Yanan
- Venue
- Journal of Sports Sciences
- Publisher
- Informa UK Limited
- Published
- 2020-06-19
- Volume
- 38
- Issue
- 17
- Pages
- 2021-2034
- ISSN
- 0264-0414 (ISSN-L)
- 1466-447X
- OpenAlex
- W3036553271
- Cited by
- 88
- References
- 65
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 15 · 2023: 14 · 2022: 15 · 2021: 10
- FWCI
- 0.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Sports Sciences (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- photoplethysmography, wrist-worn devices, heart rate measurement, device validity, consumer wearable devices, electrocardiogram, chest strap, sleep, resistance training, cycling, energy expenditure, accelerometry
- MeSH terms
- Wearable Electronic Devices, Activities of Daily Living, Bicycling, Energy Metabolism, Heart Rate, Humans, Rest, Running, Sleep, Wrist, Reproducibility of Results, Walking, Photoplethysmography, Resistance Training, Accelerometry
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