Performance and limitations of smartwatch estimation of VO2max during free-living activity in non-athletes Article Swipe
Alexandra Jamieson
,
Lee Hamill Howes
,
Siana Jones
,
Yatharth Ranjan
,
Amos Folarin
,
Richard Dobson
,
Claire J. Steves
,
Nicholas J. Timpson
,
Nish Chaturvedi
,
Alun D. Hughes
,
Michele Orini
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.21203/rs.3.rs-7480539/v1
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.21203/rs.3.rs-7480539/v1
Background. Maximal oxygen consumption (VO2max) is the gold standard for assessing cardiorespiratory fitness (CRF), and it is a strong predictor of clinical outcomes, but it is measured during cardiopulmonary exercise testing (CPET), which is expensive and time-consuming. Smartwatches provide a great opportunity to assess CRF at scale. Although smartwatches have been previously validated in young and physically active individuals, their accuracy in sedentary individuals remains undetermined and this limits the use smartwatch VO2max in large clinical or epidemiological studies. This study aims to determine the accuracy of smartwatch VO2max in a large group of individuals with varying underlying CRF. Methods. N=203 adults (160 (79%) female; median (interquartile range; IQR) 55 (32,61) years old) from the CONVALESCENCE case-control study of long COVID, performed a maximal CPET on a semi-recumbent ergometer and wore a consumer-grade smartwatch for three months. Smartwatch-estimated VO2max was compared to reference VO2max measured by CPET and predicted VO2max calculated using standard non-exercise equations. Agreement was assessed using Bland-Altman analysis (Bias [Limits of Agreement; LoA]), error (ΔVO2max), absolute error (|ΔVO2max|), and Pearson’s correlation coefficient (r). Results. CPET-measured VO2max was 22.2 (17.5, 27.3) ml/kg/min. Smartwatch-estimated VO2max correlated moderately with CPET-measured VO2max (r=0.65) and strongly with VO2max predicted using non-exercise equations (r=0.92). Bland-Altman plots showed a large positive bias and wide LoA (14.5 [2.2, 26.8 ml/kg/min]). Inaccuracy of smartwatch-estimated VO2max (ΔVO2max) linearly increased with increasing mismatch between expected and measured CRF (correlation with %pVO2max r=-0.81). The absolute error was larger in those with lower-than-expected CRF (%pVO2max<100%) and in those engaging in light intensity activities, while no differences were observed when comparing participants with or without long COVID or symptoms of fatigue. Multiple linear regression analysis of the absolute error identified the mismatch between expected and measured CRF (%pVO2max) as the main contributor to smartwatch inaccuracy. Conclusions. In non-athletes, smartwatch-derived VO2max correlated with reference values but did not provide additional accuracy to VO2max prediction based on sex, age, weight and height. Inaccuracy significantly increased in those with lower-than-expected CRF. These findings highlight current limitations in the use of smartwatch VO2max for clinical applications and large epidemiological studies. Trial registration number: Z6364106/2021/06/04.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.21203/rs.3.rs-7480539/v1
- https://www.researchsquare.com/article/rs-7480539/latest.pdf
- OA Status
- gold
- References
- 26
- OpenAlex ID
- https://openalex.org/W4414769473
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https://openalex.org/W4414769473Canonical identifier for this work in OpenAlex
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https://doi.org/10.21203/rs.3.rs-7480539/v1Digital Object Identifier
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Performance and limitations of smartwatch estimation of VO2max during free-living activity in non-athletesWork title
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articleOpenAlex work type
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enPrimary language
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2025Year of publication
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2025-10-03Full publication date if available
- Authors
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Alexandra Jamieson, Lee Hamill Howes, Siana Jones, Yatharth Ranjan, Amos Folarin, Richard Dobson, Claire J. Steves, Nicholas J. Timpson, Nish Chaturvedi, Alun D. Hughes, Michele OriniList of authors in order
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goldOpen access status per OpenAlex
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0Total citation count in OpenAlex
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| abstract_inverted_index.values | 303 |
| abstract_inverted_index.weight | 317 |
| abstract_inverted_index.(32,61) | 111 |
| abstract_inverted_index.(CPET), | 32 |
| abstract_inverted_index.Maximal | 2 |
| abstract_inverted_index.[Limits | 163 |
| abstract_inverted_index.between | 226, 282 |
| abstract_inverted_index.current | 331 |
| abstract_inverted_index.female; | 105 |
| abstract_inverted_index.fitness | 13 |
| abstract_inverted_index.height. | 319 |
| abstract_inverted_index.maximal | 124 |
| abstract_inverted_index.months. | 137 |
| abstract_inverted_index.number: | 348 |
| abstract_inverted_index.provide | 39, 307 |
| abstract_inverted_index.remains | 65 |
| abstract_inverted_index.testing | 31 |
| abstract_inverted_index.varying | 97 |
| abstract_inverted_index.without | 264 |
| abstract_inverted_index.(r=0.65) | 192 |
| abstract_inverted_index.Although | 48 |
