Validity of the Polar Vantage M watch when measuring heart rate at different exercise intensities

Advancing Sports Cardiology: Integrating Artificial Intelligence with Wearable Devices for Cardiovascular Health Management

Sports cardiology focuses on athletes' cardiovascular health, yet sudden cardiac death remains a significant concern despite preventative measures. Prolonged physical activity leads to notable cardiovascular adaptations, known as the athlete's heart, which can resemble certain pathological conditions, complicating accurate diagnoses and potentially leading to serious consequences such as unnecessary exclusion from sports or missed treatment opportunities. Wearable devices, including smartwatches and smart glasses, have become prevalent for monitoring health metrics, offering potential clinical applications for sports cardiologists. These gadgets are capable of spotting exercise-induced arrhythmias, uncovering hidden heart problems, and offering crucial information for training and recovery, to minimize exercise-related cardiac incidents and enhance heart health care. However, concerns about data accuracy and the actionable value of the obtained information persist. A major challenge lies in the integration of artificial intelligence with wearables, research gaps remain regarding their ability to provide real-time, reliable, and clinically relevant insights. Combining artificial intelligence with wearable devices can improve how data is managed and used in sports cardiology. Artificial intelligence, particularly machine learning, can classify, predict, and draw inferences from the data collected by wearables, revolutionizing patient data usage. Despite artificial intelligence's proven effectiveness in managing chronic conditions, the limited research on its application in sports cardiology, particularly regarding wearables, creates a critical gap that needs to be addressed. This review examines commercially available wearables and their applications in sports cardiology, exploring how artificial intelligence can be integrated into wearable technology to advance the field.

Validity and Inter-Device Reliability of the OTBeat BurnTM Monitor to Estimate Heart Rate During Exercise

The purpose of this study was to determine the accuracy and inter-device reliability of the OTBeat BurnTM heart rate monitor during an incremental test to exhaustion on a cycle ergometer. Twenty males (mean ± SD age = 21.1 ± 1.9 years) volunteered to complete a test to exhaustion on a cycle ergometer with OTBeat BurnTM devices placed on the forearm and upper arm, with a 12-lead electrocardiogram used as the criterion. The heart rate was recorded every 30 s and averaged across each two-minute stage. Accuracy was assessed through calculation of the mean absolute percent error (MAPE), Bland-Altman plot, and Lin's concordance correlation coefficient (CCC). An intraclass correlation coefficient (ICC) was used to assess the inter-device reliability. Statistical significance was set at α < 0.05. The MAPE (±SD), Bland-Altman regression analyses, and Lin's CCC values were 0.9 (±0.6)% and 0.8 (±0.5)%, r = 0.107 and 0.303, and rc = 0.998 and 0.998 for the forearm and the upper arm monitors, respectively. The ICC for inter-device reliability was R = 0.999. Our findings indicated the OTBeat BurnTM monitors placed on the forearm and upper arm provided highly accurate and reliable values when compared to an electrocardiogram from low to maximal exercise intensities.

Efficacy of Wearable Single-Lead ECG Monitoring during Exercise Stress Testing: A Comparative Study

BACKGROUND AND OBJECTIVES

Few comparative studies have evaluated wearable single-lead electrocardiogram (ECG) devices and standard multi-lead ECG devices during exercise testing. This study aimed to validate the accuracy of a wearable single-lead ECG monitor for recording heart rate (HR) metrics during graded exercise tests (GXTs).

METHODS

A cohort of 50 patients at a tertiary hospital underwent GXT while simultaneously being equipped with wearable single- and conventional multi-lead ECGs. The concordance between these modalities was quantified using the intraclass correlation coefficient and Bland-Altman plot analysis.

RESULTS

The minimum and average HR readings between the devices were generally consistent. Parameters such as ventricular ectopic beats and supraventricular ectopic beats showed strong agreement. However, the agreement for the Total QRS and Maximum RR was not sufficient. HR measurements across different stages of the exercise test showed sufficient agreement. Although not statistically significant, the standard multi-lead ECG devices exhibited higher noise levels compared to the wearable single-lead ECG devices.

