Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials

Abstract

Background Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. Objective This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. Methods We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. Results Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient –668, 95% CI –1157 to –180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient –517, 95% CI –1188 to –11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. Conclusions In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. Trial Registration PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012

Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials

“…This suggests that the use of wearable physical activity monitoring devices with feedback may help cardiovascular patients to increase their daily walking, overcoming common physical activity practice barriers such as inappropriate scheduling of proposed physical activity, lack of time and lack of infrastructures to practise. These results are consistent with a previous systematic review and meta-analysis: in patients with chronic CVD using a wearable device measuring physical activity, the number of daily steps significantly increased by 1300 steps/day27 and by 1656 in patients with cardiometabolic diseases (obesity, diabetes mellitus and CVD) 30…”

“…These results are consistent with a previous systematic review and meta-analysis: in patients with chronic CVD using a wearable device measuring physical activity, the number of daily steps significantly increased by 1300 steps/day 27 and by 1656 in patients with cardiometabolic diseases (obesity, diabetes mellitus and CVD). 30 A recent meta-analysis of three RCTs of supposedly healthy subjects and patients (any human population of any age) using a pedometer or accelerometer also showed a significant increase in daily steps (n=211, +2587 steps/ day (95% CI: 916 to 5257); I 2 =74.6% and p=0.002). 53 An umbrella review showed an increase of 1800 steps/day and an increase of 40 min of walking per day in clinical and non-clinical populations.…”

“…Previous systematic reviews and meta-analyses of general population patients with chronic diseases have shown that interventions including wearable physical activity monitoring devices increased the amount of daily physical activity [27][28][29][30] but did not focus only on patient population with CVD during or after cardiac rehabilitation nor took into account the length of the intervention.…”