Wearable technology is progressively applied in health care and rehabilitation to provide objective insight into physical activity levels. In addition, feedback on physical activity levels delivered by wearable monitors might be beneficial for optimizing their physical activity. A systematic review and meta-analysis was conducted to evaluate the effectiveness of interventions using feedback on objectively measured physical activity in patient populations. Fourteen studies including 1902 patients were analyzed. Overall, the physical activity levels of the intervention groups receiving objective feedback on physical activity improved, compared to the control groups receiving no objective feedback. Mostly, a variety of other strategies were applied in the interventions next to wearable technology. Together with wearable technology, behavioral change strategies, such as goalsetting and action planning seem to be an important ingredient to promote physical activity in health care and rehabilitation. Objective: To determine the effectiveness of health care interventions promoting physical activity, which use objective feedback on physical activity delivered using wearable activity monitors as part of the in tervention. Intervention groups are compared with control groups receiving usual care or interventions without objective feedback. Data sources: PubMed, EMBASE, MEDLINE and Co chrane Library were searched to identify randomized controlled trials. Study selection: Randomized controlled trials pu blished after 2007 with (former) healthcare patients ≥ 21 years of age were included if physical activity was measured objectively using a wearable moni tor for both feedback and outcome assessment. The main goal of included studies was promoting phy sical activity. Any concurrent strategies were related only to promoting physical activity. Data extraction: Effect sizes were calculated using a fixed-effects model with standardized mean dif ference. Information on study characteristics and interventions strategies were extracted from study descriptions. Data synthesis: Fourteen studies met the inclusion criteria (total n = 1,902), and 2 studies were exclu ded from metaanalysis. The overall effect size was in favour of the intervention groups (0.34, 95% CI 0.23-0.44, p < 0.01). Study characteristics and inter vention strategies varied widely. Conclusion: Healthcare interventions using feedback on objectively monitored physical activity have a moderately positive effect on levels of physical acti vity. Further research is needed to determine which strategies are most effective to promote physical ac tivity in healthcare programmes.

Objective The purpose of this study was to investigate the relationship between body mass index (BMI) class and physical activity and sedentary behavior in patients with acute coronary syndrome (ACS) during cardiac rehabilitation (CR). Methods This study was a secondary analysis of the OPTICARE trial. Physical activity and sedentary behavior were measured in patients with ACS (n = 359) using actigraphy at baseline, directly after completion of a multidisciplinary 12-week exercise-based CR program, and 9 months thereafter. Outcome measures were step count and duration of time (% of wear time) spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior. Patients were classified as normal weight (BMI = 18.5–24.99 kg/m2; n = 82), overweight (BMI = 25.0–29.99 kg/m2; n = 182), or obese (BMI ≥ 30.0 kg/m2; n = 95). Linear mixed-effects models were applied to study the relationship between BMI class and physical activity and sedentary behavior. Results At the start of CR, compared with patients with normal weight, patients with obesity made on average 1.11 steps fewer per minute (952 steps/day), spent 2.9% (25 min/day) less time in light physical activity, and spent 3.31% (28 min/day) more time in sedentary behavior. Patients of all BMI classes improved their physical activity and sedentary behavior levels similarly during CR, and these improvements were maintained after completion of CR. Conclusion Patients with ACS who had obesity started CR with a less favorable physical activity and sedentary behavior profile than that of patients with normal weight. Because all BMI classes showed similar improvement during CR, this deficit was preserved. Impact This study indicates that reconsideration of the CR program in the Netherlands for patients with ACS and obesity is warranted, and development of more inclusive interventions for specific populations is needed. A new program for people with obesity should include added counseling on increasing physical activity and preventing sedentary behavior to facilitate weight loss and reduce mortality risk. Lay Summary People with ACS who have obesity are less active and sit more than patients with normal weight, both during and after CR. This study suggests that CR needs to be changed to help patients increase their physical activity to help them lose weight and reduce their risk of death.

Physical activity monitoring with wearable technology has the potential to support stroke rehabilitation. Little is known about how physical therapists use and value the use of wearable activity monitors. This cross-sectional study explores the use, perspectives, and barriers to wearable activity monitoring in day-to-day stroke care routines amongst physical therapists. Over 300 physical therapists in primary and geriatric care and rehabilitation centers in the Netherlands were invited to fill in an online survey that was developed based on previous studies and interviews with experts. In total, 103 complete surveys were analyzed. Out of the 103 surveys, 27% of the respondents were already using activity monitoring. Of the suggested treatment purposes of activity monitoring, 86% were perceived as useful by more than 55% of the therapists. The most recognized barriers to clinical implementation were lack of skills and knowledge of patients (65%) and not knowing what brand and type of monitor to choose (54%). Of the non-users, 79% were willing to use it in the future. In conclusion, although the concept of remote activity monitoring was perceived as useful, it was not widely adopted by physical therapists involved in stroke care. To date, skills, beliefs, and attitudes of individual therapists determine the current use of wearable technology.