CONCLUSIONS

Wearable single-lead ECG devices can reliably monitor HR and detect abnormal beats across a spectrum of exercise intensities, offering a viable alternative to traditional multi-lead systems.

Evaluation of Wrist-Worn Photoplethysmography Trackers with an Electrocardiogram in Patients with Ischemic Heart Disease: A Validation Study

PURPOSE

Photoplethysmography measurement of heart rate with wrist-worn trackers has been introduced in healthy individuals. However, additional consideration is necessary for patients with ischemic heart disease, and the available evidence is limited. The study aims to evaluate the validity and reliability of heart rate measures by a wrist-worn photoplethysmography (PPG) tracker compared to an electrocardiogram (ECG) during incremental treadmill exercise among patients with ischemic heart disease.

METHODS

Fifty-one participants performed the standard incremental treadmill exercise in a controlled laboratory setting with 12-lead ECG attached to the patient's body and wearing wrist-worn PPG trackers.

RESULTS

At each stage, the absolute percentage error of the PPG was within 10% of the standard acceptable range. Further analysis using a linear mixed model, which accounts for individual variations, revealed that PPG yielded the best performance at the baseline low-intensity exercise. As the stages progressed, heart rate validity decreased but was regained during recovery. The reliability was moderate to excellent.

CONCLUSIONS

Low-cost trackers AMAZFIT Cor and Bip validity and reliability were within acceptable ranges, especially during low-intensity exercise among patients with ischemic heart disease recovering from cardiac procedures. Though using the tracker as part of the diagnosis tool still requires more supporting studies, it can potentially be used as a self-monitoring tool with precautions.

Estimation of physiological exercise thresholds based on dynamical correlation properties of heart rate variability

Aerobic and anaerobic thresholds of the three-zone exercise model are often used to evaluate the exercise intensity and optimize the training load. Conventionally, these thresholds are derived from the respiratory gas exchange or blood lactate concentration measurements. Here, we introduce and validate a computational method based on the RR interval (RRI) dynamics of the heart rate (HR) measurement, which enables a simple, yet reasonably accurate estimation of both metabolic thresholds. The method utilizes a newly developed dynamical detrended fluctuation analysis (DDFA) to assess the real-time changes in the dynamical correlations of the RR intervals during exercise. The training intensity is shown to be in direct correspondence with the time- and scale-dependent changes in the DDFA scaling exponent. These changes are further used in the definition of an individual measure to estimate the aerobic and anaerobic threshold. The results for 15 volunteers who participated in a cyclo-ergometer test are compared to the benchmark lactate thresholds, as well as to the ventilatory threshods and alternative HR-based estimates based on the maximal HR and the conventional detrended fluctuation analysis (DFA). Our method provides the best overall agreement with the lactate thresholds and provides a promising, cost-effective alternative to conventional protocols, which could be easily integrated in wearable devices. However, detailed statistical analysis reveals the particular strengths and weaknessess of each method with respect to the agreement and consistency with the thresholds-thus underlining the need for further studies with more data.

Validation of Polar Grit X Pro for Estimating Energy Expenditure during Military Field Training: A Pilot Study

Wearables are lightweight, portable technology devices that are traditionally used to monitor physical activity and workload as well as basic physiological parameters such as heart rate. However recent advances in monitors have enabled better algorithms for estimation of caloric expenditure from heart rate for use in weight loss as well as sport performance. can be used for estimating energy expenditure and nutritional demand. Recently, the military has adopted the use of personal wearables for utilization in field studies for ecological validity of training. With popularity of use, the need for validation of these devices for caloric estimates is needed to assist in work-rest cycles. Thus the purpose of this effort was to evaluate the Polar Grit X for energy expenditure (EE) for use in military training exercises. Polar Grit X Pro watches were worn by active-duty elite male operators (N = 16; age: 31.7 ± 5.0 years, height: 180.1 ± 6.2 cm, weight: 91.7 ± 9.4 kg). Metrics were measured against indirect calorimetry of a metabolic cart and heart rate via a Polar heart rate monitor chest strap while exercising on a treadmill. Participants each performed five 10-minute bouts of running at a self-selected speed and incline to maintain a heart rate within one of five heart rate zones, as ordered and defined by Polar. Polar Grit X Pro watch had a good to excellent interrater reliability to indirect calorimetry at estimating energy expenditure (ICC = 0.8, 95% CI = 0.61-0.89, F (74,17.3) = 11.76, p < 0.0001) and a fair to good interrater reliability in estimating macronutrient partitioning (ICC = 0.49, 95% CI = 0.3-0.65, F (74,74.54) = 2.98, p < 0.0001). There is a strong relationship between energy expenditure as estimated from the Polar Grit X Pro and measured through indirect calorimetry. The Polar Grit X Pro watch is a suitable tool for estimating energy expenditure in free-living participants in a field setting and at a range of exercise intensities.

