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Accuracy of wearable heart rate monitors in cardiac rehabilitation.

ABSTRACT: 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 (rc=0.99) followed by the Apple Watch (rc=0.80), Fitbit Blaze (rc=0.78), TomTom Spark (rc=0.76) and Garmin Forerunner (rc=0.52). There was variability in accuracy under different exercise conditions. On the treadmill, only the Fitbit Blaze performed well (rc=0.76), while on the stationary cycle, Apple Watch (rc=0.89) and TomTom Spark (rc=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.

SUBMITTER: Etiwy M

PROVIDER: S-EPMC6603497 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Accuracy of wearable heart rate monitors in cardiac rehabilitation.

Etiwy Muhammad M Akhrass Zade Z Gillinov Lauren L Alashi Alaa A Wang Robert R Blackburn Gordon G Gillinov Stephen M SM Phelan Dermot D Gillinov A Marc AM Houghtaling Penny L PL Javadikasgari Hoda H Desai Milind Y MY

Cardiovascular diagnosis and therapy 20190601 3

<h4>Background</h4>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).<h4>Methods</h4>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 rand ...[more]

PMID: 31275816

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Project description:BACKGROUND:Wearable fitness trackers are devices that can record and enhance physical activity among users. Recently, photoplethysmography (PPG) devices that use optical heart rate sensors to detect heart rate in real time have become popular and help in monitoring and controlling exercise intensity. Although the benefits of using optical heart rate monitors have been highlighted through studies, the accuracy of the readouts these commercial devices generate has not been widely assessed for different age groups, especially for the East Asian population with Fitzpatrick skin type III or IV. OBJECTIVE:This study aimed to examine the accuracy of 2 wearable fitness trackers with PPG to monitor heart rate in real time during moderate exercise in young and older adults. METHODS:A total of 20 young adults and 20 older adults were recruited for this study. All participants were asked to undergo a series of sedentary and moderate physical activities using indoor aerobic exercise equipment. In this study, the Polar H7 chest-strapped heart rate monitor was used as the criterion measure in 2 fitness trackers, namely Xiaomi Mi Band 2 and Garmin Vivosmart HR+. The real-time, second-by-second heart rate data obtained from both devices were recorded using the broadcast heart rate mode. To critically analyze the results, multiple statistical parameters including the mean absolute percentage error (MAPE), Lin concordance correlation coefficient (CCC), intraclass correlation coefficient, the Pearson product moment correlation coefficient, and the Bland-Altman coefficient were determined to examine the performances of the devices. RESULTS:Both test devices exhibited acceptable overall accuracy as heart rate sensors based on several statistical tests. Notably, the MAPE values were below 10% (the designated threshold) in both devices (GarminYoung=3.77%; GarminSenior=4.73%; XiaomiYoung=7.69%; and XiaomiSenior=6.04%). The scores for reliability test of CCC for Garmin were 0.92 (Young) and 0.80 (Senior), whereas those for Xiaomi were 0.76 (Young) and 0.73 (Senior). However, the results obtained using the Bland-Altman analysis indicated that both test optical devices underestimated the average heart rate. More importantly, the study documented some unexpected outlier readings reported by these devices when used on certain participants. CONCLUSIONS:The study reveals that commonly used optical heart rate sensors, such as the ones used herein, generally produce accurate heart rate readings irrespective of the age of the user. However, users should avoid relying entirely on these readings to indicate exercise intensities, as these devices have a tendency to produce erroneous, extreme readings, which might misinterpret the real-time exercise intensity. Future studies should therefore emphasize the occurrence rate of such errors, as this will likely benefit the development of improved models of heart rate sensors.

Dataset Information

Accuracy of wearable heart rate monitors in cardiac rehabilitation.

Publications

Accuracy of wearable heart rate monitors in cardiac rehabilitation.

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