Int J Sports Med 2021; 42(14): 1268-1273
DOI: 10.1055/a-1337-2790
Training & Testing

Accuracy and Reliability of Pulse O2 Saturation Measured by a Wrist-worn Oximeter

1   Univ. Littoral Côte d’Opale, Univ. Artois, Univ. Lille, CHU LIlle, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59140 Dunkerque, France
2   UMR INSERM U1272 ‘Hypoxie & Poumon’, Université Sorbonne Paris Nord, Bobigny, France
Clemence Coll
3   Hôpital Jean Verdier, Médecine de L’Exercice et du Sport, AP-HP, Bondy, France
Jean-Paul Richalet
2   UMR INSERM U1272 ‘Hypoxie & Poumon’, Université Sorbonne Paris Nord, Bobigny, France
Francois J. Lhuissier
2   UMR INSERM U1272 ‘Hypoxie & Poumon’, Université Sorbonne Paris Nord, Bobigny, France
3   Hôpital Jean Verdier, Médecine de L’Exercice et du Sport, AP-HP, Bondy, France
› Author Affiliations


This study aims to evaluate the accuracy of the Garmin Forerunner 245 heart rate (HR) and pulse O2 saturation (SpO2) sensors compared with electrocardiogram and medical oximeter, from sea level to high altitude. Ten healthy subjects underwent five tests in normoxia and hypoxia (simulated altitudes from 3000 to 5500 m), consisting in a 5-min rest phase, followed by 5-min of mild exercise. Absolute error (±10 bpm for HR and ±3% for SpO2, around criterion) and intraclass correlations (ICC) were calculated. Error rates for HR remained under 10%, except at 3000 m, and ICCs evidenced a good reliability between Garmin and criterion. Overall SpO2 was higher than criterion (P<0.001) with a >50% error rate (>80% above 4800 m), and a poor reliability with criterion. The Garmin device displayed acceptable HR data at rest and exercise for all altitudes, but failed to provide trustworthy SpO2 values, especially at high altitude, where a pronounced arterial O2 desaturation could lead to acute mountain sickness in hypoxia-sensitive subjects, and its life-threatening complications; moreover, readings of overestimated SpO2 values might induce trekkers into further hazardous behavior by pursuing an ascent while being already at risk. Therefore, its use to assess SpO2 should be proscribed in altitude for acclimatization evaluation.

