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Accuracy of Heart Rate Watches: Implications for Weight Management
Open accessAbstract
BACKGROUND: Wrist-worn monitors claim to provide accurate measures of heart rate and energy expenditure. People wishing to lose weight use these devices to monitor energy balance, however the accuracy of these devices to measure such parameters has not been established. AIM: To determine the accuracy of four wrist-worn devices (Apple Watch, Fitbit Charge HR, Samsung Gear S and Mio Alpha) to measure heart rate and energy expenditure at rest and during exercise. METHODS: Twenty-two healthy volunteers (50% female; aged 24 ± 5.6 years) completed ~1-hr protocols involving supine and seated rest, walking and running on a treadmill and cycling on an ergometer. Data from the devices collected during the protocol were compared with reference methods: electrocardiography (heart rate) and indirect calorimetry (energy expenditure). RESULTS: None of the devices performed significantly better overall, however heart rate was consistently more accurate than energy expenditure across all four devices. Correlations between the devices and reference methods were moderate to strong for heart rate (0.67-0.95 [0.35 to 0.98]) and weak to strong for energy expenditure (0.16-0.86 [-0.25 to 0.95]). All devices underestimated both outcomes compared to reference methods. The percentage error for heart rate was small across the devices (range: 1-9%) but greater for energy expenditure (9-43%). Similarly, limits of agreement were considerably narrower for heart rate (ranging from -27.3 to 13.1 bpm) than energy expenditure (ranging from -266.7 to 65.7 kcals) across devices. CONCLUSION: These devices accurately measure heart rate. However, estimates of energy expenditure are poor and would have implications for people using these devices for weight loss.
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![Fig 3 Bland-Altman plots for device [(A) Apple Watch; N = 22, (B) Fitbit Charge HR; N = 22, (C) Samsung Gear S; N = 22, (D) Mio ALPHA; N = 22] and electrocardiography (reference) average heart rate (bpm). The solid line represents the mean difference (bpm) between the two measures and the dashed lines are the 95% limits of agreement (bpm). Notes: bpm = beats per minute, LoA = limits of agreement, MD = mean difference.](/paper-figures/ec7329ed55e24deba7fd6b3688025697/accuracy-of-heart-rate-watches-implications-for-weight-management-figure-3.jpg)
![Fig 4 Bland-Altman plots for device [(A) Apple Watch; N = 22, (B) Fitbit Charge HR; N = 22, (C) Samsung Gear S; N = 19, (D) Mio ALPHA; N = 22] and METAMAX (reference) total energy expenditure (kcal). The solid line represents the mean difference (kcal) between the two measures and the dashed lines are the 95% limits of agreement (kcal). Notes: kcal = kilocalories, LoA = limits of agreement, MD = mean difference.](/paper-figures/0ff18f7ebafc4b36bad2d5daa198824a/accuracy-of-heart-rate-watches-implications-for-weight-management-figure-4.jpg)
![Fig 5 Bland-Altman plots for device [(A) Apple Watch; N = 21, (B) Fitbit Charge HR; N = 21, (C) Samsung Gear S; N = 20] and direct observation (reference) steps. The solid line represents the mean difference (steps) between the two measures and the dashed lines are the 95% limits of agreement (steps). Notes: LoA = limits of agreement, MD = mean difference.](/paper-figures/cfa0e8fbaba64507b721381b5ea24223/accuracy-of-heart-rate-watches-implications-for-weight-management-figure-5.jpg)
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In the citing paper
“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 [32]
Experimental — accuracy not yet measuredIn the citing paper
“Of those, all five found the Apple Watch to be more accurate than the other commercial devices [2, 9–12].”
From Accuracy of heart rate measurement with wrist-worn wearable devices in various skin tones: a systematic review (2023) · cites this paper as [12]
In the citing paper
“The remaining two studies showed mixed results.”
From Accuracy of heart rate measurement with wrist-worn wearable devices in various skin tones: a systematic review (2023) · cites this paper as [12]
In the citing paper
“Wallen et al. noted lower heart rate accuracy in participants with a Fitzpatrick scale score > 4 with the Apple Watch, but not in the other studied smartwatches [12].”
From Accuracy of heart rate measurement with wrist-worn wearable devices in various skin tones: a systematic review (2023) · cites this paper as [12]
In the citing paper
“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 [43]
In the citing paper
“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 [43]
In the citing paper
“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 [43]
In the citing paper
“Evidence is starting to accumulate on the importance of skin tone when it comes to accuracy and generalizability of wrist-worn wearable studies with darker skin tone (and tattoos) being found to be associated with reduced wrist-worn HR accuracy as they absorb more green light67, yet this is not found in all studies43,50.”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [43]
In the citing paper
“Inaccuracy of activity trackers may also lead individuals to overestimate their level of physical activity, limiting their effectiveness for lifestyle interventions [142,143].”
From Wearables and the Medical Revolution (2018) · cites this paper as [142]
In the citing paper
“Moreover, although the Apple Watch has become very popular, it has only been used in one validation study.”
From Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices (2017) · cites this paper as [18]
In the citing paper
“The Apple Watch was found to underestimate both heart rate and EE, with a tendency to underestimate calories expended by more than 100 calories [18].”
From Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices (2017) · cites this paper as [18]
In the citing paper
“Fitbit Charge HR has been found to underestimate heart rate and EE [18]”
From Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices (2017) · cites this paper as [18]
In the citing paper
“Apple Watch has been previously found to underestimate calories by more than 100 calories [18], whereas our study found the device to overestimate calories expended.”
From Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices (2017) · cites this paper as [18]
In the citing paper
“Most studies establishing validity only assess the overall physical activity intensity for an entire bout of physical activity [18].”
From Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices (2017) · cites this paper as [18]
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Citations
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Metadata
- Authors
- Wallen, M. P., Gomersall, S. R., Keating, S. E., Wisløff, U., & Coombes, J. S.
- Affiliations
- The University of Queensland (AU)
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Coombes, Jeff S.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-05-27
- Volume
- 11
- Issue
- 5
- Pages
- e0154420
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4883747
- OpenAlex
- W2395644623
- Cited by
- 336
- References
- 17
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 18 · 2023: 28 · 2022: 30 · 2021: 30 · 2020: 41 · 2019: 54 · 2018: 62 · 2017: 35 · 2016: 6
- FWCI
- 42.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- FedUni ResearchOnline (Federation University Australia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Coca-Cola
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- heart rate monitors, wrist-worn devices, energy expenditure, measurement accuracy, weight loss, wearable activity trackers, Apple Watch, Fitbit, physical activity, energy balance, indirect calorimetry, electrocardiogram
- MeSH terms
- Adult, Aged, Body Weight, Energy Metabolism, Female, Heart Rate, Humans, Male, Middle Aged, Monitoring, Physiologic, Wrist, Young Adult, Healthy Volunteers
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