300 Section - Wearable-Integrated Digital Cardiac Rehabilitation after Revascularization: A Multicenter Randomized Controlled Trial

Cardiac rehabilitation (CR) is an established intervention that improves survival and functional outcomes in cardiac patients, yet participation in conventional center-based programs remains low due to accessibility and engagement barriers. Digital CR models using mobile technologies and wearable sensors have emerged as alternatives. This study evaluated the efficacy and safety of a digital CR platform that provides real-time monitoring and individualized exercise guidance.

Design:

In this multicenter randomized controlled trial, patients with coronary artery disease who had undergone coronary revascularization were assigned to either a digital CR or a standard home-based CR (control) group. The digital CR group used a chest-worn Holter electrocardiogram device that continuously captured heart-rate (HR) responses during exercise, with HR data automatically transmitted to a cloud-based system for personalized exercise prescription and real-time alerts. The control group received standard education for independent exercise without HR monitoring. All participants were instructed to perform high-intensity interval training for 12 weeks. Peak oxygen consumption (peak VO₂) was the primary outcome. Secondary outcomes included quality of life, physical activity index, and depressive symptoms.

Results:

Of 104 enrolled participants, 87 (42 digital CR; 45 control) completed follow-up. The digital CR group showed a significant increase in peak VO₂ (27.0 ± 5.0 to 29.2 ± 5.0 mL/kg/min, P < 0.001), whereas the control group demonstrated no significant change (28.5 ± 5.1 to 29.1 ± 5.3, P = 0.245). A two-way repeated-measures analysis adjusted for age and sex revealed a significant group × time interaction (P = 0.006). Secondary outcomes showed no between-group differences.

Conclusion:

A home-based digital CR system integrating continuous HR monitoring and automated feedback produced greater improvements in exercise capacity than self-directed exercise alone. These findings support the utility of digital CR as an accessible and effective option for patients unable to participate in traditional center-based programs.