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Following a comprehensive literature and online search, 45 manufacturers of wrist-worn devices were identified.Criteria for inclusion included: wrist-worn watch or band; continuous measurement of HR; stated battery life 24 h; commercially available direct to consumer at the time of the study; one device per manufacturer.Thus, validation data on new devices and a forum for the ready dissemination of such data are urgent requirements.Prior studies of wrist-worn devices have focused on earlier stage devices, or have focused exclusively on HR or estimation of EE.The ability to measure physical activity through wrist-worn devices provides an opportunity for cardiovascular medicine.However, the accuracy of commercial devices is largely unknown.Some have made comparisons among devices without reference to the U. a Food and Drug Administration (FDA) approved gold standard.None proposed an error model or framework for device validation.

Participant characteristics are presented in Table 1.

More recent improvements in battery longevity and miniaturization of the processing hardware to turn raw signals in real time into interpretable data led to the commercial development of wrist-worn devices for physiological monitoring.

Such devices can provide data directly back to the owner and place estimates of heart rate (HR) and energy expenditure (EE) within a consumer model of health and fitness.

In conclusion, most wrist-worn devices adequately measure HR in laboratory-based activities, but poorly estimate EE, suggesting caution in the use of EE measurements as part of health improvement programs.

We propose reference standards for the validation of consumer health devices (

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