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

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.

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.

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.