Cardiac rehabilitation, physical activity, and the effectiveness of activity monitoring devices on cardiovascular patients: an umbrella review of systematic reviews

Aims
To consolidate the evidence on the effectiveness of activity-monitoring devices and mobile applications on physical activity and health outcomes of patients with cardiovascular disease and attended cardiac rehabilitation (CR) programs.

Methods
An umbrella review of published randomised controlled trials systematic reviews and meta-analyses was conducted. Nine databases were searched from inception to February 9th, 2022. Search and data extraction followed the JBI methodology for umbrella reviews and PRISMA guidelines. Nine systematic reviews met the inclusion criteria, comparing outcomes of participants of CR programs utilising devices/applications, to patients without access to CR with devices/applications.

Results
A wide range of physical, clinical and behavioural outcomes were reported, with results from 18 712 participants. Meta-analyses reported improvements in physical activity, mins/week (SMD 0.23, [95% CI 0.10, 0.35]) and activity levels (SMD 0.29 [95% CI 0.07, 0.51]), and a reduction in sedentariness (RR 0.54 [95% CI 0.39, 0.75]) in CR participants, compared to usual care. Of clinical outcomes, the risk of re-hospitalization reduced significantly (RR 0.49 [95% CI 0.27, 0.89]) and there was reduction (non-significant) in mortality (RR 0.27 [95% CI 0.05, 1.54]). From the behavioural outcomes, reviews reported improvements in smoking behaviour (RR 0.87 [95% CI 0.67, 1.13]) and total diet quality intake (RR 0.79 [95% CI 0.66, 0.94]) among CR patients.

Conclusions
The use of devices/applications was associated with increase in activity, healthy behaviours, and reductions in clinical indicators. Although most effects sizes indicate limited clinical benefits, the broad consistency of the narrative suggests devices/applications are effective at improving CR patients’ outcomes.