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Review
. 2024 Jan;54(1):1-21.
doi: 10.1007/s40279-023-01948-4. Epub 2023 Oct 31.

Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement

Robert Gajda  1   2 , Jacek Gajda  3 , Miłosz Czuba  4 , Beat Knechtle  5   6 , Wojciech Drygas  7   8
Affiliations
Review

Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement

Robert Gajda et al. Sports Med. 2024 Jan.

Abstract

There are countless types of portable heart rate monitoring medical devices used variously by leisure-time exercisers, professional athletes, and chronically ill patients. Almost all the currently used heart rate monitors are capable of detecting arrhythmias, but this feature is not widely known or used among their millions of consumers. The aims of this paper were as follows: (1) to analyze the currently available sports heart rate monitors and assess their advantages and disadvantage in terms of heart rate and rhythm monitoring in endurance athletes; (2) to discuss what types of currently available commercial heart rate monitors are most convenient/adjustable to the needs of different consumers (including occasionally physically active adults and cardiac patients), bearing in mind the potential health risks, especially heart rhythm disturbances connected with endurance training; (3) to suggest a set of "optimal" design features for next-generation smart wearable devices based on the consensus opinion of an expert panel of athletes, coaches, and sports medicine doctors. Ninety-two experts aged 20 years and over, involved in endurance sports on a daily basis, were invited to participate in consensus-building discussions, including 56 long-distance runners, 18 cyclists, nine coaches, and nine physicians (sports medicine specialists, cardiologists, and family medicine doctors). The overall consensus endorsed by these experts indicates that the "optimal" sports heart rate monitor should be a one-piece device of the smartwatch type (with two or more electrodes), with integrated smartphone features, and able to collect and continually transmit data without exhibiting artifacts. It should continuously record at least a single-lead electrocardiography, send an alert after an unexpected fall, be of reasonable weight, come at an affordable price, and be user friendly.

Plain language summary

Regular endurance training is among the key factors positively influencing human health. However, there are also many reports describing sudden cardiac fatalities and other serious health problems related to strenuous exercise. Millions of professional and leisure-time athletes worldwide use various digital heart rate monitors to keep track of their training volume, intensity, energy expenditure, running or cycling speed. Nevertheless, currently available heart rate monitors are not tailored to all the specific needs of their users. Moreover, they are not constructed to keep better track of important health functions and thereby improve the safety of endurance training. This paper presents a set of consensus statements developed by a panel of expert heart rate monitor users (endurance athletes, their physicians, and coaches) from three countries. In the panel’s view, the “optimal” heart rate monitor should improve users’ safety during exercise by providing more reliable medical data informative of potential health risks. A specific set of features of the proposed “optimal” digital heart rate monitor was identified and accepted by the panel of experts. Based on the consensus statements and the available literature, the authors propose next-generation portable devices for use by professional and ambitious leisure-time endurance athletes or even by cardiac patients involved in exercise training (a design called the “Gajda Watch” after the surname of two of the panel organizers/paper authors). One of the biggest challenges is dealing with artifacts and avoiding false information. This consensus document may also be helpful for manufacturers of heart rate monitors seeking new solutions for the sports and medical community.

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Conflict of interest statement

Robert Gajda, Jacek Gajda, Miłosz Czuba, Beat Knechtle, and Wojciech Drygas have no conflicts of interests that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
(A) Motiv ring and (B) LifeSignals Biosensor
Fig. 2
Fig. 2
Frontier X2 heart rate monitor recorder, compatible with third-party devices (smartwatch, smartphone, and/or PC), connected via Bluetooth Low-Energy
Fig. 3
Fig. 3
Procedure for managing suspected arrhythmias based on indications by different types of heart rate monitors (HRMs). ECG electrocardiography, ECG-S electrocardiography sensors, EPS intracardiac electrophysiology study, ETT exercise tolerance test, MRI magnetic resonance imaging, PPG-S photoplethysmography sensors, s seconds, TTE transthoracic echocardiography
Fig. 4
Fig. 4
Attributes of a sophisticated sports heart monitor for endurance athletes, the “Gajda Watch”: an expert consensus. AF atrial fibrillation, ECG electrocardiography, HR heart rate
See this image and copyright information in PMC

References

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