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

Hila Ariela Dafny; Stephanie Champion; Lemlem G Gebremichael; Vincent Pearson; Jeroen M Hendriks; Robyn A Clark; Maria Alejandra Pinero de Plaza; Aarti Gulyani; Sonia Hines; Alline Beleigoli

doi:10.1093/ehjqcco/qcad005

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

Eur Heart J Qual Care Clin Outcomes. 2023 Jun 21;9(4):323-330. doi: 10.1093/ehjqcco/qcad005.

Authors

Hila Ariela Dafny^{1

2}, Stephanie Champion^{1

2}, Lemlem G Gebremichael^{1

2}, Vincent Pearson¹, Jeroen M Hendriks^{1

2

3}, Robyn A Clark^{1

2}, Maria Alejandra Pinero de Plaza^{1

2

4}, Aarti Gulyani¹, Sonia Hines^{2

5}, Alline Beleigoli^{1

2}

Affiliations

¹ Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia.
² Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia.
³ Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia.
⁴ National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia.
⁵ Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Alice Springs, NT, Australia.

Abstract

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 who attended cardiac rehabilitation (CR) programmes.

Methods and results: An umbrella review of published randomized controlled trials, systematic reviews, and meta-analyses was conducted. Nine databases were searched from inception to 9 February 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 in CR programmes utilizing devices/applications, to patients without access to CR with devices/applications. A wide range of physical, clinical, and behavioural outcomes were reported, with results from 18 712 participants. Meta-analyses reported improvements in physical activity, minutes/week [standardized mean difference (SMD) 0.23, 95% confidence interval (CI) 0.10-0.35] and activity levels (SMD 0.29, 95% CI 0.07-0.51), and a reduction in sedentariness [risk ratio (RR) 0.54, 95% CI 0.39-0.75] in CR participants, compared with 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 effect sizes indicate limited clinical benefits, the broad consistency of the narrative suggests devices/applications are effective at improving CR patients' outcomes.

Keywords: Activity-monitoring; Cardiac rehabilitation; Physical activity; Randomized controlled trials; Umbrella review.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Rehabilitation* / methods
Exercise
Health Status
Humans