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Real-time digital heart rate (HR) monitoring in sports can provide unique physiological insights into athletic performance. However, most HR monitoring of elite athletes is limited to non-real-time, non-competition settings while utilizing sensors that are cumbersome. The present study was undertaken to test the feasibility of using small, wearable medical-grade sensors, paired with a novel technology system, to capture and process real-time HR data from elite athletes during professional competition.   Methods:   We examined the performance of the BioStamp nPoint® sensor compared to the Polar chest strap HR sensor in 15 Professional Squash Association (PSA) tournament matches in 2019–2020. Fourteen male professional squash players volunteered for the study (age = 23.8 ± 4.9 years; height = 177.9 ± 7.1 cm; weight = 71 ± 7.0 kg), which was approved by the PSA in accordance with their Code of General Conduct and Ethics. Algorithms developed by Sports Data Labs (SDL; Detroit, MI, USA) used proprietary data collection, transmission, and signal processing protocols to produce HR values in real-time during matches. We calculated the mean and maximum HR from both sensors and used widely accepted measures of agreement to compare their performance.   Results:   The system captured 99.8% of HR data across all matches (range 98.3–100%). The BioStamp’s mean HR was 170.4 ± 20.3 bpm, while the Polar’s mean HR was 169.4 ± 21.7 bpm. Maximum HR ranged from 182 to 202 bpm (Polar) and 185 to 203 bpm (BioStamp). Spearman’s correlation coefficient ( r <sub>s</sub>) was 0.986 ( p  < 0.001), indicating a strong correlation between the 2 devices. The mean difference ( d ) in HR was 1.0 bpm, the mean absolute error was 2.2 bpm, and the percent difference was 0.72%, demonstrating high agreement between device measurements.   Conclusions:   It is feasible to accurately measure and monitor real-time HR in elite athletes during competition using BioStamp’s and SDL’s proprietary system. This system facilitates development and understanding of physiological digital biomarkers of athletic performance and physical and psychosocial demands in elite athletic competition.

Real-Time Digital Biometric Monitoring during Elite Athletic Competition: System Feasibility with a Wearable Medical-Grade Sensor