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ABSTRACT
GAMELIN, F. X., S. BERTHOIN, and L. BOSQUET. Validity of the Polar S810 Heart Rate Monitor to Measure RR Intervals at
Rest. Med. Sci. Sports Exerc., Vol. 38, No. 5, pp. 887893, 2006. Purpose: This study was conducted to compare RR intervals and
the subsequent analysis of heart rate variability (HRV) obtained from the Polar S810 heart rate monitor (HRM) (Polar Electro Oy)
with an electrocardiogram (ECG) (Physiotrace, Estaris, Lille, France) during an orthostatic test. Methods: A total of 18 healthy men
(age: 27.1 T 1.9 yr; height: 1.82 T 0.06 m; mass 77.1 T 7.7 kg) performed an active orthostatic test during which RR intervals were
simultaneously recorded with the HRM and the ECG recorder The two signals were synchronized and corrected before a time domain
analysis, the fast Fourier transform (FFT) and a Poincare plot analysis. Bias and limits of agreement (LoA), effect size (ES), and
correlation coefficients were calculated. Results: RR intervals were significantly different in the supine and standing position
between the ECG and the HRM uncorrected and corrected signal (P G 0.05, ES = 0.000 and 0.006, respectively). The bias T LoA,
however, were 0.9 T 12 ms. HRV parameters derived from both signals in both positions were not different (P > 0.05) and well
correlated (r > 0.97, P G 0.05), except root mean square of difference (RMSSD) and SD1 in standing position (P G 0.05, ES = 0.052
and 0.057; r = 0.99 and 0.98, respectively). Conclusion: Narrow LoA, good correlations, and small effect sizes support the validity of
the Polar S810 HRM to measure RR intervals and make the subsequent HRV analysis in supine position. Caution must be taken in
standing position for the parameters sensitive to the short-term variability (i.e., RMSSD and SD1). Key Words: HEART RATE
VARIABILITY, TIME DOMAIN ANALYSIS, FREQUENCY DOMAIN ANALYSIS, POINCARE GRAPH ANALYSIS
METHODS
Subjects
A total of 18 active men (age: 27.1 T 1.9 yr; height: 1.82 T
0.06 m; mass 77.1 T 7.7 kg) with no smoking history and no
known cardiovascular disease gave their written, informed
consent to participate in the study. All of the subjects submitted
to an inclusion protocol before the start of the study. This
consisted of an information session about the nature, the
potential risks involved, and the benefits of the study, followed
by a complete medical screening when the subjects were
interested in participating to the study. The protocol has been
reviewed and approved by the consultative committee for the
protection of human subjects in biomedical research of the
NordPas de Calais (France) before the start of the study.
887
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Experimental Design
Two weeks after the inclusion visit, the subjects reported
to the laboratory within 2 h of waking (between 6:00 and
10:00 A.M.). Subjects were asked to abstain from caffeinecontaining foods and beverages on the day before the test.
Before the 17-min recording, the skin of the subject was
cleaned and prepared for the attachment of surface electrodes (Blue Sensor, Medicotest Ltd, Klstykke, Denmark).
The electrodes of the ECG were placed in such a way not to
prevent the installation of the HRM elastic electrode belt
(T61, Polar Electro Oy). The electrode belt was placed just
below the chest muscles with conductive gel being applied
as described by the manufacturer.
The subject rested comfortably during the recording for
at least 10 min in a supine position and 7 min in a standing
position in a quiet, semidark laboratory room, maintained
at a temperature of 1921-C. To control the respiratory
influence on HRV, the subjects matched their breathing
frequency to an auditory metronome set at 0.20 Hz
(12 breathsIminj1). No attempt was made to control the
tidal volume.
Data Acquisition
RR intervals were recorded simultaneously with a Polar
S810 HRM and a two-lead ECG recorder (Physiotrace
Estaris, Lille, France) at a sampling frequency of 1000 Hz
for both devices.
