Impact of wearable physical activity monitoring devices with exercise prescription or advice in the maintenance phase of cardiac rehabilitation: systematic review and meta-analysis

Abstract

Background Physical activity (PA) is a component of cardiac rehabilitation (CR). However, life-long engagement in PA is required to maintain benefits gained. Wearable PA monitoring devices (WPAM) are thought to increase PA. There appear to be no reviews which investigate the effect of WPAM in cardiac populations. We firstly aimed to systematically review randomised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR. We specifically examined the effect on cardiorespiratory fitness (CRF), amount and intensity of daily PA, and sedentary time. Secondly, we aimed to collate outcome measures reported, reasons for drop out, adverse events, and psychological impact from utilising a WPAM. Methods A systematic search (up to January 2019) of relevant databases was completed, followed by a narrative synthesis, meta-analysis and qualitative analysis. Results Nine studies involving 1,352 participants were included. CRF was improved to a greater extent in participants using WPAM with exercise prescription or advice compared with controls (MD 1.65 mL/kg/min;95% confidence interval [CI; 0.64–2.66]; p = 0.001; I 2 = 0%). There was no significant between group difference in six-minute walk test distance. In 70% of studies, step count was greater in participants using a WPAM with exercise prescription or advice, however the overall effect was not significant (SMD 0.45;95% [CI; − 0.17-1.07] p = 0.15; I 2 = 81%). A sensitivity analysis resulted in significantly greater step counts in participants using a WPAM with exercise prescription or advice and reduced the heterogeneity from 81 to 0% (SMD 0.78;95% [CI;0.54–1.02]; p < 0.001; I 2 = 0%). Three out of four studies reporting on intensity, found significantly increased time spent in moderate and moderate-vigorous intensity PA. No difference between groups was found for sedentary time. Three of six studies reported improved psychological benefits. No cardiac adverse events related to physical activity were reported and 62% of non-cardiac adverse events were primarily musculoskeletal injuries. Reasons for dropping out included medical conditions, lack of motivation, loss of interest, and technical difficulties. Conclusions Our meta-analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use. Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count. WPAM with exercise prescription or advice did not change sedentary time. Psychological health and exercise intensity may potentially be enhanced by WPAM with exercise prescription or advice, however furthe...

Long-term follow-up with a smartphone application improves exercise capacity post cardiac rehabilitation: A randomized controlled trial

“…Recently, a systematic review and meta-analyses evaluating the impact of wearable physical activity monitoring devices in the maintenance phase of CR were published. 14 Three of the nine included studies in this systematic review measured VO 2peak , 35–37 and the overall mean difference was 2.24 ml/kg/min, 95% CI 0.58–3.89, 14 which is similar to our result. However, the total number of participants included in this meta-analysis ( n = 133) was just above the number of participants included in our analyses ( n = 102), and time to follow-up ranged from 12 weeks 35,36 to six months.…”

“…The exclusion criteria were as follows: ischemia or arrhythmias uncovered at cardiopulmonary exercise test (CPET) that gave restrictions equivalent to <80% of maximal heart rate or BORG scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) <15 at exercise. In addition, patients with muscular or skeletal disorders that affected exercise capacity more than the heart disease were excluded.…”

“…12,13 In a recent systematic review, the use of wearable physical activity monitors (including apps) has shown to improve exercise capacity to a greater extent compared with controls post-CR. 14 Only three of the nine included studies in this systematic review evaluated VO 2peak with a follow-up time ranging from 12 weeks to six months.…”

The use of physical activity trackers devices and physical activity levels in adolescents and adults.

“…Wearable devices offer a useful approach for monitoring PA in both clinical research involving patient populations and community-based research (Yingling, et al, 2016). A systematic review and meta-analysis study (Hannan et al, 2019) on the impact of PAT to monitoring exercise prescription or advice in cardiac rehabilitation shown that in 70% of studies, step count was greater in participants using a PAT with exercise prescription or advice, however the overall effect was not significant. Similar results were found by Gal et al (2018).…”

Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation

“…There may be little racial staff diversity, language barriers, and cultural beliefs that add to the patient's lack of CR participation (Rush et al, 2018). Incorporating preferences such as tai chi, dance, yoga may also improve participation (Hannan et al, 2019).…”