Cited by 373Heart Rate Variability and Autonomic ControlNon-Invasive Vital Sign MonitoringCardiovascular and exercise physiology

The DOI matches its Crossref record; 37 of the 38 references it cites were found in a registry or an index; none of the 18 sources its claims cite is checked for support yet.

Validity of the Polar H10 Sensor for Heart Rate Variability Analysis during Resting State and Incremental Exercise in Recreational Men and Women

Open access

Abstract

Heart rate variability (HRV) is frequently applied in sport-specific settings. The rising use of freely accessible applications for its recording requires validation processes to ensure accurate data. It is the aim of this study to compare the HRV data obtained by the Polar H10 sensor chest strap device and an electrocardiogram (ECG) with the focus on RR intervals and short-term scaling exponent alpha 1 of Detrended Fluctuation Analysis (DFA a1) as non-linear metric of HRV analysis. A group of 25 participants performed an exhaustive cycling ramp with measurements of HRV with both recording systems. Average time between heartbeats (RR), heart rate (HR) and DFA a1 were recorded before (PRE), during, and after (POST) the exercise test. High correlations were found for the resting conditions (PRE: r = 0.95, rc = 0.95, ICC3,1 = 0.95, POST: r = 0.86, rc = 0.84, ICC3,1 = 0.85) and for the incremental exercise (r > 0.93, rc > 0.93, ICC3,1 > 0.93). While PRE and POST comparisons revealed no differences, significant bias could be found during the exercise test for all variables (p < 0.001). For RR and HR, bias and limits of agreement (LoA) in the Bland–Altman analysis were minimal (RR: bias of 0.7 to 0.4 ms with LoA of 4.3 to −2.8 ms during low intensity and 1.3 to −0.5 ms during high intensity, HR: bias of −0.1 to −0.2 ms with LoA of 0.3 to −0.5 ms during low intensity and 0.4 to −0.7 ms during high intensity). DFA a1 showed wider bias and LoAs (bias of 0.9 to 8.6% with LoA of 11.6 to −9.9% during low intensity and 58.1 to −40.9% during high intensity). Linear HRV measurements derived from the Polar H10 chest strap device show strong agreement and small bias compared with ECG recordings and can be recommended for practitioners. However, with respect to DFA a1, values in the uncorrelated range and during higher exercise intensities tend to elicit higher bias and wider LoA.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In 25 recreational men and women, the Polar H10 chest strap with Elite HRV showed near-perfect agreement with a 12-channel ECG for RR and HR at rest and during incremental cycling, with small bias despite significant exercise differences. DFA a1 agreement was high but weaker, with wider bias and limits of agreement, especially at higher exercise intensities.

Key findings

  • Linear HRV measures showed near-perfect agreement: PRE/POST RR and HR had r = 1.00, rc = 1.00, ICC3,1 = 1.00, and incremental exercise also had r = 1.00, rc = 1.00, ICC3,1 = 1.00. Resting PRE/POST comparisons showed no significant differences, while exercise comparisons showed significant bias for all variables (p < 0.001).
  • DFA a1 correlations were high but comparatively weaker: PRE/POST r > 0.86, rc > 0.84, ICC3,1 > 0.85; incremental exercise r > 0.93, rc > 0.93, ICC3,1 > 0.93, with significant differences during exercise (p < 0.001).
  • DFA a1 bias and limits of agreement were wider than for linear measures: PRE bias −2.1%, POST bias 2.5%; during exercise, low intensity bias 0.9% with LoA 11.6 to −9.9%, and high intensity bias 8.6% with LoA 58.1 to −40.9%.
  • DFA a1 index values were approximately 6% and 7.5% higher for Polar H10 at fixed values of 0.75 and 0.5 compared with ECG, so threshold boundaries were crossed at higher HRs when using Polar H10.

Methods

  • Cross-sectional validation study: 25 participants (men n = 14, age 40 ± 14 years; women n = 11, age 34 ± 10 years) performed an exhaustive cycling ramp with simultaneous Polar H10/Elite HRV and 12-channel ECG recordings before (PRE), during, and after (POST) exercise.
  • RR, HR, and DFA a1 were analyzed in Kubios HRV Premium 3.5.0; resting analyses used a 2-min window, exercise used a 2-min moving window with 20-s grid, and datasets with artefacts >5% were excluded.
  • Agreement was assessed with linear regression, Pearson’s r, Lin’s concordance correlation coefficient, ICC3,1, R², SEE, Bland–Altman LoA, paired t-test or Wilcoxon signed ranks test, and Cohen’s d, with significance at p ≤ 0.05.