R-wave peaks were detected automatically in the ECG
series using a detection algorithm supplied by the manufacturer (Estaris). Following the recordings and storage of
the raw ECG data, ECG signals were replayed to verify
and validate visually each R-wave peak by an accustomed
person. A vertical mark on the ECG indicated the detection
of an R-wave. If the detection was incorrect, R-wave peak
was determined manually by replacing the vertical marks
on the correct R-wave peak. Subsequently, RR intervals
were exported under the ASCII format. The HRM signal
was transferred to the Polar Precision Performance Software (release 3.00; Polar Electro Oy) and RR intervals
were exported under ASCII format.
Data Analysis
RR interval comparison. The ECG and HRM
signals were synchronized for further analysis by marking
the data using the temporal event marker available in
both systems. Raw R R intervals from both acquisition
systems were edited and compared to discriminate error
caused by the HRM acquisition or by a nonsinus beat.
Nonsinus beats, which were present in both signals, were
replaced by interpolated data derived from adjacent normal
R R intervals.
An error caused by the HRM acquisition was considered
when the difference between ECG and HRM interval
exceeded 20 ms (11). Then the HRM interval was labeled
anomalous and later assigned to one of five identified error
categories (11). A type 1 error was defined as a single point
888
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Description of Error
Supine
Standing
0
4
0
21
3
1
12
1
32
11
Statistical Analysis
Standard statistical methods were used to calculate the
means and standard deviations. Normal Gaussian distribution and homogeneity of variance were verified by the
ShapiroWilk and the Levenne tests, respectively. Homoscedasticity was checked with a modified Levenne test. A
paired t-test or, when appropriate, a Wilcoxon matchedpairs test, was used to detect the presence of a systematic
difference in RR interval or HRV indices calculated from
both systems. Effect size (ES), which represents the ratio
of the mean difference over the pooled variance (20), was
used to estimate the magnitude of the difference. As
proposed by Cohen (4), the difference was considered
small when ES e 0.2, moderate when ES e 0.5, and great
when ES > 0.8. Relative reliability, defined as the degree to
FIGURE 1Representative BlandAltman plot for electrocardiogram (ECG) and uncorrected heart rate monitor (HRM) RR intervals (A) and
for ECG and corrected HRM RR intervals (B) in supine position. Center solid line equals mean difference between the two devices to detect RR
intervals and outer dot-dash lines equal T 2 standard deviations (SD) of the mean.
VALIDITY OF THE POLAR S810 HEART RATE MONITOR
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889
FIGURE 2Representative BlandAltman plot for electrocardiogram (ECG) and uncorrected heart rate monitor (HRM) RR intervals (A) and
for ECG and corrected HRM RR intervals (B) in standing position. Center solid line equals mean difference between the two devices to detect RR
intervals and outer dot-dash lines equal T 2 standard deviations (SD) of the mean.
RESULTS
The number of RR intervals detected was 11,353 and
9,878 in supine and standing position, respectively, for the
890
ECG, and 11,335 and 9,857 for the HRM. The degree and the
type of error are described in Table 1. The t-test revealed that
uncorrected and corrected RR intervals were different from
ECG RR intervals in supine position (P G 0.05, ES = 0.025
and 0.000, respectively). Figures 1 and 2 represent Bland
Altman plots for combined ECG and uncorrected RR
intervals and the ECG and corrected RR intervals. The
correlations were 0.88 and 0.99 for the uncorrected and the
corrected HRM RR intervals with the ECG in supine
position, respectively (P G 0.001). In standing position,
coefficients of correlation with ECG RR intervals were
0.88 and 0.99 for uncorrected and corrected HRM data,
respectively (P G 0.001). No significant differences were
noted for time domain, FFT, and Poincare plot parameters
obtained from the corrected Polar and ECG signals, except
for RMSSD, SD1 in standing position (P G 0.05). The
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TABLE 2. Heart rate variability parameters obtain from the electrocardiogram (ECG) and heart rate monitor (HRM) signal (means T SD), correlation between ECG and HRM
parameters, bias, magnitude of the bias, and limit of agreement (LoA) in supine position.
