Agreement Between a Smart Ring and Manual Pulse Palpation for Heart Rate Measurement After the Six-Minute Walk Test in Male Hajj Pilgrims: A Cross-Sectional Agreement Study
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Syarief Hasan Lutfie, Anggy Firmansyah, Andes Rizky, Muhammad Alif Adril, Larisa Sabrina Rahadiyanti (2026). Agreement Between a Smart Ring and Manual Pulse Palpation for Heart Rate Measurement After the Six-Minute Walk Test in Male Hajj Pilgrims: A Cross-Sectional Agreement Study. Journal of Pharmaceutical and Sciences, JPS Volume 9 Nomor 4 (2026). https://doi.org/10.36490/journal-jps.com.v9i4.1921
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Abstract
This cross-sectional method-comparison study assessed the agreement between heart rate measured by a smart ring and by manual pulse palpation after the six-minute walk test in Hajj pilgrims, and the consistency of repeated smart-ring readings. The study was conducted at the Pondok Gede Hajj Dormitory, East Jakarta, in April 2026. We enrolled 108 healthy male special Hajj pilgrims aged 18–60 years using on-site random sampling. Consistency was assessed in 10 participants, each with 10 consecutive smart-ring readings. Immediately after the six-minute walk test, trained staff recorded heart rate with the smart ring and, at the same time, by palpation of the radial artery for 60 s. We assessed agreement using the paired t-test, Pearson's correlation, and Bland–Altman analysis. The comparator was manual palpation, not electrocardiography. The 10 repeated smart-ring readings were highly consistent as an average (Cronbach's alpha 0.962; intraclass correlation coefficient for average measures 0.959, 95% confidence interval 0.908–0.988; P <0.001), whereas the consistency of a single reading was moderate (intraclass correlation coefficient 0.702). Mean heart rate after the test was 86.42 ± 6.54 beats/min with the smart ring and 86.25 ± 6.68 beats/min with palpation, a mean difference of 0.17 beats/min that was not significant (P = 0.120); the two methods were closely correlated (r = 0.986; P <0.001). The 95% limits of agreement were −2.04 to 2.38 beats/min, within a clinically acceptable margin of ±5 beats/min, with no proportional bias. In healthy male pilgrims, smart-ring heart rate agreed closely with manual palpation, supporting the smart ring as a practical, non-invasive option for fitness screening
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[1] American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription, 11th ed. Philadelphia, PA, USA: Wolters Kluwer, 2021.
[2] Ministry of Health of the Republic of Indonesia. Pedoman Istithaah Kesehatan Jemaah Haji [Guideline on the Health Readiness of Hajj Pilgrims]. Jakarta, Indonesia: Ministry of Health of the Republic of Indonesia, 2024.
[3] Pane M, Imari S, Alwi Q, Kandun IN, Cook AR, Samaan G. Causes of mortality for Indonesian Hajj pilgrims: comparison between routine death certificate and verbal autopsy findings. PLoS One 2013;8:e73243. https://doi.org/10.1371/journal.pone.0073243.
[4] Ardiana M, Utami ER, Al Farabi MJ, Azmi Y. The impact of classical cardiovascular risk factors on hospitalization and mortality among Hajj pilgrims. Sci World J 2023;2023:9037159. https://doi.org/10.1155/2023/9037159.
[5] Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46. https://doi.org/10.1183/09031936.00150314.
[6] Bent B, Goldstein BA, Kibbe WA, Dunn JP. Investigating sources of inaccuracy in wearable optical heart rate sensors. NPJ Digit Med 2020;3:18. https://doi.org/10.1038/s41746-020-0226-6.
[7] Shcherbina A, Mattsson CM, Waggott D, Salisbury H, Christle JW, Hastie T, et al. Accuracy in wrist-worn, sensor-based measurements of heart rate and energy expenditure in a diverse cohort. J Pers Med 2017;7:3. https://doi.org/10.3390/jpm7020003.
[8] Parak J, Korhonen I. Evaluation of wearable consumer heart rate monitors based on photoplethysmography. Annu Int Conf IEEE Eng Med Biol Soc 2014;2014:3670-3. https://doi.org/10.1109/EMBC.2014.6944419.
[9] Chow HW, Yang CC. Accuracy of optical heart rate sensing technology in wearable fitness trackers for young and older adults: validation and comparison study. JMIR mHealth uHealth 2020;8:e14707. https://doi.org/10.2196/14707.
[10] Inoue A, Soares JPF, Antunes-Santos F, Ferreira A, Gonçalves A, Alcântara JA, et al. Heart rate estimation using the Galaxy Watch during maximal cardiopulmonary exercise testing: cross-sectional validation study. JMIR Cardio 2026;10:e81917. https://doi.org/10.2196/81917.
[11] ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7. https://doi.org/10.1164/ajrccm.166.1.at1102.
[12] Koo TK, Li MY. A guideline for selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15:155-63. https://doi.org/10.1016/j.jcm.2016.02.012.
[13] Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10. https://doi.org/10.1016/S0140-6736(86)90837-8.
[14] Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999;8:135-60. https://doi.org/10.1177/096228029900800204.
[15] Association for the Advancement of Medical Instrumentation. ANSI/AAMI EC13:2002. Cardiac monitors, heart rate meters, and alarms. Arlington, VA, USA: Association for the Advancement of Medical Instrumentation, 2002.
[16] Cao R, Azimi I, Sarhaddi F, Niela-Vilen H, Axelin A, Liljeberg P, et al. Accuracy assessment of Oura ring nocturnal heart rate and heart rate variability in comparison with electrocardiography in time and frequency domains: comprehensive analysis. J Med Internet Res 2022;24:e27487. https://doi.org/10.2196/27487.
[17] Kinnunen H, Rantanen A, Kenttä T, Koskimäki H. Feasible assessment of recovery and cardiovascular health: accuracy of nocturnal HR and HRV assessed via ring PPG in comparison to medical-grade ECG. Physiol Meas 2020;41:04NT01. https://doi.org/10.1088/1361-6579/ab840a.
[18] McArdle WD, Katch FI, Katch VL. Exercise Physiology: Nutrition, Energy, and Human Performance, 9th ed. Philadelphia, PA, USA: Wolters Kluwer, 2022.
[19] Düking P, Giessing L, Frenkel MO, Koehler K, Holmberg HC, Sperlich B. Wrist-worn wearables for monitoring heart rate and energy expenditure while sitting or performing light-to-vigorous physical activity: Validation study. JMIR mHealth uHealth 2020;8:e16716. https://doi.org/10.2196/16716.
[20] Düking P, Fuss FK, Holmberg HC, Sperlich B. Recommendations for assessment of the reliability, sensitivity, and validity of data provided by wearable sensors designed for monitoring physical activity. JMIR mHealth uHealth 2018;6:e102. https://doi.org/10.2196/mhealth.9341.