Limitations

  • Stated by the paper: the study did not group samples by individual personal characteristics; future studies could examine whether body composition, gender, age, or ventricular characteristics influence outcomes.
  • Stated by the paper: the Polar H10 stores RR intervals but not ECG waveforms, so excessive artefacts cannot be identified or corrected, and noise cannot be differentiated from cardiac arrhythmia; five participants were excluded from exercise analysis and two from resting POST measurement due to artefacts >5%.
  • Stated by the paper: raw data were analyzed with Kubios HRV Premium using automatic artefact correction, and the free standard Kubios version with threshold-based correction could yield slightly different results; the text also makes evident that device and lead placement differences prevent attributing discrepancies to a single variable.

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Integrity signals

Registry

Crossref · 10.3390/s22176536

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure A1 Figure A1. Representative participant ECG waveforms and background noise during 6 s windows using Kubios HRV software Premium. (A) Pre incremental ramp, HR of 65 bpm. (B) During incremental ramp just prior to exhaustion, HR of 180 bpm. (C) Post incremental ramp, HR of 92 bpm.
Figure A1 Figure A1. Representative participant ECG waveforms and background noise during 6 s windows using Kubios HRV software Premium. (A) Pre incremental ramp, HR of 65 bpm. (B) During incremental ramp just prior to exhaustion, HR of 180 bpm. (C) Post incremental ramp, HR of 92 bpm.CC BY · PubMed Central
Figure 1 Flow chart of the methodical procedure.
Figure 1 Flow chart of the methodical procedure.CC BY · PubMed Central
Figure 2 Placement of 12-channel ECG electrodes and Polar H10 chest strap device. V1 = 4th intercostal space at the right border of the sternum, V2 = 4th intercostal space at the left border of the sternum, V3 = midway between locations V2 and V4, V4 = at the mid-clavicular line in the 5th intercostal space, V5 = at the anterior axillary line in the same horizontal level as V4, V6 = at the mid-axillary line on the same horizontal level as V4 and V5. Limb leads of the right arm (RA) and left arm (LA) outwardly on the shoulders and right leg (RL) and left leg (LL) leads at the lower edge of the ribcage.
Figure 2 Placement of 12-channel ECG electrodes and Polar H10 chest strap device. V1 = 4th intercostal space at the right border of the sternum, V2 = 4th intercostal space at the left border of the sternum, V3 = midway between locations V2 and V4, V4 = at the mid-clavicular line in the 5th intercostal space, V5 = at the anterior axillary line in the same horizontal level as V4, V6 = at the mid-axillary line on the same horizontal level as V4 and V5. Limb leads of the right arm (RA) and left arm (LA) outwardly on the shoulders and right leg (RL) and left leg (LL) leads at the lower edge of the ribcage.CC BY · PubMed Central
Figure 3 Regression plots for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during PRE and POST the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Slope, coefficient of determination (R2), standard error of estimate (SEE), and p-value shown in the bottom right plot.
Figure 3 Regression plots for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during PRE and POST the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Slope, coefficient of determination (R2), standard error of estimate (SEE), and p-value shown in the bottom right plot.CC BY · PubMed Central
Figure 4 Bland–Altman analysis for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during PRE and POST the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Center solid line in each plot represents the mean bias (difference) between each paired value as absolute (RR, HR) or relative values (DFA a1). The top and bottom dashed lines are 1.96 standard deviations from the mean difference.
Figure 4 Bland–Altman analysis for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during PRE and POST the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Center solid line in each plot represents the mean bias (difference) between each paired value as absolute (RR, HR) or relative values (DFA a1). The top and bottom dashed lines are 1.96 standard deviations from the mean difference.CC BY · PubMed Central
Figure 5 Regression Plots for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Slope, coefficient of determination (R2), standard error of estimate (SEE), and p-value are shown in the bottom right of each plot.
Figure 5 Regression Plots for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Slope, coefficient of determination (R2), standard error of estimate (SEE), and p-value are shown in the bottom right of each plot.CC BY · PubMed Central
Figure 6 Bland–Altman analysis for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Center solid line in each plot represents the mean bias (difference) between each paired value as absolute (RR, HR) or relative values (DFA a1). The top and bottom dashed lines are 1.96 standard deviations from the mean difference.
Figure 6 Bland–Altman analysis for the comparison of the ECG (ECG) and the Polar H10 sensor chest strap device (H10) during the incremental exercise test for RR (A), HR (B) and DFA a1 (C). Center solid line in each plot represents the mean bias (difference) between each paired value as absolute (RR, HR) or relative values (DFA a1). The top and bottom dashed lines are 1.96 standard deviations from the mean difference.CC BY · PubMed Central
Figure 7 (A) Modified Kubios HRV Premium software output of the raw data of the Polar H10 in one female participant during incremental cycling ramp; the measurement window from minute 12 to 14 indicated artifacts over 6%. (B) Evaluation of the lead 2 ECG waveform recordings during the same measurement window, there could be found some runs of atrial premature complexes (APC, red circles) pointing to the artifacts not really being artifacts and the pitfall of a mere RR recording.
Figure 7 (A) Modified Kubios HRV Premium software output of the raw data of the Polar H10 in one female participant during incremental cycling ramp; the measurement window from minute 12 to 14 indicated artifacts over 6%. (B) Evaluation of the lead 2 ECG waveform recordings during the same measurement window, there could be found some runs of atrial premature complexes (APC, red circles) pointing to the artifacts not really being artifacts and the pitfall of a mere RR recording.CC BY · PubMed Central
Figure 8 Course of DFA a1 during incremental cycling ramp until voluntary exhaustion, including 3 min of warm-up at 50 W and 5 min cool-down of unloaded pedaling (vertical lines mark the start of the incremental test and voluntary exhaustion) wearing a 12-channel ECG (lead 2 and 3 depicted), a Polar H10 sensor chest strap device, and a Movesense Medical sensor single channel ECG chest strap device. (A) Good agreement between both chest strap devices and ECG lead 3 in a male participant with ECG lead 2 showing up to 50% divergence from the Polar H10 sensor (artifacts 2% during the marked range; black line). (B) Female participant with excellent agreement in all four signal sources. (C) Female participant showing high artifacts (>5%) in the marked range (black line) and deviations between all 4 devices. (D) Obese participant with artifacts >5% in the marked range (black line) for ECG Lead 2 and 3 with a subsequent complete loss of the signals. However, minimal artefacts in Polar H10 and Movesense Medical sensor (<1%).
Figure 8 Course of DFA a1 during incremental cycling ramp until voluntary exhaustion, including 3 min of warm-up at 50 W and 5 min cool-down of unloaded pedaling (vertical lines mark the start of the incremental test and voluntary exhaustion) wearing a 12-channel ECG (lead 2 and 3 depicted), a Polar H10 sensor chest strap device, and a Movesense Medical sensor single channel ECG chest strap device. (A) Good agreement between both chest strap devices and ECG lead 3 in a male participant with ECG lead 2 showing up to 50% divergence from the Polar H10 sensor (artifacts 2% during the marked range; black line). (B) Female participant with excellent agreement in all four signal sources. (C) Female participant showing high artifacts (>5%) in the marked range (black line) and deviations between all 4 devices. (D) Obese participant with artifacts >5% in the marked range (black line) for ECG Lead 2 and 3 with a subsequent complete loss of the signals. However, minimal artefacts in Polar H10 and Movesense Medical sensor (<1%).CC BY · PubMed Central

