Early Detection of COVID-19 in Female Athletes Using Wearable Technology

Background: Heart rate variability (HRV), respiratory rate (RR), and resting heart rate (RHR) are common variables measured by wrist-worn activity trackers to monitor health, fitness, and recovery in athletes. Variations in RR are observed in lower-respiratory infections, and preliminary data suggest changes in HRV and RR are linked to early detection of COVID-19 infection in nonathletes. Hypothesis: Wearable technology measuring HRV, RR, RHR, and recovery will be successful for early detection of COVID-19 in NCAA Division I female athletes. Study Design: Cohort study. Level of Evidence: Level 2. Methods: Female athletes wore WHOOP, Inc. bands through the 2020 to 2021 competitive season. Of the athletes who tested positive for COVID (n = 33), 14 had enough data to be assessed (N = 14; 20.0 ± 1.3 years; 69.8 ± 7.2 kg; 172.0 ± 8.3 cm). Roughly 2 weeks of noninfected days were used to set baseline levels of HRV, RR, recovery, and RHR to compare with -3, -2, and -1 days before a positive COVID-19 result. Results: Increases in RR ( P = 0.02) were detected on day -3. RHR ( P < 0.01) and RR increased ( P < 0.01), while HRV decreased ( P < 0.05) on day -1, compared with baseline. Differences were noted in all variables on the day of the positive COVID-19 result: decreased HRV ( P < 0.05) and recovery scores ( P < 0.01), and increased RHR ( P < 0.01) and RR ( P < 0.01). Conclusion: In female athletes, wearable technology was successful in predicting COVID-19 infection through changes in RR 3 days before a positive test, and also HRV and RHR the day before a positive test. Clinical Relevance: Wearable technology may be used, as part of a multifaceted approach, for the early detection of COVID-19 in elite athletes through monitoring of HRV, RR, and RHR for overall team health.