Purpose Assessing the validity of maximum oxygen uptake (VO2max) estimates provided by a commercially available smartwatch (Garmin Forerunner 245, Garmin Ltd., Olathe, USA) compared to laboratory-based respiratory gas analysis in moderately-to-highly trained athletes. Methods Thirty-five endurance athletes (Tier 2-3 athletes, 24 males, 11 females; age: 25.1 ± 3.5 years; VO2max: 60.1 ± 8.2 ml·min-1·kg-1) completed a treadmill ramp test with respiratory gas analysis to determine criterion VO2max. Additionally, each athlete performed two submaximal 15-min outdoor runs at > 70% of maximum heart rate, during which the smartwatch estimated VO2max. Athletes were stratified into moderately trained (VO2max = 59.8 ml·min-1·kg-1) and highly trained (VO2max > 59.8 ml·min-1·kg-1) subgroups. Results Across all athletes, the smartwatch underestimated VO2max [mean differences: - 4.73 ml·min-1·kg-1 (run 1), -4.05 ml·min-1·kg-1 (run 2)]. Intraclass correlation coefficients (ICC) indicated moderate agreement between smartwatch and laboratory values (run 1: ICC = 0.71 [95% CI: 0.03-0.90]; run 2: ICC = 0.75 [95% CI: 0.17-0.91]), with mean absolute percentage errors (MAPE) of 7.9% and 7.2%. Subgroup analyses revealed better accuracy of smartwatch estimated VO2max in moderately trained group (MAPE: 4.1-2.8%; ICC: 0.63-0.66 [95% CI: 0.09-0.87]), whereas in highly trained athletes, the smartwatch underestimated VO2max by 6.3 ml·min-1·kg-1 (MAPE: 10.4-9.4%; ICC: 0.34-0.41 [95% CI: - 0.11-0.75]). Conclusion Smartwatch-derived VO2max estimates are valid in moderately trained athletes but less valid in highly trained individuals. While smartwatches are useful for general monitoring, caution is warranted in their interpretation, particularly in highly trained individuals. Laboratory-based gas analysis remains the preferred method when precision is required.
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