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

Wearing WHOOP More Frequently Is Associated with Better Biometrics and Healthier Sleep and Activity Patterns

Wearable devices are increasingly used for health monitoring, yet the impact of consistent wear on physiological and behavioral outcomes is unclear. Leveraging nearly a million days and nights of longitudinal data from 11,914 subscribers, we examined the associations between the frequency of wearing a wrist-worn wearable device (WHOOP Inc., Boston, MA, USA) and 12-week changes in biometric, sleep, and activity profiles, modeling both between- and within-person effects. Higher average wear frequency and week-to-week increases in wear were associated with a lower resting heart rate (RHR), higher heart rate variability (HRV), longer and more consistent sleep, and greater weekly and daily physical activity duration (Ps < 0.01). A within-person multiple mediation analysis indicated that increased sleep duration partially mediated the association between wear frequency and a standardized (z-scored) RHR (indirect effect = -0.0387 [95% CI: -0.0464, -0.0326]), whereas physical activity minutes did not (indirect effect = 0.0003 [95% CI: -0.0036, 0.0040]). A Granger causality analysis revealed a modest but notable association between prior wear frequency and future RHR in participants averaging ≤5 days of weekly wear (p < 0.05 in 10.92% of tests). While further research is needed, our findings provide real-world evidence that sustained wearable engagement may support healthier habits and improved physiological outcomes over time.

Design and baseline characteristics of an implementation study to increase activity with social incentives: The STEP together trial

BACKGROUND

The majority of people in the United States do not achieve recommended levels of physical activity. Even small, daily increases can have health benefits. Wearable devices paired with social incentives increased daily steps in pilot studies but have not been tested for long-term effectiveness in community settings. This paper describes the study design and baseline participant characteristics of a trial testing these approaches to increase physical activity among families in the Philadelphia area.

METHODS

The trial, called STEP Together, is a Hybrid Type 1 effectiveness-implementation study. Participants enroll on family teams of 2-10 people, including at least one person 60 years old or older. Each participant receives a Fitbit device, establishes a baseline daily step count, and selects a daily step goal 1500 to 3000 steps greater than their baseline. Family teams are stratified based on family size and randomized to Control, Social Incentive Gamification, or Social Goals through Incentives to Charity. Participation is 18-months: a 12-month intervention and 6-month follow up.

RESULTS

779 participants on 285 family teams were randomized. Recruitment was more difficult than anticipated due to the COVID-19 pandemic and higher-than expected numbers of participants who were already physically active and therefore ineligible. Changes to the eligibility criteria that did not impact the underlying intent or conceptual basis for the trial improved recruitment feasibility.

CONCLUSION

The results from this study will contribute to the growing body of evidence about scalable, effective strategies to motivate individuals and families to increase their daily physical activity.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04942535.

Wearable devices, ischemic heart disease and cardiovascular outcomes: A systematic review and meta-analysis

OBJECTIVES

To evaluate the impact of wearable devices when associated with usual care on the incidence of major adverse cardiovascular events (MACE) in patients with ischemic heart disease compared with usual care alone.

METHODS

Randomised clinical trials with patients aged 18 years and above with ischemic heart disease, using wearable devices and assessing at least one of the primary outcomes (myocardial infarction, stroke, cardiovascular mortality, or major adverse cardiovascular events) or secondary outcomes (all-cause mortality, hospitalisation, all arrhythmias, heart failure, unstable angina or revascularisation procedures) were included. MEDLINE, EMBASE, Cochrane Library, CINHAL, INAHTA and the Web of Science Core Collection were searched in April 2024. Studies were also identified via citation searching. Cochrane Risk of Bias version 1 was applied as provided in Covidence. Meta-analyses were performed when possible.

RESULTS

Six studies of moderate quality were included. Wearables showed positive effects in reducing major adverse cardiovascular events (RR 0.75, 95 % CI 0.57-0.98, two studies) and all-cause mortality (RR 0.64, 95 % CI 0.43-0.96, three studies); no significant effects were found on myocardial infarction (RR 0.89, 95 % CI 0.59-1.34, four studies), cardiovascular mortality (RR 0.35, 95 % CI 0.07-1.73, three studies), hospitalisations (RR 0.77, 95 % CI 0.56-1.07, five studies), all arrhythmias (RR 1.10, 95 % CI 0.49-2.48, two studies), and heart failure (RR 0.85, 95 % CI 0.61-1.18, two studies). Meta-analysis could not be performed for stroke, unstable angina, and revascularisation procedures. Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence was deemed low or very low.

DISCUSSION

While wearables seem to have some positive effects for patients with ischemic heart disease, only weak recommendations for use are possible. More large-scale, high-quality randomised clinical trials are needed to recommend the routine use of wearables in combination with usual care.

PROTOCOL REGISTRATION ON PROSPERO

CRD42024586137.

The effectiveness of digital physical activity interventions in older adults: a systematic umbrella review and meta-meta-analysis

BACKGROUND

Physical activity is important for healthy ageing, however most older adults are inactive. Numerous reviews with a range of inclusion criteria have been conducted on digital interventions to promote physical activity in older adults, and a synthesis of these is needed. Therefore, the objective of this study is to conduct an umbrella review and meta-meta-analysis on the effectiveness of digital interventions to promote physical activity in older adults.

METHODS

Nine databases were searched from January 2010 to December 2023. Systematic reviews and meta-analyses of primary studies using digital physical activity interventions to target healthy older adults or clinical populations of older adults with a self-reported or device measured physical activity outcome were eligible for inclusion.