| abstract_inverted_index.Multiple | 271 |
| abstract_inverted_index.absolute | 169, 236, 277 |
| abstract_inverted_index.accuracy | 61, 86, 309 |
| abstract_inverted_index.analysis | 161, 274 |
| abstract_inverted_index.assessed | 158 |
| abstract_inverted_index.clinical | 22, 76, 340 |
| abstract_inverted_index.compared | 141 |
| abstract_inverted_index.engaging | 249 |
| abstract_inverted_index.exercise | 30 |
| abstract_inverted_index.expected | 227, 283 |
| abstract_inverted_index.fatigue. | 270 |
| abstract_inverted_index.findings | 329 |
| abstract_inverted_index.linearly | 221 |
| abstract_inverted_index.measured | 27, 145, 229, 285 |
| abstract_inverted_index.mismatch | 225, 281 |
| abstract_inverted_index.observed | 258 |
| abstract_inverted_index.positive | 207 |
| abstract_inverted_index.standard | 9, 153 |
| abstract_inverted_index.strongly | 194 |
| abstract_inverted_index.studies. | 79, 345 |
| abstract_inverted_index.symptoms | 268 |
| abstract_inverted_index.(r=0.92). | 201 |
| abstract_inverted_index.Agreement | 156 |
| abstract_inverted_index.assessing | 11 |
| abstract_inverted_index.comparing | 260 |
| abstract_inverted_index.determine | 84 |
| abstract_inverted_index.equations | 200 |
| abstract_inverted_index.ergometer | 129 |
| abstract_inverted_index.expensive | 35 |
| abstract_inverted_index.highlight | 330 |
| abstract_inverted_index.increased | 222, 322 |
| abstract_inverted_index.intensity | 252 |
| abstract_inverted_index.outcomes, | 23 |
| abstract_inverted_index.performed | 122 |
| abstract_inverted_index.predicted | 149, 197 |
| abstract_inverted_index.predictor | 20 |
| abstract_inverted_index.r=-0.81). | 234 |
| abstract_inverted_index.reference | 143, 302 |
| abstract_inverted_index.sedentary | 63 |
| abstract_inverted_index.validated | 53 |
| abstract_inverted_index.Agreement; | 165 |
| abstract_inverted_index.Inaccuracy | 216, 320 |
| abstract_inverted_index.additional | 308 |
| abstract_inverted_index.calculated | 151 |
| abstract_inverted_index.correlated | 187, 300 |
| abstract_inverted_index.equations. | 155 |
| abstract_inverted_index.identified | 279 |
| abstract_inverted_index.increasing | 224 |
| abstract_inverted_index.ml/kg/min. | 184 |
| abstract_inverted_index.moderately | 188 |
| abstract_inverted_index.physically | 57 |
| abstract_inverted_index.prediction | 312 |
| abstract_inverted_index.previously | 52 |
| abstract_inverted_index.regression | 273 |
| abstract_inverted_index.smartwatch | 72, 88, 134, 293, 337 |
| abstract_inverted_index.underlying | 98 |
| abstract_inverted_index.Pearson’s | 173 |
| abstract_inverted_index.activities, | 253 |
| abstract_inverted_index.coefficient | 175 |
| abstract_inverted_index.consumption | 4 |
| abstract_inverted_index.contributor | 291 |
| abstract_inverted_index.correlation | 174 |
| abstract_inverted_index.differences | 256 |
| abstract_inverted_index.inaccuracy. | 294 |
| abstract_inverted_index.individuals | 64, 95 |
| abstract_inverted_index.limitations | 332 |
| abstract_inverted_index.opportunity | 42 |
| abstract_inverted_index.(correlation | 231 |
| abstract_inverted_index.Bland-Altman | 160, 202 |
| abstract_inverted_index.Smartwatches | 38 |
| abstract_inverted_index.applications | 341 |
| abstract_inverted_index.case-control | 117 |
| abstract_inverted_index.individuals, | 59 |
| abstract_inverted_index.ml/kg/min]). | 215 |
| abstract_inverted_index.non-exercise | 154, 199 |
| abstract_inverted_index.participants | 261 |
| abstract_inverted_index.registration | 347 |
| abstract_inverted_index.smartwatches | 49 |
| abstract_inverted_index.undetermined | 66 |
| abstract_inverted_index.CONVALESCENCE | 116 |
| abstract_inverted_index.CPET-measured | 178, 190 |
| abstract_inverted_index.non-athletes, | 297 |
| abstract_inverted_index.significantly | 321 |
| abstract_inverted_index.(interquartile | 107 |
| abstract_inverted_index.consumer-grade | 133 |
| abstract_inverted_index.semi-recumbent | 128 |
| abstract_inverted_index.cardiopulmonary | 29 |
| abstract_inverted_index.epidemiological | 78, 344 |
| abstract_inverted_index.time-consuming. | 37 |
| abstract_inverted_index.VO<sub>2</sub>max | 73, 89, 139, 144, 150, 179, 186, 191, 196, 219, 299, 311, 338 |
| abstract_inverted_index.cardiorespiratory | 12 |
| abstract_inverted_index.smartwatch-derived | 298 |
| abstract_inverted_index.%pVO<sub>2</sub>max | 233 |
| abstract_inverted_index.(VO<sub>2</sub>max) | 5 |
| abstract_inverted_index.lower-than-expected | 243, 326 |
| abstract_inverted_index.Smartwatch-estimated | 138, 185 |
| abstract_inverted_index.Z6364106/2021/06/04. | 349 |
| abstract_inverted_index.smartwatch-estimated | 218 |
| abstract_inverted_index.(%pVO<sub>2</sub>max) | 287 |
| abstract_inverted_index.(ΔVO<sub>2</sub>max) | 220 |
| abstract_inverted_index.(ΔVO<sub>2</sub>max), | 168 |
| abstract_inverted_index.<title>Abstract</title> | 0 |
| abstract_inverted_index.(|ΔVO<sub>2</sub>max|), | 171 |
| abstract_inverted_index.<italic>Methods.</italic> | 100 |
| abstract_inverted_index.<italic>Results.</italic> | 177 |
| abstract_inverted_index.<italic>Background.</italic> | 1 |
| abstract_inverted_index.(%pVO<sub>2</sub>max<100%) | 245 |
| abstract_inverted_index.<italic>Conclusions.</italic> | 295 |
| cited_by_percentile_year | |
| countries_distinct_count | 1 |
| institutions_distinct_count | 11 |
| citation_normalized_percentile.value | 0.62209754 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |