The Apple Watch (Apple Inc) is a wrist-worn commercially available device that uses PPG for HR assessment. The purpose of this study was to evaluate the accuracy of the Apple Watch with regard to HR and EE measurements during exercise in patients with cardiovascular diseases. This study aimed to assess if commercially available mobile health technology such as the Apple Watch could be used for monitoring home-based exercise in future cardiac rehabilitation programs. Modern health care is shifting its focus to home-centered health care with the aid of mobile technology. However, none of the tested devices had EE estimates within an acceptable range. Shcherbina et al tested seven devices on healthy subjects and found that HR measurements were within acceptable error range (5%). They conclude that wearable devices are not medical devices and users should be cautious when interpreting results of activity monitoring. It was also found that EE estimates were inaccurate. Boudreaux et al tested eight devices for accuracy of HR and EE measurements on healthy subjects and found that HR accuracy from wearable devices differed at different exercise intensities with an increasing underestimation of HR at higher exercise intensities. Validation studies have been done to evaluate the accuracy of HR, EE, and other measurements in healthy subjects for a variety of fitness trackers. EE is calculated with algorithms that are not openly disclosed. The Apple Watch uses photoplethysmography (PPG) with optical sensors at the wrist to measure HR. Validation studies comparing assessments by these devices to clinically approved measurements are often lacking. Wrist-worn devices have the ability to monitor vital parameters and provide the user with an overview and feedback on the collected data. Demand in patient population is also rising, with recent studies showing that up to one-third of patients with chronic heart disease use personal heart rate monitors and over two-thirds of patients who don’t already use a heart monitor reporting that they appreciate heart monitoring as being important for home-based exercise. One type of technology that is particularly interesting for mobile health is the wrist-worn device capable of monitoring a large variety of parameters including heart rate (HR), energy expenditure (EE), steps taken, distance traveled, and in the near future possibly even oxygen saturation, blood glucose, and cardiac arrhythmia. Future perspectives are promising for further growth and integration of mobile technology in health care. Mobile health has been growing tremendously in the last decade.
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