RESULTS

In total, 22 systematic reviews and meta-analyses covering 185 primary research papers were eligible for inclusion. The total number of participants across all primary studies was 28,198. Most (21, 95%) reviews and meta-analyses were rated as having a low or critically low AMSTAR-2 confidence rating. Of the 22 included systematic reviews, 13 (59%) conducted a meta-analysis and 10 (45%) conducted a narrative synthesis. Most systematic reviews with a narrative synthesis found strong evidence for a positive effect or moderate evidence for a positive effect for physical activity outcomes (7/9, 78%) and steps (3/3, 100%). The meta-meta-analysis of primary papers included in meta-analyses demonstrated a significant moderate effect for steps and a significant small effect for total PA and MVPA. The strength of effect did not vary by intervention components (activity tracker, app-based, SMS/phone, web-based, and face-to-face), population (primary or secondary prevention), control group (none, other digital intervention, or non-digital intervention), or outcome measurement (self-reported or device measured). Only 3 (14%) reviews included longer term follow up outcomes after the end of the intervention, with mixed results.

CONCLUSIONS

Evidence from 22 reviews and meta-analyses suggests that digital physical activity interventions are effective at increasing physical activity in older adults. Further primary research is needed in adults 65 years and over exclusively, and with longer-term follow up of physical activity outcomes. Future reviews should include a published protocol and interpret results according to risk-of-bias.

Recent Advances in the Wearable Devices for Monitoring and Management of Heart Failure

Heart failure (HF) is an acute and degenerative condition with high morbidity and mortality rates. Early diagnosis and treatment of HF can significantly enhance patient outcomes through admission and readmission reduction and improve quality of life. Being a progressive condition, the continuous monitoring of vital signs and symptoms of HF patients to identify any deterioration and to customize treatment regimens can be beneficial to the management of this disease. Recent breakthroughs in wearable technology have revolutionized the landscape of HF management. Despite the potential benefits, the integration of wearable devices into HF management requires careful consideration of technical, clinical, and ethical challenges, such as performance, regulatory requirements and data privacy. This review summarizes the current evidence on the role of wearable devices in heart failure monitoring and management, and discusses the challenges and opportunities in the field.

A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial

BACKGROUND

Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD.

OBJECTIVE

We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD.

METHODS

This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ≥40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables.

RESULTS

In total, 162 met the inclusion criteria and 75 (46.3%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49%; White: n=46, 61%). Heart failure was the most common diagnosis (37/75, 49%). In total, 62/75 (83%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95% CI 1.1-4.3) and 2.2 (SD 9.09) points (95% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported.

CONCLUSIONS

The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500.

Approaches of wearable and implantable biosensor towards of developing in precision medicine

In the relentless pursuit of precision medicine, the intersection of cutting-edge technology and healthcare has given rise to a transformative era. At the forefront of this revolution stands the burgeoning field of wearable and implantable biosensors, promising a paradigm shift in how we monitor, analyze, and tailor medical interventions. As these miniature marvels seamlessly integrate with the human body, they weave a tapestry of real-time health data, offering unprecedented insights into individual physiological landscapes. This log embarks on a journey into the realm of wearable and implantable biosensors, where the convergence of biology and technology heralds a new dawn in personalized healthcare. Here, we explore the intricate web of innovations, challenges, and the immense potential these bioelectronics sentinels hold in sculpting the future of precision medicine.

Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks

United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

BACKGROUND

Physical activity is pivotal in managing heart failure with reduced ejection fraction, and walking integrated into daily life is an especially suitable form of physical activity. This study aimed to determine whether a 6-month lifestyle walking intervention combining self-monitoring and regular telephone counseling improves functional capacity assessed by the 6-minute walk test (6MWT) in patients with stable heart failure with reduced ejection fraction compared with usual care.

METHODS

The WATCHFUL trial (Pedometer-Based Walking Intervention in Patients With Chronic Heart Failure With Reduced Ejection Fraction) was a 6-month multicenter, parallel-group randomized controlled trial recruiting patients with heart failure with reduced ejection fraction from 6 cardiovascular centers in the Czech Republic. Eligible participants were ≥18 years of age, had left ventricular ejection fraction <40%, and had New York Heart Association class II or III symptoms on guidelines-recommended medication. Individuals exceeding 450 meters on the baseline 6MWT were excluded. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly telephone counseling from research nurses who encouraged them to use behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The patients in the control group continued usual care. The primary outcome was the between-group difference in the distance walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate to vigorous physical activity as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity C-reactive protein biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention to treat.

RESULTS

Of 218 screened patients, 202 were randomized (mean age, 65 years; 22.8% female; 90.6% New York Heart Association class II; median left ventricular ejection fraction, 32.5%; median 6MWT, 385 meters; average 5071 steps/day; average 10.9 minutes of moderate to vigorous physical activity per day). At 6 months, no between-group differences were detected in the 6MWT (mean 7.4 meters [95% CI, -8.0 to 22.7]; P=0.345, n=186). The intervention group increased their average daily step count by 1420 (95% CI, 749 to 2091) and daily minutes of moderate to vigorous physical activity by 8.2 (95% CI, 3.0 to 13.3) over the control group. No between-group differences were detected for any other secondary outcomes.

CONCLUSIONS

Whereas the lifestyle intervention in patients with heart failure with reduced ejection fraction improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the lack of association between increased physical activity and functional outcomes.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03041610.