Verification

Claims the paper makes

14 Not checked yet · 14 Own result · 10 Own interpretation · 6 Own method · 2 No basis given

Verify all 18 references — free account

Show all 18 claims

  • It may state two separate claims as one. 11
  • Probably not a substantial claim. 22
28 of 28
  • The paper relies on this without support.

    To date no validation has been conducted for non-linear measures of HRV.

    “In addition to the requirement to perform population-based validations, to date no validation has been conducted for non-linear measures of HRV.”
  • The paper relies on this without support.

    Researchers and recreational athletes frequently use the Polar H10 device for data collection and rely on appropriate measurements.

    “since researchers and recreational athletes frequently use this device for data collection and therefore rely on appropriate measurements.”
  • The paper relies on this without support.

    The Polar H10 only stores RR intervals and not ECG waveform recordings.

    “Since the Polar H10 only stores RR intervals and not ECG waveform recordings”
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Metadata

Authors
Schaffarczyk, M., Rogers, B., Reer, R., & Gronwald, T.
Affiliations
  • Universität Hamburg (DE)
  • University of Central Florida (US)
  • MSH Medical School Hamburg – University of Applied Sciences and Medical University (DE)
Corresponding author
Schaffarczyk, Marcelle
Venue
Sensors
Publisher
MDPI AG
Published
2022-08-30
Volume
22
Issue
17
Pages
6536
ISSN
1424-8220 (ISSN-L)
OpenAlex
W4293715556
Cited by
349
References
38
Citations by year
2026: 132 · 2025: 108 · 2024: 75 · 2023: 32 · 2022: 2
FWCI
37.75
Type
journal article
Language
en
Open access
Locations
  • Sensors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
Keywords
heart rate variability, electrocardiogram comparison, RR interval, incremental exercise, measurement bias, limits of agreement, recreational athletes, sex differences
MeSH terms
Bicycling, Electrocardiography, Exercise Test, Female, Heart Rate, Humans, Male, Exercise

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