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The Accuracy of Acquiring Heart Rate Variability from Portable Devices: A Systematic Review and Meta-Analysis

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Abstract

Background

Advancements in wearable technology have provided practitioners and researchers with the ability to conveniently measure various health and/or fitness indices. Specifically, portable devices have been devised for convenient recordings of heart rate variability (HRV). Yet, their accuracies remain questionable.

Objective

The aim was to quantify the accuracy of portable devices compared to electrocardiography (ECG) for measuring a multitude of HRV metrics and to identify potential moderators of this effect.

Methods

This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles published before July 29, 2017 were located via four electronic databases using a combination of the terms related to HRV and validity. Separate effect sizes (ESs), defined as the absolute standardized difference between the HRV value recorded using the portable device compared to ECG, were generated for each HRV metric (ten metrics analyzed in total). A multivariate, multi-level model, incorporating random-effects assumptions, was utilized to quantify the mean ES and 95% confidence interval (CI) and explore potential moderators.

Results

Twenty-three studies yielded 301 effects and revealed that HRV measurements acquired from portable devices differed from those obtained from ECG (ES = 0.23, 95% CI 0.05–0.42), although this effect was small and highly heterogeneous (I2 = 78.6%, 95% CI 76.2–80.7). Moderator analysis revealed that HRV metric (p <0.001), position (p = 0.033), and biological sex (β = 0.45, 95% CI 0.30–0.61; p <0.001), but not portable device, modulated the degree of absolute error. Within metric, absolute error was significantly higher when expressed as standard deviation of all normal–normal (R–R) intervals (SDNN) (ES = 0.44) compared to any other metric, but was no longer significantly different after a sensitivity analysis removed outliers. Likewise, the error associated with the tilt/recovery position was significantly higher than any other position and remained significantly different without outliers in the model.

Conclusions

Our results suggest that HRV measurements acquired using portable devices demonstrate a small amount of absolute error when compared to ECG. However, this small error is acceptable when considering the improved practicality and compliance of HRV measurements acquired through portable devices in the field setting. Practitioners and researchers should consider the cost–benefit along with the simplicity of the measurement when attempting to increase compliance in acquiring HRV measurements.

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Data Availability Statement

Data used for this analysis are available from the corresponding author upon request.

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Author information

Authors and Affiliations

  1. Department of Exercise and Sport Science, University of Wisconsin - La Crosse, La Crosse, WI, USA

    Ward C. Dobbs

  2. Department of Kinesiology, The University of Alabama, Tuscaloosa, AL, USA

    Ward C. Dobbs, Michael V. Fedewa, Hayley V. MacDonald, Clifton J. Holmes, Zackary S. Cicone & Michael R. Esco

  3. Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand

    Daniel J. Plews

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Contributions

Ward Dobbs designed the study, coded and analyzed effects, carried out the initial analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Michael Fedewa conceptualized and designed the study, coded and analyzed effects, carried out the initial analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Hayley MacDonald designed the study, coded and analyzed effects, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. Clifton Holmes coded and analyzed effects, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. Zackary Cicone coded and analyzed effects, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. Daniel Plews reviewed and revised the initial manuscript, and approved the final manuscript as submitted. Michael Esco conceptualized the study, coded and analyzed effects, drafted the initial manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Ward C. Dobbs.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Ward Dobbs, Michael Fedewa, Hayley MacDonald, Clifton Holmes, Zackary Cicone, Daniel Plews and Michael Esco declare that they have no conflicts of interest relevant to the content of this review.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic Supplementary Material Table S1a.

Standard for Reporting Diagnostic Accuracy Studies Guidelines for Heart Rate Variability Research (STARDHRV) Methodology Study Quality Assessment Tool for Primary-Level Evidence. BMI, body mass index; ES, effect size; ICC, intra-class correlation; LOA, limits of agreement; SD, standard deviation

Electronic Supplementary Material Table S1b.

Item Description of the Standard for Reporting Diagnostic Accuracy Studies Guidelines for Heart Rate Variability Research (STARDHRV) Methodology Study Quality Assessment Tool for Primary-Level Evidence. The source of the STARDHRV quality item is provided, and if applicable, describes whether the item was used in its original form, modified, or newly added by authors. Abbreviations: BMI, body mass index; ECG, electrocardiogram; GRAPH, Guidelines for Reporting Articles on Psychiatry and Heart rate variability; ICC, intra-class correlation; LOA, limits of agreement; STARD, Standard for Reporting Diagnostic Accuracy Studies Guidelines

Electronic Supplementary Material Table S2.

Description of selected studies (k = 23) examining the validity of heart rate variability measurements obtained from portable heart rate monitors compared to a criterion electrocardiogram.  %, percentage; a, calculated from data provided; ApEn, approximate entropy; AR, autoregressive; b/w, between; BMI, body mass index; kg/m, kilograms/meters; CWT, continuous wavelet transform; ECG, electrocardiogram; FFT, fast Fourier transform; HF, high frequency; HR, heart rate; HRV, heart rate variability; LF, low frequency; lnRMSSD, log transformed RMSSD; LoA, limits of agreement; N, study population size; NR, not reported; PA, physical activity; pNN50, percentage of consecutive N-N intervals that deviate from one another by more than 50 ms; RR, RR interval; RMSSD, square root of the mean squared differences between normal adjacent R-R intervals; SaEn, sample entropy; SD1, dispersion of points perpendicular to the line of identity; SD2, dispersion of points along the line of identity; SDNN, standard deviation of all normal–normal (R-R) intervals; TP, total power; VLF, very low frequency; WP, Welch’s paradigm; yrs, year

Electronic Supplementary Material Table S3.

Item-by-item summary of methodology study quality for the included studies (k = 23) using a version of the Standard for Reporting Diagnostic Accuracy Studies modified for the use of heart rate variability (STARDHRV). n/a, not applicable due to the study design

Electronic Supplementary Material Table S4.

Individual moderator analyses for categorical variables of interest after removal of outliers (n = 275 total effects).  %, proportion of effects accounted for; a, significant omnibus test; b, significantly different from all other measurements within the variable; ES, estimated absolute standardized mean difference effect size; HF, high frequency; HR, heart rate; HRV, heart rate variability; LF, low frequency; LF:HF, LF to HF ratio; n, number of effects; pNN50, percentage of consecutive N-N intervals that deviate from one another by more than 50 ms; PPG, photoplethysmogrophy; RMSSD, square root of the mean squared differences between normal adjacent R-R intervals; SD1, dispersion of points perpendicular to the line of identity; SD2, dispersion of points along the line of identity; SDNN, standard deviation of all normal–normal (R-R) intervals; SE, standard error; TP, total power; VLF, very low frequency

Electronic Supplementary Material Table S5:

Moderating relationships greater than zero within the multiple moderator model after removal of outliers (n = 275 total effects). CI, confidence interval; ES, estimated absolute standardized mean difference effect size; HF, high frequency power; LF, low frequency power; SDNN, standard deviation of all normal–normal (R-R) intervals; SE, standard error; RMSSD, square root of the mean squared differences between normal adjacent R-R intervals

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Dobbs, W.C., Fedewa, M.V., MacDonald, H.V. et al. The Accuracy of Acquiring Heart Rate Variability from Portable Devices: A Systematic Review and Meta-Analysis. Sports Med 49, 417–435 (2019). https://doi.org/10.1007/s40279-019-01061-5

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