Validity of heart rate measurements in wrist-based monitors across skin tones during exercise
Open accessAbstract
Purpose: To evaluate the accuracy of a wrist-based heart rate (HR) monitor at different exercise intensities across different skin tones. Methods: Using a cross-sectional design, we compared HR measures from the wrist-based photoplethysmography Fitbit Charge 5 to the Polar H10 chest strap at rest and during the YMCA Protocol using a recumbent cycle ergometer. Participant were grouped into three skin tone categories: light (Fitzpatrick Scale Skin Types 1+2), medium (Types 3+4), and darker skin tone (Types 5+6). HR measures using the Polar chest strap during the exercise test were categorized as <40%, 40–60%, or >60% HR reserve (HRR). Absolute error in beats per minute (bpm) between the two devices was calculated for each measure. A linear mixed effects model was used to assess interaction effects between skin tone and exercise intensity, with participants as the random effect. Bland-Altman plots were used for visual analyses. Results: Twenty-five participants [mean (SD): 25.8 (1.9) years old; 64% female] were included with 495 observations of simultaneous Fitbit and Polar HR recordings collected during exercise. During exercise, we observed a statistically significant interaction effect between skin tone and exercise intensity. Compared with light skin tone at <40% HRR, mean error was greater for medium skin tone at >60% HRR [mean error (95%CI): 11.8 (5.6–17.9) bpm, p<0.001] and darker skin tone at 40–60% HRR [7.6 (1.7–13.5) bpm, p = 0.011] and >60% HRR [11.7 (5.3–18.0) bpm, p<0.001]. Conclusion: HR measurement error using a wrist-based device was greater with increasing exercise intensity for people with darker skin tones.
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Studies using recumbent cycling have demonstrated that errors in HR measurement persist and increase with rising intensity, even with reduced limb movement.
“Studies using recumbent cycling have demonstrated that errors in HR measurement not only persist but actually increase with rising intensity, even with reduced limb movement [28].”
From PPG-Based Heart Rate Accuracy in Hispanic Adults with Fitzpatrick III–V Skin Tones: An Evaluation of Body Composition and Skin-Tone Effects (2026) · cites this paper as [28]
The Study procedures and Discussion sections say the researchers used a recumbent bike to reduce arm movement and still observed HR measurement errors as exercise intensity increased. However, the Discussion specifies that the increase occurred predominantly in participants with darker skin tones, not lighter skin tones; the citing sentence omits that qualification. Page numbers are not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThis pattern is consistent with optical absorption by melanin in the green band and reduced pulsatile content reaching the photodiode.
“consistent with optical absorption by melanin in the green band and reduced pulsatile content reaching the photodiode [10,11,28].”
From PPG-Based Heart Rate Accuracy in Hispanic Adults with Fitzpatrick III–V Skin Tones: An Evaluation of Body Composition and Skin-Tone Effects (2026) · cites this paper as [28]
The Introduction (page unavailable) says melanin absorbs green light and reduces reflection, potentially affecting PPG signal accuracy. The Discussion (page unavailable) suggests this may impair detection of pulsatile signal changes, but does not establish that reduced pulsatile content reaches the photodiode; it says the mechanism requires further research. (LLM, conf=0.84)
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- Authors
- Hung, S. H., Serwa, K., Rosenthal, G., & Eng, J. J.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Eng, Janice J.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2025-02-10
- Volume
- 20
- Issue
- 2
- Pages
- e0318724
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC11809914
- OpenAlex
- W4407317618
- Cited by
- 21
- References
- 52
- Citations by year
- 2026: 14 · 2025: 7
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canada Research Chairs
- Michael Smith Health Research BC
- Canadian Institutes of Health Research Foundation Grant (143340)
- 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
- heart rate monitoring, wrist-worn devices, photoplethysmography, skin tone, Fitzpatrick skin type, exercise intensity, measurement error, chest strap, Fitbit, Polar H10
- MeSH terms
- Adult, Cross-Sectional Studies, Exercise Test, Female, Heart Rate, Humans, Male, Skin Pigmentation, Wrist, Exercise, Photoplethysmography, Young Adult
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