Can Wearable Devices Accurately Measure Heart Rate Variability? A Systematic Review
Open accessAbstract
BACKGROUND: A growing number of wearable devices claim to provide accurate, cheap and easily applicable heart rate variability (HRV) indices. This is mainly accomplished by using wearable photoplethysmography (PPG) and/or electrocardiography (ECG), through simple and non-invasive techniques, as a substitute of the gold standard RR interval estimation through electrocardiogram. Although the agreement between pulse rate variability (PRV) and HRV has been evaluated in the literature, the reported results are still inconclusive especially when using wearable devices. AIM: The purpose of this systematic review is to investigate if wearable devices provide a reliable and precise measurement of classic HRV parameters in rest as well as during exercise. MATERIALS AND METHODS: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases, as well as, through internet search. The 308 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. RESULTS: Eighteen studies were included. Sixteen of them integrated ECG - HRV technology and two of them PPG - PRV technology. All of them examined wearable devices accuracy in RV detection during rest, while only eight of them during exercise. The correlation between classic ECG derived HRV and the wearable RV ranged from very good to excellent during rest, yet it declined progressively as exercise level increased. CONCLUSIONS: Wearable devices may provide a promising alternative solution for measuring RV. However, more robust studies in non-stationary conditions are needed using appropriate methodology in terms of number of subjects involved, acquisition and analysis techniques implied.
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Pulse rate variability cannot yet be considered a surrogate of heart rate variability during exercise or stress.
“However, it cannot yet be considered to be a surrogate during exercise or stress [17], [129].”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [129]
Reviews have concluded that pulse rate variability is a good surrogate of heart rate variability for certain applications at rest.
“Nonetheless, reviews have concluded that PRV is a good surrogate of HRV for certain applications at rest.”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [129]
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- Authors
- Georgiou, K., Larentzakis, A. V., Khamis, N. N., Alsuhaibani, G. I., Alaska, Y. A., & Giallafos, E. J.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- King Saud University (SA)
- Venue
- Folia Medica
- Publisher
- Pensoft Publishers
- Published
- 2018-01-01
- Volume
- 60
- Issue
- 1
- Pages
- 7-20
- ISSN
- 0204-8043 (ISSN-L)
- 1314-2143
- OpenAlex
- W2801709500
- Cited by
- 244
- References
- 50
- Citations by year
- 2026: 17 · 2025: 29 · 2024: 36 · 2023: 34 · 2022: 37 · 2021: 33 · 2020: 33 · 2019: 20 · 2018: 3
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Folia Medica (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- 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 › ECG Monitoring and Analysis
- Keywords
- heart rate variability, wearable devices, photoplethysmography, electrocardiogram, pulse rate variability, physical activity, measurement accuracy, non-stationary conditions
- MeSH terms
- Wearable Electronic Devices, Electrocardiography, Heart Rate, Humans, Exercise, Photoplethysmography, Monitoring, Ambulatory
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