ArticleJournal of medical systems2019
Pilot Study Assessing the Influence of Skin Type on the Heart Rate Measurements Obtained by Photoplethysmography with the Apple Watch.
Article in Journal of medical systems, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Wearable Devices for Remote Monitoring of Chronic Diseases: Systematic Review.JMIR mHealth and uHealth · 2026Pooled it
- Impact of Skin Pigmentation on Pulse Oximetry Blood Oxygenation and Wearable Pulse Rate Accuracy: Systematic Review and Meta-Analysis.Journal of medical Internet research · 2024Pooled it
- Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network.British journal of sports medicine · 2021Guideline
- Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review.JMIR mHealth and uHealth · 2020Pooled it
- Accuracy and Systematic Biases of Heart Rate Measurements by Consumer-Grade Fitness Trackers in Postoperative Patients: Prospective Clinical Trial.Journal of medical Internet research · 2022Trial
- The Representation of Different Populations in Studies Assessing the Validity of Consumer Wearable Photoplethysmography-Based Measurements: Scoping Review.JMIR mHealth and uHealth · 2026Article
- Influence of skin pigmentation on the accuracy and data quality of photoplethysmographic heart rate measurement during exercise.European journal of applied physiology · 2026Article
- Wearable technology for athletes: material innovations, performance monitoring, and emerging paradigms.Mikrochimica acta · 2026Review
- Photoplethysmography in Diverse Skin Tones: Evaluating Bias in Smartwatch Health Monitoring.Cureus · 2025Review
- Investigating the accuracy of Garmin PPG sensors on differing skin types based on the Fitzpatrick scale: cross-sectional comparison study.Frontiers in digital health · 2025Article
- Validity of heart rate measurements in wrist-based monitors across skin tones during exercise.PloS one · 2025Article
- Accuracy of the Apple Watch Series 9 for Measures of Energy Expenditure and Heart Rate at Rest and During Exercise: Impact of Skin Pigmentation.Journal of functional morphology and kinesiology · 2024Article
- Model Quality in AI-based Bruise Detection: Rethinking IoU and Confidence Thresholds.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2024Article
- Artificial intelligence-enabled atrial fibrillation detection using smartwatches: current status and future perspectives.Frontiers in cardiovascular medicine · 2024Review
- Assessment of Heart Rate Monitoring During Exercise With Smart Wristbands and a Heart Rhythm Patch: Validation and Comparison Study.JMIR formative research · 2023Article
- The Feasibility and Reliability of Upper Arm-Worn Apple Watch Heart Rate Monitoring for Surgeons During Surgery: Observational Study.JMIR human factors · 2023Observational
- Heart rate processing algorithms and exercise duration on reliability and validity decisions in biceps-worn Polar Verity Sense and OH1 wearables.Scientific reports · 2023Article
- Step Count, Self-reported Physical Activity, and Predicted 5-Year Risk of Atrial Fibrillation: Cross-sectional Analysis.Journal of medical Internet research · 2023Article
- Estimating Physical Activity and Sleep using the Combination of Movement and Heart Rate: A Systematic Review and Meta-Analysis.International journal of exercise science · 2023Review
- Using wearable devices to generate real-world, individual-level data in rural, low-resource contexts in Burkina Faso, Africa: A case study.Frontiers in public health · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Photoplethysmographic imaging (PPG) is currently used to measure heart rate (HR) and the accuracy of PPG can be influenced by pigmentation of the skin; however, the effects of skin color-related artifacts on PPG during exercise remain unclear. This study aimed to assess the agreement between the Apple Watch photoplethysmography sensor and a criterion, for measuring heart rate across a range of intensities during exercise and to determine the influence of skin type on the accuracy of the measure. Forty-five males (20-43 y) completed the Fitzpatrick Skin Scale and were classified into three different skin type groups: a) types II (n = 15), III (n = 15) and IV (n = 15). Participants performed a graded incremental cycle-ergometer test while simultaneously wearing the Apple Watch and a Polar monitor as a criterion measure. Data from both devices were collected in 5-s epochs. Correlations between devices were very good (0.96-0.99 [95%CI: 0.94 to 0.99]). Significant differences were observed between skin types II and III when the intensity of the exercise was increased, albeit with trivial to small effect sizes (ES: 0.05 to 0.28). All significant differences corresponded to <2% of relative difference between both devices. Bland-Altman analyses showed a trivial but systematic underestimation of HR in the Apple Watch compared to Polar for all skin types during exercise. In conclusion, the Apple Watch accurately measures HR when cycling at different intensities and certain types of skin seem not to influence these measures, which may have important implications for controlling the intensity of exercise.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.