Pilot Study Assessing the Influence of Skin Type on the Heart Rate Measurements Obtained by Photoplethysmography with the Apple Watch.

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.