Accuracy of consumer-level and research-grade activity trackers in ambulatory settings in older adults
Open accessAbstract
Wrist-worn activity trackers have experienced a tremendous growth lately and studies on the accuracy of mainstream trackers used by older adults are needed. This study explores the performance of six trackers (Fitbit Charge2, Garmin VivoSmart HR+, Philips Health Watch, Withings Pulse Ox, ActiGraph GT9X-BT, Omron HJ-72OITC) for estimating: steps, travelled distance, and heart-rate measurements for a cohort of older adults. Eighteen older adults completed a structured protocol involving walking tasks, simulated household activities, and sedentary activities. Less standardized activities were also included, such as: dusting, using a walking aid, or playing cards, in order to simulate real-life scenarios. Wrist-mounted and chest/waist-mounted devices were used. Gold-standards included treadmill, ECG-based chest strap, direct observation or video recording according to the activity and parameter. Every tracker showed a decreasing accuracy with slower walking speed, which resulted in a significant step under-counting. A large mean absolute percentage error (MAPE) was found for every monitor at slower walking speeds with the lowest reported MAPE at 2 km/h being 7.78%, increasing to 20.88% at 1.5 km/h, and 44.53% at 1 km/h. During household activities, the MAPE climbing up/down-stairs ranged from 8.38-19.3% and 10.06-19.01% (dominant and non-dominant arm), respectively. Waist-worn devices showed a more uniform performance. However, unstructured activities (e.g. dusting, playing cards), and using a walking aid represent a challenge for all wrist-worn trackers as evidenced by large MAPE (> 57.66% for dusting, > 67.32% when using a walking aid). Poor performance in travelled distance estimation was also evident during walking at low speeds and climbing up/down-stairs (MAPE > 71.44% and > 48.3%, respectively). Regarding heart-rate measurement, there was no significant difference (p-values > 0.05) in accuracy between trackers placed on the dominant or non-dominant arm. Concordant with existing literature, while the mean error was limited (between -3.57 bpm and 4.21 bpm), a single heart-rate measurement could be underestimated up to 30 beats-per-minute. This study showed a number of limitations of consumer-level wrist-based activity trackers for older adults. Therefore caution is required when used, in healthcare or in research settings, to measure activity in older adults.
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In healthy older adults, Fitbit Charge 2 showed good reliability during treadmill and overground bouts and poor reliability during hand movement tasks such as dusting [58].
“In the examination of interdevice reliability in healthy older adults, Fitbit Charge 2 showed good reliability during treadmill and overground bouts and poor reliability during hand movement tasks such as dusting [58].”
From Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review (2020) · cites this paper as [58]
Three studies (23 comparisons) examined interdevice reliability for heart rate, with analyzed sample sizes ranging from 13 to 21.
“Three studies (23 comparisons) examined interdevice reliability for heart rate [24,26,58], with analyzed sample sizes ranging from 13 [24] to 21 [26].”
From Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review (2020) · cites this paper as [58]
During the same tasks, Garmin Vivosmart HR+ showed good reliability during all tasks and had narrower limits of agreement than Fitbit.
“During the same tasks, Garmin Vivosmart HR+ showed good reliability during all tasks and had narrower limits of agreement than Fitbit.”
From Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review (2020) · cites this paper as [58]
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- Authors
- Tedesco, S., Sica, M., Ancillao, A., Timmons, S., Barton, J., & O’Flynn, B.
- Affiliations
- University College Cork (IE)
- Corresponding author
- Tedesco, Salvatore
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-05-21
- Volume
- 14
- Issue
- 5
- Pages
- e0216891
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6529154
- OpenAlex
- W2946778292
- Cited by
- 116
- References
- 54
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 13 · 2023: 18 · 2022: 17 · 2021: 25 · 2020: 23 · 2019: 2
- FWCI
- 11.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Cork Open Research Archive (University College Cork, Ireland) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- H2020 Societal Challenges (689996)
- Science Foundation Ireland (13/RC/2077)
- Interreg (SenDOC)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- wearable activity trackers, older adults, device accuracy, step counting, distance estimation, heart rate monitoring, walking speed, stair climbing, housework, sedentary activity, walking aids, wrist-worn devices, ambulatory monitoring, Fitbit, Garmin, ActiGraph, Omron, ActiGraph GT9X
- MeSH terms
- Wearable Electronic Devices, Activities of Daily Living, Aged, Exercise Test, Female, Heart Rate, Humans, Male, Video Recording, Walking
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