Effectiveness of Wrist-Worn Wearable-Guided Cardiac Rehabilitation Delivered Through Fully Remote or Hybrid Programs in Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Why clinicians should know about it

• Picked for Health Informatics (paper of the day, 28 October 2026): Remote wearable-guided care and patient outcomes evaluated

Abstract

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death worldwide, yet participation in cardiac rehabilitation (CR) remains suboptimal. Wrist-worn wearables may support fully remote or hybrid CR through activity monitoring and individualized feedback, but the effectiveness and consistency of benefits remain uncertain. OBJECTIVE: This study aimed to evaluate the effectiveness of wrist-worn wearable-guided CR delivered through fully remote or hybrid programs initiated during phase II or III CR in patients with CVD. METHODS: A total of 8 databases were searched for randomized controlled trials published from January 1, 2015, through August 7, 2026. Eligible trials enrolled adults with CVD and integrated a wrist-worn wearable into fully remote or hybrid CR. Studies focused primarily on heart failure or using wearables only for outcome measurement were excluded. Primary outcomes were peak oxygen consumption (VO2), 6-minute walk distance (6MWD), and daily steps. Random-effects meta-analyses used mean differences (MDs), except for quality of life, which used standardized MDs. Between-study variance was estimated using the DerSimonian-Laird method, pooled-effect CIs used the Knapp-Hartung adjustment, and 95% prediction intervals (PIs) used the Nagashima-Noma-Furukawa parametric bootstrap method. Risk of bias was assessed with Cochrane Risk of Bias 2. Subgroup and univariable meta-regression analyses explored study and intervention characteristics. RESULTS: A total of 18 trials involving 1993 randomized participants, reported in 20 publications, were included; 17 contributed to meta-analysis. Pooled estimates favored wearable-guided CR for peak VO2 (10 studies; 591 participants; MD 1.69, 95% CI 0.46-2.92, 95% PI -2.21 to 5.39 mL/kg/min), 6MWD (9 studies; 1094 participants; MD 31.03, 95% CI 7.66-53.92, 95% PI -62.11 to 123.18 m), and daily steps (8 studies; 474 participants; MD 1062.8, 95% CI 383.5-1825.0, 95% PI -503.0 to 2860.0 steps/day). All 3 PIs included the null, indicating uncertainty about consistency across future comparable settings. No clear pooled effects were observed for anaerobic threshold, BMI, waist circumference, grip strength, or quality of life. Subgroup differences were not statistically significant. In univariable meta-regression, a higher proportion of female participants was associated with greater peak VO2 improvement, although this aggregate-level finding was exploratory. CONCLUSIONS: Wrist-worn wearable-guided CR delivered through fully remote or hybrid programs may improve average exercise capacity and physical activity in patients with CVD. However, PIs included the null, indicating uncertainty about consistency across future settings. These programs may extend activity monitoring, individualized feedback, and behavioral support beyond center-based CR, but their multicomponent nature prevents attributing effects to wearables alone. Larger, rigorously designed trials with standardized protocols and outcomes should identify the patients and program components most likely to benefit. Future research should also evaluate long-term adherence, safety, equity, and implementation within routine multidisciplinary CR across diverse health systems.

Abstract as published, via PubMed.