Benefits of wearable-based cardiac rehabilitation interventions in secondary prevention of coronary artery disease – a systematic review and meta-analysis

Abstract

Aim

To assess the benefits of wearable activity trackers in the treatment and care of patients with coronary artery disease (CAD), we performed a systematic review and meta-analysis.

Methods

We systematically searched databases and trial registries until March 2025 for randomized controlled trials employing wearable devices (such as activity tracker, pedometer or accelerometer) in cardiac rehabilitation (CR) interventions in patients with CAD. The outcome data were pooled using fixed-effects meta-analysis. Subgroup analyses were conducted for risk of bias, length of follow up, type of wearable and presence of additional interventions. To assess the robustness of the main findings we carried out sensitivity analyses using random effects models and exclusion of outliers. Outcomes of interest were indicators of prognosis and prognostic factors.

Results

We included a total of 23 studies and synthesized data from 20 studies in meta-analyses. Meta-analysis of steps per day showed a statistically significant difference favouring the intervention (MD 1060 steps/day, 95 % CI 650 to 1460). Subgroup analyses indicated smaller effects for studies with longer follow-up periods, and for those with high risk of bias. Sensitivity analyses showed robustness of these results. Meta-analyses of rehospitalizations (RR 0.70, 95 % CI 0.52 to 0.95), 6 min walking test (MD 13.06 m, 95 % CI 0.10 to 26.03), and absolute VO₂peak (MD 0.22 L/min, 95 % CI 0.02 to 0.49) also yielded statistically significant differences favouring the intervention. Findings from other physical performance measures favoured the intervention group without reaching significance. Anthropometric outcomes presented no consistent effect.

Conclusions

Our results indicate that wearables significantly enhance effectiveness of CR by increasing physical activity, improving exercise capacity, and reducing rehospitalizations in CAD patients. This suggests that wearable-supported CR programs may positively affect prognosis in CAD. However, further research is needed to corroborate these findings and to ascertain the sustainability of these effects over the long term.

Lay summary

In our study, we found that wearable activity trackers significantly increased steps per day, improved exercise capacity and reduced rehospitalizations in patients with coronary artery disease compared to usual care. These findings suggest that the implementation of wearable activity trackers into cardiac rehabilitation might improve clinical outcomes and potentially reduce the burden of the disease.