Variable Accuracy of Wearable Heart Rate Monitors during Aerobic Exercise
Abstract
PURPOSE: Athletes and members of the public increasingly rely on wearable HR monitors to guide physical activity and training. The accuracy of newer, optically based monitors is unconfirmed. We sought to assess the accuracy of five optically based HR monitors during various types of aerobic exercise. METHODS: Fifty healthy adult volunteers (mean ± SD age = 38 ± 12 yr, 54% female) completed exercise protocols on a treadmill, a stationary bicycle, and an elliptical trainer (±arm movement). Each participant underwent HR monitoring with an electrocardiogaphic chest strap monitor (Polar H7), forearm monitor (Scosche Rhythm+), and two randomly assigned wrist-worn HR monitors (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, and TomTom Spark Cardio), one on each wrist. For each exercise type, HR was recorded at rest, light, moderate, and vigorous intensity. Agreement between HR measurements was assessed using Lin's concordance correlation coefficient (rc). RESULTS: Across all exercise conditions, the chest strap monitor (Polar H7) had the best agreement with ECG (rc = 0.996) followed by the Apple Watch (rc = 0.92), the TomTom Spark (rc = 0.83), and the Garmin Forerunner (rc = 0.81). Scosche Rhythm+ and Fitbit Blaze were less accurate (rc = 0.75 and rc = 0.67, respectively). On treadmill, all devices performed well (rc = 0.88-0.93) except the Fitbit Blaze (rc = 0.76). While bicycling, only the Garmin, Apple Watch, and Scosche Rhythm+ had acceptable agreement (rc > 0.80). On the elliptical trainer without arm levers, only the Apple Watch was accurate (rc = 0.94). None of the devices was accurate during elliptical trainer use with arm levers (all rc < 0.80). CONCLUSION: The accuracy of wearable, optically based HR monitors varies with exercise type and is greatest on the treadmill and lowest on elliptical trainer. Electrode-containing chest monitors should be used when accurate HR measurement is imperative.
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Other 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 [46]
Motion artifacts and level of physical activity are two related factors identified as influencing wearable heart rate accuracy.
“two related factors identified as influencing wearable HR accuracy are motion artifacts23 and level of physical activity46.”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [46]
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- Authors
- GILLINOV, S., ETIWY, M., WANG, R., BLACKBURN, G., PHELAN, D., GILLINOV, A. M., HOUGHTALING, P., JAVADIKASGARI, H., & DESAI, M. Y.
- Affiliations
- Cleveland Clinic (US)
- ORCID
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2017-08
- Volume
- 49
- Issue
- 8
- Pages
- 1697-1703
- ISSN
- 0195-9131 (ISSN-L)
- OpenAlex
- W2597782088
- Cited by
- 345
- References
- 15
- Citations by year
- 2026: 23 · 2025: 30 · 2024: 28 · 2023: 52 · 2022: 42 · 2021: 52 · 2020: 49 · 2019: 35 · 2018: 28 · 2017: 4
- FWCI
- 14.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- wearable heart rate monitor, heart rate accuracy, aerobic exercise, wrist-worn devices, treadmill exercise, stationary cycling, elliptical trainer, exercise intensity, Apple Watch, Fitbit
- MeSH terms
- Adult, Equipment Design, Female, Heart, Humans, Male, Prospective Studies, Exercise, Electrocardiography, Ambulatory, Optical Phenomena
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