Cuffless Blood Pressure Estimation During Moderate- and Heavy-Intensity Exercise Using Wearable ECG and PPG

Objective: To develop and evaluate an accurate method for cuffless blood pressure (BP) estimation during moderate- and heavy-intensity exercise. Methods: Twelve participants performed three cycling exercises: a ramp-incremental exercise to exhaustion, and moderate and heavy pseudorandom binary sequence exercises on an electronically braked cycle ergometer over the course of 21 minutes. Subject-specific and population-based nonlinear autoregressive models with exogenous inputs (NARX) were compared with feedforward artificial neural network (ANN) models and pulse arrival time (PAT) models. Results: Population-based NARX models, (applying leave-one-subject-out cross-validation), performed better than the other models and showed good capability for estimating large changes in mean arterial pressure (MAP). The models were unable to track consistent decreases in BP during prolonged exercise caused by reduction in peripheral vascular resistance, since this information is apparently not encoded in the employed proxy physiological signals (electrocardiography and forehead PPG) used for BP estimation. Nevertheless, the population-based NARX model had an error standard deviation of 11.0 mmHg during the entire exercise window, which improved to 9.0 mmHg when the model was periodically calibrated every 7 minutes. Conclusion: Population-based NARX models can estimate BP during moderate- and heavy-intensity exercise but need periodic calibration to account for the change in vascular resistance during exertion. Significance: MAP can be continuously tracked during exercise using only wearable sensors, making monitoring exercise physiology more convenient and accessible.