Validation of Biofeedback Wearables for Photoplethysmographic Heart Rate Tracking

The purpose of this study was to examine the validity of HR measurements by two commercial-use activity trackers in comparison to ECG. Twenty-four healthy participants underwent the same 77-minute protocol during a single visit. Each participant completed an initial rest period of 15 minutes followed by 5 minute periods of each of the following activities: 60W and 120W cycling, walking, jogging, running, resisted arm raises, resisted lunges, and isometric plank. In between each exercise task was a 5-minute rest period. Each subject wore a Basis Peak (BPk) on one wrist and a Fitbit Charge HR (FB) on the opposite wrist. Criterion measurement of HR was administered by 12-lead ECG. Time synced data from each device and ECG were concurrently and electronically acquired throughout the entire 77-minute protocol. When examining data in aggregate, there was a strong correlation between BPk and ECG for HR (r = 0.92, p < 0.001) with a mean bias of -2.5 bpm (95% LoA 19.3, -24.4). The FB demonstrated a moderately strong correlation with ECG for HR (r = 0.83, p < 0.001) with an average mean bias of -8.8 bpm (95% LoA 24.2, -41.8). During physical efforts eliciting ECG HR > 116 bpm, the BPk demonstrated an r = 0.77 and mean bias = -4.9 bpm (95% LoA 21.3, -31.0) while the FB demonstrated an r = 0.58 and mean bias = -12.7 bpm (95% LoA 28.6, -54.0). The BPk satisfied validity criteria for HR monitors, however showed a marginal decline in accuracy with increasing physical effort (ECG HR > 116 bpm). The FB failed to satisfy validity criteria and demonstrated a substantial decrease in accuracy during higher exercise intensities.