The effect of postural orientation on body composition and total body water estimates produced by smartwatch bioelectrical impedance analysis: an intra- and inter-device evaluation

Advances in wearable technologies now allow modern smartwatches to collect body composition estimates through bioelectrical impedance techniques embedded within their design. However, this technique is susceptible to increased measurement error when postural changes alter body fluid distribution. The purpose of this study was to evaluate the effects of postural orientation on body composition and total body water (TBW) estimates produced by smartwatch bioelectrical impedance analysis (SWBIA) and determine its agreement with criterion measures. For this cross-sectional evaluation, 117 (age: 21.4±3.0 y; BMI: 25.3±5.7 kg/m²) participants (F:69, M:48) completed SWBIA measurements while in the seated, standing, and supine positions, then underwent criterion dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance spectroscopy (BIS) assessments. In the combined sample and females, body fat percent, fat mass, and fat-free mass using SWBIA were significantly different between the supine and standing positions (all p<0.001), though group level agreement with DXA was similar across positions. Supine SWBIA TBW estimates were significantly different between seated and standing estimates (all p≤0.026), but further analyses revealed that this was driven by the supine and seated differences observed in females (p=0.003). SWBIA TBW demonstrated similar group and individual level agreement with BIS across body positions with slight improvements observed during seated and supine assessments for females and males, respectively. SWBIA may demonstrate slight intra- and inter-device differences in body composition and TBW when measured across postural orientations, though further evaluations in external/clinical samples are necessary. While sex/position-specific guidelines may improve precision, these findings highlight the importance of standardized body positioning when using SWBIA.