Accuracy of wearable heart rate monitors in cardiac rehabilitation
Open accessAbstract
Background: To assess the accuracy of four wearable heart rate (HR) monitors in patients with established cardiovascular disease enrolled in phase II or III cardiac rehabilitation (CR). Methods: Eighty adult patients enrolled in phase II or III CR were monitored during a CR session that included exercise on a treadmill and/or stationary cycle. Participants underwent HR monitoring with standard ECG limb leads, an electrocardiographic (ECG) chest strap monitor (Polar H7), and two randomly assigned wrist-worn HR monitors (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, TomTom Spark Cardio), one on each wrist. HR was recorded at rest and at 3, 5, and 7 minutes of steady-state exercise on the treadmill and stationary cycle. Results: Across all exercise conditions, the chest strap monitor (Polar H7) had the best agreement with ECG (r c =0.99) followed by the Apple Watch (r c =0.80), Fitbit Blaze (r c =0.78), TomTom Spark (r c =0.76) and Garmin Forerunner (r c =0.52). There was variability in accuracy under different exercise conditions. On the treadmill, only the Fitbit Blaze performed well (r c =0.76), while on the stationary cycle, Apple Watch (r c =0.89) and TomTom Spark (r c =0.85) were most accurate. Conclusions: In cardiac patients, the accuracy of wearable, optically based HR monitors varies, and none of those tested was as accurate as an electrode-containing chest monitor. This observation has implications for in-home CR, as electrode-containing chest monitors should be used when accurate HR measurement is imperative.
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In patients with established heart disease undergoing phase II or phase III cardiac rehabilitation, the chest strap had the best concordance with standard ECG during all activities (Lin's concordance coefficient rc = 0.99).
“The chest strap had the best concordance with the standard ECG during all activities (Lin’s concordance coefficient rc = 0.99);”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [23]
In patients with established heart disease undergoing phase II or phase III cardiac rehabilitation, the accuracy of wrist-worn devices varied substantially by the type of activity and 5% of heart rate measurements were substantially inaccurate.
“the accuracy of wrist-worn devices varied substantially by the type of activity and 5% of HR measurements were substantially inaccurate23.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [23]
Four of the ten included studies found no difference in heart rate accuracy between participants of different skin tones.
“Four studies noted no effect of user skin tone on accuracy.”
From Accuracy of heart rate measurement with wrist-worn wearable devices in various skin tones: a systematic review (2023) · cites this paper as [9]
Etiwy et al. found the Apple Watch to follow ECG data with a correlation coefficient of 0.80, compared to 0.52 in Garmin devices.
“For instance, Etiwy et al. found the Apple Watch to follow ECG data with a correlation coefficient of 0.80, compared to 0.52 in Garmin devices [9].”
From Accuracy of heart rate measurement with wrist-worn wearable devices in various skin tones: a systematic review (2023) · cites this paper as [9]
All five studies that compared manufacturers found the Apple Watch to be more accurate than the other commercial devices.
“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 [9]
Etiwy et al. and Sanudo et al. found that skin color did not influence heart rate accuracy.
“Etiwy et al. and Sanudo et al. similarly found that skin color did not influence heart rate accuracy [1, 9].”
From Accuracy of heart rate measurement with wrist-worn wearable devices in various skin tones: a systematic review (2023) · cites this paper as [9]
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- Authors
- Etiwy, M., Akhrass, Z., Gillinov, L., Alashi, A., Wang, R., Blackburn, G., Gillinov, S. M., Phelan, D., Gillinov, A. M., Houghtaling, P. L., Javadikasgari, H., & Desai, M. Y.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Desai, Milind Y.
- ORCID
- Venue
- Cardiovascular Diagnosis and Therapy
- Publisher
- AME Publishing Company
- Published
- 2019-06
- Volume
- 9
- Issue
- 3
- Pages
- 262-271
- ISSN
- 2223-3652 (ISSN-L)
- 2223-3660
- PMC
- PMC6603497
- OpenAlex
- W2944738013
- Cited by
- 143
- References
- 33
- Citations by year
- 2026: 14 · 2025: 26 · 2024: 20 · 2023: 21 · 2022: 27 · 2021: 18 · 2020: 13 · 2019: 4
- FWCI
- 5.46
- Type
- journal article
- Language
- en
- Update notices
- erratum (2020-06-29)
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Cardiovascular Diagnosis and Therapy (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cleveland Clinic
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- wearable heart rate monitor, cardiac rehabilitation, heart rate accuracy, wrist-worn devices, Apple Watch, Fitbit, treadmill exercise, stationary cycling, cardiovascular disease
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