Wearable Devices for Exercise Prescription and Physical Activity Monitoring in Patients with Various Cardiovascular Conditions.

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• Despite the benefits of wearable devices, they have limitations regarding heart rate tracking in AF patients and the potential false-positives signals caused by motion artifacts.

•Successful clinical implementation requires education for both patients and practitioners to ensure safe data interpretation.

Introduction:

A review was conducted to discuss the application of wearable devices in patients with coronary artery disease (CAD), heart failure (HF), arterial fibrillation (AF), cardiac implantable electronic devices (CIEDs) and peripheral artery disease (PAD) in different cardiovascular rehabilitation settings.

Reported Outcomes:

 CAD

• Systematics reviews were undertaken by Ezekowitz et al. (n = 11 trials, 1356 participants and Hannan (n = 9 studies, 1352 participants) and reported that wrist worn devices and pedometers when combined with established exercise programmes promoted physical activity, which in turn increased peak oxygen consumption (VO_2peak) and quality of life (QoL) and reduced the risk by 49% (95% CI: 0.31 to 0.86) of major cardiovascular events in patients with CAD (p=0.004).

HF
• Peng et al. (2018) reported a positive effect when using an instant messaging platform to communicate via text-based, audio, or video calls to support patients with HF who were undergoing exercise telerehabilitation. Compared to the control group, those who received telerehabilitation improved their 6-minute walking test distance (from 407 +/- 12 to 420 +/- 10 minutes vs from 406 +/- 12 to 407+/- 13 minutes, p<0.01) and QoL (from 48.8+/- 12.2 to 49.2+/- 12.4 points vs from 49.4+/- 12.3 to 43.1+/- 8.8 points, p < 0.05).

AF

• Quinn et al.  (2024) tested 6 commercial wearables and found a mean absolute difference between ECG-measured HR vs HR as measured by the wearables of 7 -12 bpm at rest and 28 bpm at peak exercise in patients with persistent AF. Additionally, Al-Kaisey et al. (2020) reported that smartwatches underestimate HR in those with persistent AF, particularly at HR ranges that are > 100 bpm; peak HR measured during a treadmill stress test showed greater absolute mean differences (21-36 bpm) between wearables and ECG recordings.This review reported on mean absolute HR differences however, it did not provide p-values or confidence intervals to confirm statistical significance for these differences.

CIEDs

• Smolis-Bak et al. (2015) and Piotrowicz et al. (2020) assessed the safety and efficacy of an 8-week home-based exercise program in patients with CIEDs and demonstrated that the integration of mobile phones into home-based exercise is safe (eg, no adverse events occurred) and feasible (> 90% adherence), and was associated with improvement in VO_2peak (16.1+/- 4.0 vs 18.4 +/-  4.1 mL/kg per minute, p < 0.001), 6MWT distance (428 +/-  93 vs 480 +/-  87 meters,

p < 0.001), and QoL (79.0 +/- 31.3 vs 70.8 +/-  30.3 points, p< 0.001). 93% of patients reported that the telerehabilitation program stimulated their exercise, and 87% increased their everyday physical activities.

PAD

• Normahani et al. (2018) and Duscha et al. (2018) demonstrated the enhanced benefits of homebased interventions that include wearable devices in maximum walking distance (82 m vs. -5 m) (p=0.009), claudication distance (63m vs. 10m) (p=0.02), steps per day (3492 (95% CI: 2661–4322) to 4502 (95% CI: 3636–5367) , VO_2peak, (15.2 ± 4.3 to 18.0 ± 4.8 mL/kg/min) (p<0.05) and QoL (0.9 points vs. 0.2) (p=0.004) in PAD patients compared to those with standard care and/or supervised exercise.

Conclusion:

When combined with feedback from healthcare practitioners, wearable devices were reported to improve a range of health measures in patients with cardiovascular diseases, including daily physical activity level, cardiorespiratory fitness, functional capacity, and QoL.

• Clinicians may consider utilising wearable devices to receive real-time feedback on their patients' physical activity, allowing for the implementation of home-based walking programmes to help improve walking distance and quality of life in those with cardiovascular disease.

• However, clinicians need to assess the wearable device data by considering the patient - device interface, presence or the absence of symptoms and the frequency of irregular occurrences.

• Successful clinical application requires practitioner and patient education to understand the limitations and validity of wearable  technology.

• Wearable-based diagnosis algorithms can be susceptible to false-positive signals; therefore, further research and technological advances are needed to establish quality control standards.

• Further research is needed to investigate effective education methods for practitioners and patients to facilitate effective and long-term use of wearable technology in cardiovascular health.