Validity of Smartphone Heart Rate Variability Pre- and Post-Resistance Exercise

The aim was to examine the validity of heart rate variability (HRV) measurements from photoplethysmography (PPG) via a smartphone application pre- and post-resistance exercise (RE) and to examine the intraday and interday reliability of the smartphone PPG method. Thirty-one adults underwent two simultaneous ultrashort-term electrocardiograph (ECG) and PPG measurements followed by 1-repetition maximum testing for back squats, bench presses, and bent-over rows. The participants then performed RE, where simultaneous ultrashort-term ECG and PPG measurements were taken: two pre- and one post-exercise. The natural logarithm of the root mean square of successive normal-to-normal (R-R) differences (LnRMSSD) values were compared with paired-sample t-tests, Pearson product correlations, Cohen's d effect sizes (ESs), and Bland-Altman analysis. Intra-class correlations (ICC) were determined between PPG LnRMSSDs. Significant, small-moderate differences were found for all measurements between ECG and PPG: Base_Pre1 (ES = 0.42), Base_Pre2 (0.30), RE_Pre1 (0.26), RE_Pre2 (0.36), and RE_Post (1.14). The correlations ranged from moderate to very large: Base_Pre1 (r = 0.59), Base_Pre2 (r = 0.63), RE_Pre1 (r = 0.63), RE_Pre2 (r = 0.76), and RE_Post (r = 0.41)-all p < 0.05. The agreement for all the measurements was "moderate" (0.10-0.16). The PPG LnRMSSD exhibited "nearly-perfect" intraday reliability (ICC = 0.91) and "very large" interday reliability (0.88). The smartphone PPG was comparable to the ECG for measuring HRV at rest, but with larger error after resistance exercise.