Development and Usage of Analytic Tools and Recommendations for Validation and Reliability Studies Using Consumer-Grade Wearable Technology

Introduction: Wearable technology is increasingly utilized across various fields, yet the validity and reliability of the physiological data these devices provide are often unverified due to a lack of rigorous testing standards. Purpose: This dissertation contains three primary works, and therefore multiple purposes. The purpose of the first project (Chapter 2) is to introduce a new risk of bias assessment tool, specifically for assessing methodological quality and the risk of bias in validity and reliability studies using wearable technology, with a focus on consumer-grade wearable technology. The purpose of the second project (Chapter 3) was to perform a systematic review and meta-analysis that served a dual purpose: to review the current validity and reliability literature concerning consumer-grade wearable technology measurements/estimates of physiological variables (e.g. heart rate, energy expenditure, etc.) during exercise. Additionally, we sought to perform risk of bias assessments utilizing the novel WEArable technology Risk of Bias and Objectivity Tool (WEAR-BOT) and perform meta-analytic calculations on the reported data. The purpose of the third project (Chapter 4) was to evaluate the accuracy (validity) of maximal oxygen consumption (VO2max) estimates and blood oxygen saturation (BOS) measured via pulse oximetry using the Garmin fēnix 6 with a general population participant pool. Methods: Chapter 1: The development of WEAR-BOT through a multi-institutional collaboration, employing iterative discussions, Delphi-style surveys, and pilot testing. Chapter 2: A systematic review and meta-analysis using WEAR-BOT to assess the risk of bias and analyze the validity and reliability data of physiological measurements from consumer-grade wearables during exercise. Chapter 3: A validation study employing WEAR-BOT guidelines to test the accuracy of a wearable device in measuring aerobic capacity (VO2max) and pulse oximetry in the general population. Results: The development of WEAR-BOT established a detailed and structured approach to evaluate wearable technology studies. The systematic review highlighted a prevalent high risk of bias within the field, indicating the need for standardization. The validation study demonstrated the practical application of WEAR-BOT, confirming its effectiveness in guiding rigorous research methodologies and producing reliable data. Conclusion: By introducing and applying the WEAR-BOT, this dissertation significantly contributes to the standardization and enhancement of research methods in the domain of wearable technology. The tool not only aids researchers in designing and evaluating studies but also ensures that the data generated from wearable devices are both reliable and valid, fostering greater trust and broader application in health-related and athletic settings.