A review on wearable photoplethysmography sensors and their potential future applications in health care
Open accessAbstract
Photoplethysmography (PPG) is an uncomplicated and inexpensive optical measurement method that is often used for heart rate monitoring purposes. PPG is a non-invasive technology that uses a light source and a photodetector at the surface of skin to measure the volumetric variations of blood circulation. Recently, there has been much interest from numerous researchers around the globe to extract further valuable information from the PPG signal in addition to heart rate estimation and pulse oxymetry readings. PPG signal's second derivative wave contains important health-related information. Thus, analysis of this waveform can help researchers and clinicians to evaluate various cardiovascular-related diseases such as atherosclerosis and arterial stiffness. Moreover, investigating the second derivative wave of PPG signal can also assist in early detection and diagnosis of various cardiovascular illnesses that may possibly appear later in life. For early recognition and analysis of such illnesses, continuous and real-time monitoring is an important approach that has been enabled by the latest technological advances in sensor technology and wireless communications. The aim of this article is to briefly consider some of the current developments and challenges of wearable PPG-based monitoring technologies and then to discuss some of the potential applications of this technology in clinical settings.
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Many sensors lack algorithms to effectively separate weak physiological signals from background noise in darker skin tones, further lowering accuracy.
“Many sensors lack algorithms to effectively separate weak physiological signals from background noise in darker skin tones, further lowering accuracy [20].”
From Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring (2025) · cites this paper as [20]
The Introduction (page unavailable) says environmental noise can affect PPG signal acquisition and heart-rate estimation accuracy. The Discussion (page unavailable) describes signal-processing approaches to reducing motion artifacts. Neither passage supports the claim that many sensors lack effective algorithms for darker skin tones or that this specifically lowers accuracy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPPG detects heart rate by measuring light absorption and reflection occurring within the skin's microvascular bed during blood pulses.
“Photoplethysmography (PPG) detects heart rate by measuring light absorption and reflection occurring within the skin's microvascular bed during blood pulses according to [20].”
From Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring (2025) · cites this paper as [20]
Weaker signals and increased scattering from darker skin degrade measurement accuracy.
“This results in weaker signals and increased scattering, which degrade measurement accuracy [19,20].”
From Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring (2025) · cites this paper as [20]
The Introduction’s “Factors affecting PPG sensor recordings” section says that anatomy and tissue differences can change how light propagates and alter the signal. But our copy does not link darker skin to weaker signals, increased scattering, or degraded measurement accuracy. Searches for skin pigmentation, melanin, scattering, and measurement accuracy did not find that link. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSkin pigmentation affects light absorption and reflection such that darker skin tones reduce sensor signal detection capabilities and increase misread errors.
“Skin pigmentation affects light absorption and reflection rates such that darker skin tones reduce sensor signal detection capabilities while increasing misread errors.”
From Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring (2025) · cites this paper as [20]
The Introduction’s “PPG sensors” section describes how sensors detect reflected light, and “Factors affecting PPG sensor recordings” discusses other sources of signal variation. Neither section addresses skin pigmentation, darker skin tones, or increased misread errors; searches for those terms found no supporting passage in our copy. No page numbers were available. (LLM, conf=0.72)
Experimental — accuracy not yet measuredSocioeconomic disparities in access to smartwatches may interact with skin-tone-related bias, raising additional equity concerns.
“However, regional variations may exist, and socioeconomic disparities in access to these devices may further interact with skin-tone-related bias, raising additional equity concerns [17-23].”
From Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring (2025) · cites this paper as [20]
The Introduction discusses consumer interest in smartwatches, and the 'Factors affecting PPG sensor recordings' section discusses anatomical and movement-related effects; neither addresses socioeconomic access or skin-tone-related bias. Searches for disparities in smartwatch access and for skin pigmentation or skin-tone bias found no passage linking those concerns. Page numbers were not available in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
Differences in the interaction of light with human tissues at differing wavelengths is exploited to provide information including oxygen saturation, blood pressure, and other cardiovascular-related diseases.
“Differences in the interaction of light with human tissues at differing wavelengths is exploited to provide information including oxygen saturation, blood pressure, and more recently other cardiovascular-related diseases.131”
From Effect of skin color on optical properties and the implications for medical optical technologies: a review (2024) · cites this paper as [131]
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“Another suspected measurement error in wrist-worn devices is motion artifact, which is typically caused by displacement of the PPG sensor over the skin, changes in skin deformation, blood flow dynamics, and ambient temperature.(33,34) Motion artifacts may manifest as missing or false beats which result in incorrect HR…”
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El Atrache, R., Tamilia, E., Mohammadpour Touserkani, F., Hammond, S., Papadelis, C., Kapur, K., Jackson, M., Bucciarelli, B., Tsuboyama, M., Sarkis, R. A., et al. (2020) · Epilepsia · doi:10.1111/epi.16621 · Cited by 16 · see citing works
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- Authors
- Ghamari, M.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- Ghamari, Mohammad
- ORCID
- Ghamari, Mohammad
- Venue
- International Journal of Biosensors & Bioelectronics
- Publisher
- MedCrave Group Kft.
- Published
- 2018
- Volume
- 4
- Issue
- 4
- Pages
- 195-202
- ISSN
- 2573-2838 (ISSN-L)
- PMC
- PMC6426305
- OpenAlex
- W2894956427
- Cited by
- 945
- References
- 101
- Citations by year
- 2026: 60 · 2025: 141 · 2024: 168 · 2023: 184 · 2022: 152 · 2021: 136 · 2020: 80 · 2019: 22 · 2018: 1
- FWCI
- 23.87
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- International Journal of Biosensors & Bioelectronics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion, cc-by-nc)
- PubMed Central (acceptedVersion, cc-by-nc)
- Funders
- National Institute of General Medical Sciences (UL1GM118970, TL4GM118971, RL5GM118969)
- National Institute on Minority Health and Health Disparities (RL5MD009592)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- photoplethysmography, wearable sensors, heart rate monitoring, pulse oximetry, atherosclerosis, arterial stiffness, early detection of cardiovascular disease, wireless health monitoring
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