Are We Really Training at the Desired Intensity? Concurrent Validity of 16 Commercial Photoplethysmography-Based Heart Rate Monitors

The validity and accuracy of photoplethysmography (PPG)-based wearable heart rate (HR) monitors remain debatable. This study aimed to determine the concurrent validity of HR records from a wide range of contemporary PPG monitors across the full spectrum of exercise intensities and running conditions. Ten well-trained male endurance athletes performed several incremental maximal aerobic (IMA) tests and high-intensity interval training (HIIT) sessions while wearing a Polar H9 chest strap, as the reference criterion; 16 PPG-based heart rate monitors were tested (Amazfit Fit5; Apple Ultra and SE; Garmin 35, 45, 235, and 935; Polar M200, M430, OH1, Vantage M, Vantage V, Vantage V3, and Verity Sense; Galaxy Watch 5, Suunto 3 Fitness). The results showed excellent ICC (>0.90) versus the reference device across IMA and HIIT tests. Overall, the ICC decreased, and magnitudes of error increased (BIAS, SEM, and CV) as the intensity increased. Moreover, lower ICC values and greater BIAS, SEM, and CV were observed during the HIIT compared to the IMA test. Nevertheless, notable differences between devices were observed in magnitude of errors, accuracy, data loss, and read failures. In conclusion, PPG-based HR monitor validity is device-dependent and therefore exercise data from running training and competitions should be interpreted with caution.