Monitoring Heart Rate under Psychological Stress: A Validation Study Comparing a Fitbit Wearable to an ECG Gold Standard (Preprint)

BACKGROUND Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. OBJECTIVE This study followed three objectives. First, to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory. Second, to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac). Third, to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. METHODS Participants underwent the Trier Social Stress Test protocol which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and two relaxation phases (at the beginning and the end). During the stress protocol, participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used to assess 1) the effect of experimental conditions on HR and 2) to estimate several metrics of accuracy and 3) agreement: the Bland-Altman limits of agreement, the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. RESULTS A total of 34 university students were recruited for this study (64% of participants were female with a mean age of 26.8 years SD=8.3). Overall, results showed significant HR variations across experimental phases. Post-hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. CONCLUSIONS Overall, results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit device can be used in research to measure HR variations caused by stress although it cannot replace an ECG instrument when precision is of utmost importance.