Heart rate processing algorithms and exercise duration on reliability and validity decisions in biceps-worn Polar Verity Sense and OH1 wearables

Consumer wearable technology use is widespread and there is a need to validate measures obtained in uncontrolled settings. Because no standard exists for the treatment of heart rate data during exercise, the effect of different approaches on reliability (Coefficient of Variation [CV], Intraclass Correlation Coefficient [ICC]) and validity (Mean Absolute Percent Error [MAPE], Lin's Concordance Correlation Coefficient [CCC)] were determined in the Polar Verity Sense and OH1 during trail running. The Verity Sense met the reliability (CV < 5%, ICC > 0.7) and validity thresholds (MAPE < 5%, CCC > 0.9) in all cases. The OH1 met reliability thresholds in all cases except entire session average (ICC = 0.57). The OH1 met the validity MAPE threshold in all cases (3.3-4.1%), but not CCC (0.6-0.86). Despite various heart rate data processing methods, the approach may not affect reliability and validity interpretation provided adequate data points are obtained. It is also possible that a large volume of data will artificially inflate metrics.

Characterization of Female US Marine Recruits: Workload, Caloric Expenditure, Fitness, Injury Rates, and Menstrual Cycle Disruption during Bootcamp

Basic training is centered on developing the physical and tactical skills essential to train a recruit into a Marine. The abrupt increase in activity and energy expenditure in young recruits may contribute to high rates of musculoskeletal injuries, to which females are more susceptible. To date, the total workload of United State Marine Corps (USMC) bootcamp is unknown and should include movement around the military base (e.g., to and from dining facilities, training locations, and classrooms). Thus, the purpose of this effort was to quantify workload and caloric expenditure, as well as qualitatively assess the impact of female reproductive health and injury rates in female recruits. Female recruits (n = 79; age: 19.1 ± 0.2 years, weight: 59.6 ± 0.8 kg, height: 161.6 ± 0.7 cm) wore physiological monitors daily throughout 10 weeks of USMC bootcamp. Physical fitness test scores, physiological metrics from wearables, injury data, and menstrual cycle information were obtained. Female recruits on average expended 3096 ± 9 kcal per day, walked 11.0 ± 0.1 miles per day, and slept 5:43 ± 1:06 h:min per night throughout the 10 weeks of bootcamp. About one-third (35%) of female recruits sustained an injury. In a subset of females that were not taking birth control and had previously been menstruating, 85% experienced cycle dysfunction during boot camp. High levels of physical activity and caloric expenditure, coupled with the stress of a new environment and insufficient sleep, may lead to alterations in female reproductive cycles and musculoskeletal injuries in young USMC recruits.

Accuracy of the Apple Watch Series 6 and the Whoop Band 3.0 for assessing heart rate during resistance exercises

This study aimed to determine heart rate accuracy measured by wearable devices during resistance exercises at various intensities. Twenty-nine participants (16 female) aged 19-37 years participated in this cross-sectional study. Participants completed five resistance exercises; Barbell Back Squat, Barbell Deadlift, Dumbbell Curl to Overhead Press, Seated Cable Row, and Burpees. During the exercises, heart rate was concurrently measured using the Polar H10, the Apple Watch Series 6 and the Whoop 3.0. The Apple Watch had high agreement with the Polar H10 during Barbell Back Squats, Barbell Deadlift, and Seated Cable Rows (rho > 0.832) and moderate to low agreement during Dumbbell Curl to Overhead Press and Burpees (rho > 0.364). The Whoop Band 3.0 had high agreement with the Polar H10 during Barbell Back Squats (r > 0.697), moderate agreement during Barbell Deadlift and Dumbbell Curl to Overhead Press (rho > 0.564) and low agreement during Seated Cable Rows and Burpees (rho > 0.383). The results varied across exercises and intensities and indicated the most favourable outcomes for the Apple Watch. In conclusion, our data suggest that the Apple Watch Series 6 is suitable for measuring heart rate during exercise prescription or monitoring resistance exercise performance.

