The accuracy of Apple Watch measurements: a living systematic review and meta-analysis

Apple Watch provides continuous monitoring of physiological and behavioural health metrics, increasingly used to support health-care delivery. Yet, evidence regarding its measurement accuracy remains limited. We aimed to assess the accuracy of measurements from Apple Watch. We searched nine databases from inception to September 24, 2025, with no restrictions on language or publication type. Eligible studies validated any Apple Watch health metric against a criterion method. The primary outcome was the agreement between Apple Watch and the criterion. We included 82 studies, which assessed 14 health metrics (430,052 participants; pooled mean age 41.3 years [SD 13.3]). Bland-Altman meta-analysis showed a small underestimation of heart rate, although limits of agreement (LoA) indicated moderate measurement variability (mean bias -0.27 bpm [95% CI -0.72-0.17]; LoA -7.19 to 6.64). For atrial fibrillation detection, Apple Watch was more specific than sensitive (specificity 0.91 [95% CI 0.81-0.96]; sensitivity 0.79 [95% CI 0.61-0.90]). For blood oxygen saturation, there was low mean bias (-0.04% [95% CI -0.42-0.35]) but wide limits of agreement (-4.00 to 3.94). Accuracy for sleep and step count was moderate, whereas error for energy expenditure was inconsistent and frequently large. Measurement accuracy varied by metric, measurement conditions, and individual physiology. Longitudinal validation of key clinical metrics, including vital signs, is needed to inform clinical practice and policy. This study was registered with PROSPERO, CRD42023481841.