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Updated: Mar 22, 2026

Assessing the Accuracy of Fitness Smartwatch Data for Cardiovascular and Physical Activity Monitoring: A Validation Study in Digital Health
Published on: February 21, 2025
Validation of the Fitbit One® for physical activity measurement at an upper torso attachment site
Keith M Diaz1, David J Krupka2, Melinda J Chang2
1Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH 9-319, New York, NY, 10032, USA. kd2442@cumc.columbia.edu.
Background:
The upper torso is recommended as an attachment site for the Fitbit One(®), one of the most common wireless physical activity trackers in the consumer market, and could represent a viable alternative to wrist- and hip-attachment sites. The objective of this study was to provide evidence concerning the validity of the Fitbit One(®) attached to the upper torso for measuring step counts and energy expenditure among female adults.
Results:
Thirteen female adults completed a four-phase treadmill exercise protocol (1.9, 3.0, 4.0, and 5.2 mph). Participants were fitted with three Fitbit(®) trackers (two Fitbit One(®) trackers: one on the upper torso, one on the hip; and a wrist-based Fitbit Flex(®)). Steps were assessed by manual counting of a video recording. Energy expenditure was measured by gas exchange indirect calorimetry. Concordance correlation coefficients of Fitbit-estimated step counts to observed step counts for the upper torso-attached Fitbit One(®), hip-attached Fitbit One(®) and wrist-attached Fitbit Flex(®) were 0.98 (95% CI 0.97-0.99), 0.99 (95% CI 0.99-0.99), and 0.75 (95% CI 0.70-0.79), respectively. The percent error for step count estimates from the upper torso attachment site was ≤3% for all walking and running speeds. Upper torso step count estimates showed similar accuracy relative to hip attachment of the Fitbit One(®) and were more accurate than the wrist-based Fitbit Flex(®). Similar results were obtained for energy expenditure estimates. Energy expenditure estimates for the upper torso attachment site yielded relative percent errors that ranged from 9 to 19% and were more accurate than the wrist-based Fitbit Flex(®), but less accurate than hip attachment of the Fitbit One(®).
Conclusions:
Our study shows that physical activity measures obtained from the upper torso attachment site of the Fitbit One(®) are accurate across different walking and running speeds in female adults. The upper torso attachment site of the Fitbit One(®) outperformed the wrist-based Fitbit Flex(®) and yielded similar step count estimates to hip-attachment. These data support the upper torso as an alternative attachment site for the Fitbit One(®).
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