Accuracy of Heart Rate Measurement Under Transient States: A Validation Study of Wearables for Real-Life Monitoring

Abstract

Wearable devices are increasingly used for health and stress monitoring, yet their accuracy under dynamic, real-world conditions remains uncertain. This study validated the heart rate measurement accuracy of one chest-worn device (Zephyr BioHarness 3.0), a research-grade wrist-worn device (EmbracePlus), and five commercial wrist-worn wearable devices (Fitbit Charge 5, Fitbit Sense 2, Garmin Vivosmart 4, WHOOP 4.0, and Withings Scanwatch) against a 12-lead ECG using a 20 min protocol simulating real-life dynamics, including rest and varied-intensity walking. Device performance was evaluated across the full protocol and during transient states, defined as periods of rapid heart rate change. Accuracy and agreement were evaluated across per-second, 10 s, and 60 s resolutions. The Zephyr device showed a strong performance during all dynamic conditions. Among the wrist-worn devices, the Fitbit Charge 5 and Sense 2 showed the highest accuracy overall, while the Garmin Vivosmart 4 demonstrated greater stability during transitions. The WHOOP 4.0, Withings Scanwatch, and EmbracePlus devices performed acceptably during steady-state conditions, but were less accurate during transitions. Performance notably declined across all wrist-worn devices during transient states, with motion onset and large step changes in heart rate exacerbating measurement errors. Larger averaging windows improved accuracy by smoothing variability. The findings underscore that wrist-worn wearable devices may be better suited for average and trend heart rate monitoring rather than capturing acute dynamics. However, the Garmin and Fitbit devices showed suitable when requiring moderate accuracy during dynamic conditions. These results highlight the importance of context-specific validation and informed device selection to ensure effective use in health and stress-related applications.