Publication History

Received: 04 August 2020

Accepted: 07 December 2020

Article published online:
17 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Achten J, Jeukendrup AE. Heart rate monitoring: Applications and limitations. Sports Med 2003; 33: 517-538
  • 2 Schneider C, Hanakam F, Wiewelhove T. et al. Heart rate monitoring in team sports-a conceptual framework for contextualizing heart rate measures for training and recovery prescription. Front Physiol 2018; 9: 639
  • 3 Cardinale M, Varley MC. Wearable training-monitoring technology: applications, challenges, and opportunities. Int J Sports Physiol Perform 2017; 12: S255-S262
  • 4 Sartor F, Gelissen J, van Dinther R. et al. Wrist-worn optical and chest strap heart rate comparison in a heterogeneous sample of healthy individuals and in coronary artery disease patients. BMC Sports Sci Med Rehabil 2018; 10: 10
  • 5 Hertzman AB. The blood supply of various skin areas as estimated by the photoelectric plethysmograph. Am J Physiol 1938; 124: 328-340
  • 6 Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas 2007; 28: R1–R39
  • 7 Severinghaus JW. Takuo Aoyagi: Discovery of pulse oximetry. Anesth Analg 2007; 105: S1-S4
  • 8 Elliott M, Coventry A. Critical care: The eight vital signs of patient monitoring. Br J Nurs 2012; 21: 621-625
  • 9 Lockwood C, Conroy-Hiller T, Page T. Vital signs. JBI Reports 2004; 2: 207-230
  • 10 Burtscher M, Philadelphy M, Gatterer H. et al. Physiological responses in humans acutely exposed to high altitude (3480 m): Minute ventilation and oxygenation are predictive for the development of acute mountain sickness. High Alt Med Biol 2019; 20: 192-197
  • 11 Karinen HM, Peltonen JE, Kähönen M. et al. Prediction of acute mountain sickness by monitoring arterial oxygen saturation during ascent. High Alt Med Biol 2010; 11: 325-332
  • 12 Richalet J-P, Larmignat P, Poitrine E. et al. Physiological risk factors for severe high-altitude illness: A prospective cohort study. Am J Respir Crit Care Med 2012; 185: 192-198
  • 13 Lauterbach CJ, Romano PA, Greisler LA. et al. Accuracy and reliability of commercial wrist-worn pulse oximeter during normobaric hypoxia exposure under resting conditions. Res Q Exerc Sport 2020; Online ahead of print. DOI: 10.1080/02701367.2020.1759768.
  • 14 Woorons X, Mollard P, Pichon A. et al. Moderate exercise in hypoxia induces a greater arterial desaturation in trained than untrained men. Scand J Med Sci Sports 2007; 17: 431-436
  • 15 Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869-871
  • 16 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
  • 17 Hermand E, Cassirame J, Ennequin G. et al. Validation of a photoplethysmographic heart rate monitor: Polar OH1. Int J Sports Med 2019; 40: 462–467
  • 18 Buekers J, Theunis J, Boever PD. et al. Wearable finger pulse oximetry for continuous oxygen saturation measurements during daily home routines of patients with Chronic Obstructive Pulmonary Disease (COPD) over one week: Observational study. JMIR Mhealth Uhealth 2019; 7: e12866
  • 19 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
  • 20 Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep 1966; 19: 3-11
  • 21 Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155-163
  • 22 Gillinov S, Etiwy M, Wang R. et al. Variable accuracy of wearable heart rate monitors during aerobic exercise. Med Sci Sports Exerc 2017; 49: 1697-1703
  • 23 Claes J, Buys R, Avila A. et al. Validity of heart rate measurements by the Garmin Forerunner 225 at different walking intensities. J Med Eng Technol 2017; 41: 480-485
  • 24 Horton JF, Stergiou P, Fung TS. et al. Comparison of polar M600 optical heart rate and ECG heart rate during exercise. Med Sci Sports Exerc 2017; 49: 2600–2607
  • 25 Seshadri DR, Li RT, Voos JE. et al. Wearable sensors for monitoring the internal and external workload of the athlete. NPJ Digit Med 2019; 2: 71
  • 26 Wang R, Blackburn G, Desai M. et al. Accuracy of wrist-worn heart rate monitors. JAMA Cardiol 2017; 2: 104
  • 27 Alzahrani A, Hu S, Azorin-Peris V. et al. A multi-channel opto-electronic sensor to accurately monitor heart rate against motion artefact during exercise. Sensors (Basel) 2015; 15: 25681-25702
  • 28 Lemay M, Bertschi M, Sola J. et al. Application of optical heart rate monitoring. In: Sazonov E, Neuman MR. Werable Sensors: Fundamentals, Implementation and Applications. Elsevier; Imprint: Academic Press: 2014: 105-129
  • 29 Maeda Y, Sekine M, Tamura T. Relationship between measurement site and motion artifacts in wearable reflected photoplethysmography. J Med Syst 2011; 35: 969-976
  • 30 Richalet J-P, Chenivesse C, Larmignat P. et al. High altitude pulmonary edema, down syndrome, and obstructive sleep apneas. High Alt Med Biol 2008; 9: 179-181
  • 31 Jubran A. Pulse oximetry. Crit Care 2015; 19: 272
  • 32 Lee J, Matsumura K, Yamakoshi K. et al. Comparison between red, green and blue light reflection photoplethysmography for heart rate monitoring during motion. In: 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013: 1724-1727
  • 33 Lee S, Shin H, Hahm C. Effective PPG sensor placement for reflected red and green light, and infrared wristband-type photoplethysmography. In: 2016 18th International Conference on Advanced Communication Technology (ICACT); 2016; 556-558
  • 34 Clayton DG, Webb RK, Ralston AC. et al. Pulse oximeter probes. A comparison between finger, nose, ear and forehead probes under conditions of poor perfusion. Anaesthesia 1991; 46: 260-265
  • 35 Seifi S, Khatony A, Moradi G. et al. Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: Comparison of finger, toe, forehead and earlobe probes. BMC Nurs 2018; 17: 15
  • 36 Nitzan M, Romem A, Koppel R. Pulse oximetry: Fundamentals and technology update. Med Devices (Auckl) 2014; 7: 231-239
  • 37 Bent B, Goldstein BA, Kibbe WA. et al. Investigating sources of inaccuracy in wearable optical heart rate sensors. NPJ Digit Med 2020; 3: 18
  • 38 Bickler PE, Feiner JR, Severinghaus JW. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology 2005; 102: 715-719