Hannan Amanda L, Harders Michael P, Hing Wayne, Climstein Mike, Coombes Jeff S, Furness James
1Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia.
2Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group Faculty of Health Sciences, University of Sydney, Lidcombe, NSW Australia.
BMC Sports Sci Med Rehabil. 2019 Jul 30;11:14. doi: 10.1186/s13102-019-0126-8. eCollection 2019.
Physical activity (PA) is a component of cardiac rehabilitation (CR). However, life-long engagement in PA is required to maintain benefits gained. Wearable PA monitoring devices (WPAM) are thought to increase PA. There appear to be no reviews which investigate the effect of WPAM in cardiac populations. We firstly aimed to systematically review randomised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR. We specifically examined the effect on cardiorespiratory fitness (CRF), amount and intensity of daily PA, and sedentary time. Secondly, we aimed to collate outcome measures reported, reasons for drop out, adverse events, and psychological impact from utilising a WPAM.
A systematic search (up to January 2019) of relevant databases was completed, followed by a narrative synthesis, meta-analysis and qualitative analysis.
Nine studies involving 1,352 participants were included. CRF was improved to a greater extent in participants using WPAM with exercise prescription or advice compared with controls (MD 1.65 mL/kg/min;95% confidence interval [CI; 0.64-2.66]; = 0.001; I = 0%). There was no significant between group difference in six-minute walk test distance. In 70% of studies, step count was greater in participants using a WPAM with exercise prescription or advice, however the overall effect was not significant (SMD 0.45;95% [CI; - 0.17-1.07] = 0.15; I = 81%). A sensitivity analysis resulted in significantly greater step counts in participants using a WPAM with exercise prescription or advice and reduced the heterogeneity from 81 to 0% (SMD 0.78;95% [CI;0.54-1.02]; < 0.001; I = 0%). Three out of four studies reporting on intensity, found significantly increased time spent in moderate and moderate-vigorous intensity PA. No difference between groups was found for sedentary time. Three of six studies reported improved psychological benefits.No cardiac adverse events related to physical activity were reported and 62% of non-cardiac adverse events were primarily musculoskeletal injuries. Reasons for dropping out included medical conditions, lack of motivation, loss of interest, and technical difficulties.
Our meta-analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use. Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count. WPAM with exercise prescription or advice did not change sedentary time. Psychological health and exercise intensity may potentially be enhanced by WPAM with exercise prescription or advice, however further research would strengthen this conclusion.
PROSPERO Registration Number: CRD42019106591.
体力活动（PA）是心脏康复（CR）的一个组成部分。然而，需要终身坚持体力活动才能维持所获得的益处。可穿戴式体力活动监测设备（WPAM）被认为可以增加体力活动。似乎没有综述研究WPAM对心脏疾病人群的影响。我们的首要目标是系统评价在心脏疾病人群中开展的、研究WPAM在心脏康复维持阶段所产生影响的随机对照试验。我们特别考察了其对心肺适能（CRF）、每日体力活动的量和强度以及久坐时间的影响。其次，我们旨在整理所报告的结局指标、退出原因、不良事件以及使用WPAM所产生的心理影响。
对相关数据库进行了系统检索（截至2019年1月），随后进行叙述性综合分析、荟萃分析和定性分析。
纳入了9项研究，涉及1352名参与者。与对照组相比，使用WPAM并结合运动处方或建议的参与者心肺适能得到了更大程度的改善（平均差1.65 mL/kg/min；95%置信区间[CI]：0.64 - 2.66；P = 0.001；I² = 0%）。六分钟步行试验距离在组间无显著差异。在70%的研究中，使用WPAM并结合运动处方或建议的参与者步数更多，但总体效应不显著（标准化均数差0.45；95%[CI]：-0.17 - 1.07；P = 0.15；I² = 81%）。敏感性分析显示，使用WPAM并结合运动处方或建议的参与者步数显著更多，异质性从81%降至0%（标准化均数差0.78；95%[CI]：0.54 - 1.02；P < 0.001；I² = 0%）。在报告强度的四项研究中，有三项发现中度和中高强度体力活动的时间显著增加。久坐时间在组间无差异。六项研究中有三项报告了心理益处得到改善。未报告与体力活动相关的心脏不良事件，62%的非心脏不良事件主要为肌肉骨骼损伤。退出原因包括健康状况、缺乏动力、兴趣丧失和技术困难。
我们的荟萃分析表明，在心脏康复维持阶段，使用WPAM并结合运动处方或建议在改善心肺适能方面优于不使用设备，且使用WPAM未报告心脏不良事件。我们的定性分析显示，有证据支持使用WPAM并结合运动处方或建议对心肺适能和步数均有益。使用WPAM并结合运动处方或建议并未改变久坐时间。使用WPAM并结合运动处方或建议可能会改善心理健康和运动强度，然而进一步的研究将强化这一结论。
PROSPERO注册号：CRD42019106591。