Estimation of Heart Rate and Energy Expenditure Using a Smart Bracelet during Different Exercise Intensities: A Reliability and Validity Study

Background. With wrist-worn wearables becoming increasingly available, it is important to understand their reliability and validity in different conditions. The primary objective of this study was to examine the reliability and validity of the Lexin Mio smart bracelet in measuring heart rate (HR) and energy expenditure (EE) in people with different physical activity levels exercising at different intensities. Methods. A total of 65 participants completed one maximal oxygen uptake test and two running exercise tests wearing the Mio smart bracelet, the Polar H10 HR band, and a gas-analysis system. Results. In terms of HR measurement reliability, the Mio smart bracelet showed good reliability in a left versus right test and good test−retest reliability (p > 0.05; mean absolute percentage error (MAPE) < 10%; intraclass correlation coefficient (ICC) > 0.4). For EE measurement, the Mio smart bracelet showed good reliability in a left versus right test, good test−retest reliability on the right (p > 0.05; MAPE > 10%; ICC > 0.4), and low test−retest reliability on the left (p > 0.05; MAPE > 10%; ICC < 0.4). Regarding validity, the Mio smart bracelet showed good validity for HR measurement (p > 0.05; MAPE < 10%; ICC > 0.4) and low validity for EE measurement (p < 0.05; MAPE > 10%; ICC < 0.4). Conclusion. The Lexin Mio smart bracelet showed good reliability and validity for HR measurement among people with different physical activity levels exercising at various exercise intensities in a laboratory setting. However, the smart bracelet showed good reliability and low validity for the estimation of EE.

Validity of the Wrist-Worn Polar Vantage V2 to Measure Heart Rate and Heart Rate Variability at Rest

Heart rate (HR) and heart rate variability (HRV) can be monitored with wearable devices throughout the day. Resting HRV in particular, reflecting cardiac parasympathetic activity, has been proposed to be a useful marker in the monitoring of health and recovery from training. This study examined the validity of the wrist-based photoplethysmography (PPG) method to measure HR and HRV at rest. Recreationally endurance-trained participants recorded pulse-to-pulse (PP) and RR intervals simultaneously with a PPG-based watch and reference heart rate sensor (HRS) at a laboratory in a supine position (n = 39; 5-min recording) and at home during sleep (n = 29; 4-h recording). In addition, analyses were performed from pooled laboratory data (n = 11344 PP and RR intervals). Differences and correlations were analyzed between the HRS- and PPG-derived HR and LnRMSSD (the natural logarithm of the root mean square of successive differences). A very good agreement was found between pooled PP and RR intervals with a mean bias of 0.17 ms and a correlation coefficient of 0.993 (p < 0.001). In the laboratory, HR did not differ between the devices (mean bias 0.0 bpm), but PPG slightly underestimated the nocturnal recordings (mean bias -0.7 bpm, p < 0.001). PPG overestimated LnRMSSD both in the laboratory (mean bias 0.20 ms, p < 0.001) and nocturnal recordings (mean bias 0.17 ms, p < 0.001). However, very strong intraclass correlations in the nocturnal recordings were found between the devices (HR: 0.998, p < 0.001; LnRMSSD: 0.931, p < 0.001). In conclusion, PPG was able to measure HR and HRV with adequate accuracy in recreational athletes. However, when strict absolute values are of importance, systematic overestimation, which seemed to especially concern participants with low LnRMSSD, should be acknowledged.

Applicability of Physiological Monitoring Systems within Occupational Groups: A Systematic Review

The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.