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During exercise, pulse oximetry is problematic due to motion artifact and altered digital perfusion. New pulse oximeter technology addresses these issues and may offer improved performance. We simultaneously compared Nellcor N-395 (Oxismart XLTM) pulse oximeters with an RS-10 forehead sensor (RS-10), a D-25 digit sensor (D-25), and the Ivy 2000 (Masimo SETTM)/LNOP-Adt digit sensor (Ivy) to arterial blood oxygen saturation (Sa_O2 ) by cooximetry. Nine normal subjects, six athletes, and four patients with chronic disease exercised to maximum oxygen consumption (V˙o _2 max) under various conditions [normoxia, hypoxia inspired oxygen fraction (Fi _O2 ) = 0.125; hyperoxia, Fi _O2 = 1.0]. Regression analysis for normoxia and hypoxic data was performed (n = 161 observations, Sa_O2 = 73–99.9%), and bias (B) and precision (P) were calculated. RS10 offered greater validity than the other two devices …