Magnitude of the Bias
Parameter
SDNN (ms)
RMSSD (ms)
NN50 (count)
pNN50 (%)
SD1 (ms)
SD2 (ms)
VLF (ms2)
LF (ms2)
HF (ms2)
LF nu
HF nu
LF/HF
ECG
50.2 T 18.8
46.7 T 23.7
65.2 T 48.2
26.2 T 20.8
33.3 T 16.8
70.8 T 22.1
98.0 T 80.6
192.0 T 119.4
335.0 T 429. 8
44.9 T 22.5
55.0 T 22.5
1.2 T 1.2
Polar
Correlation (r)
T
T
T
T
T
T
T
T
T
T
T
T
0.99
0.99
0.99
0.99
0.99
0.99
0.99
0.99
0.99
0.99
0.99
0.99
50.1
46.5
64.3
25.9
33.2
70.8
97.7
192.8
333.9
45.0
55.0
1.3
18.8
23.7
48.0
20.7
16.8
22.1
80.7
122.1
428.9
22.9
22.9
1.2
Bias
0.08
0.21
0.78
0.29
0.15
0.02
0.08
0.06
0.39
0.03
j0.03
j0.02
LoA
j0.47
j1.17
j6.51
j2.47
j0.85
j0.56
j4.61
j5.82
j8.63
j1.90
j1.96
j0.18
to
to
to
to
to
to
to
to
to
to
to
to
0.63
1.58
8.07
3.04
1.15
0.60
4.78
5.94
9.42
1.96
1.90
0.13
Effect Size
Interpretation
0.004
0.009
0.017
0.015
0.009
0.000
0.003
0.007
0.003
0.000
0.000
0.021
Small
Small
Small
Small
Small
Small
Small
Small
Small
Small
Small
Small
DISCUSSION
This study compared raw data and the HRV parameters derived from a Polar S810 HRM and a two-lead
ECG recorder. The present results demonstrate the
HRM can provide HRV measurements consistent with
an ECG recorder in healthy subjects during an active
orthostatic test.
The error rate in detection of R-waves for Polar
compared with the ECG system was 0.40%. This is in
accordance with previous studies that reported a rate of
0.322.8% (8,17). The most common error occurring in the
uncorrected HRM signal was a type 4 error (too few RR
intervals detected). It represented 75 and 56% of the total
errors in supine and standing position, respectively. The
origin of this error is not known, but a lack of contact
between the skin and the elastic electrode belt could cause
TABLE 3. Heart rate variability parameters obtain from the electrocardiogram (ECG) and heart rate monitor (HRM) signal (means T SD), correlation between ECG and HRM
parameters, bias, magnitude of the bias, and limit of agreement (LoA) in standing position.
Magnitude of the Bias
Parameter
SDNN (ms)
RMSSD (ms)
NN50 (count)
pNN50 (%)
SD1 (ms)
SD2 (ms)
VLF (ms2)
LF (ms2)
HF (ms2)
LF nu
HF nu
LF/HF
ECG
Polar
Correlation (r)
41.4 T 13.1
21.1 T 8.9
12.9 T 16.5
4.1 T 5.5
15.1 T 6.3
67.1 T 21.0
141.4 T 85.4
243.7 T 180.6
67.1 T 64.9
77.4 T 15.5
22.6 T 15.5
6.8 T 7.3
41.4 T 13.0
20.7 T 8.6a
12.7 T 16.2
4.0 T 5.4
14.8 T 6.1a
67.2 T 21.0
142.1 T 86.6
244.6 T 180.3
64.9 T 62.1
77.9 T 15.2
22.1 T 15.2
6.8 T 7.3
0.99
0.99
0.98
0.97
0.98
0.99
0.99
0.99
0.99
0.98
0.98
0.98
Bias
0.06
0.46
0.28
0.10
0.35
j0.04
j0.76
j0.86
2.13
j0.47
0.47
j0.03
LoA
Effect Size
Interpretation
j0.28 to 0.40
j1.15 to 2.07
j3.45 to 4.01
j1.03 to 1.23
j0.92 to 1.63
j0.30 to 0.21
j6.06 to 4.54
j6.66 to 4.94
j6.72 to 10.97
j3.53 to 2.58
j2.58 to 3.53
j0.85 to 0.78
0.004
0.052
0.017
0.018
0.057
0.002
0.009
0.005
0.033
0.031
0.031
0.005
Small
Small
Small
Small
Small
Small
Small
Small
Small
Small
Small
Small
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891
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