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Wearable Activity Trackers to Improve Physical Activity During Hospitalizations
Quick Takes
- Wearable activity tracker (WAT) interventions delivered to hospitalized patients were associated with higher physical activity levels and improved physical function, though the interventions and patient populations studied were heterogenous.
- WAT interventions were associated with a mean increase in step count of 826 steps/day, exceeding thresholds previously associated with reduced risk for adverse hospital outcomes.
- WAT interventions were not associated with hospital efficiency outcomes (e.g., length of stay , readmission), though evidence for these outcomes was more limited.
Study Questions:
Are wearable activity tracker (WAT) interventions delivered to hospitalized patients associated with patient physical activity (PA), sedentary behavior, clinical outcomes, or hospital efficiency outcomes?
Methods:
The authors conducted a systemic review and meta-analysis in accordance with the revised Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included for adult patients hospitalized for medical illnesses or undergoing rehabilitation or surgery. Included studies used WATs as the sole intervention or as part of a multicomponent intervention. The primary outcomes were objectively measured overall PA and sedentary behavior. Secondary outcomes were specific PA measures (e.g., step count), clinical outcomes (e.g., physical function, mental health), and hospital efficiency outcomes (e.g., length of stay, readmission).
Results:
The authors identified 15 studies (16 comparisons), of which 11 were randomized clinical trials and four non–randomized clinical trials. The total sample size across all studies was 1,911 participants (range 41-255 participants). Populations included four surgical cohorts, three stroke rehabilitation studies, three orthopedic rehabilitation studies, three mixed rehabilitation studies, and two mixed medical studies. Most studies used WATs as the sole intervention and four studies deployed WATs as part of a multicomponent intervention. Studies were mixed as to whether the intervention provided individual tailoring, and the majority of interventions were limited to the hospitalization period. WAT interventions were significantly associated with higher overall PA (14 studies), though with considerable heterogeneity and fewer minutes of sedentary behavior (two studies) with no heterogeneity. There was a significant association between WAT interventions and higher daily step counts (11 studies; mean difference, 826.08 steps/day; 95% confidence interval [CI], 416.92-1,235.24 steps/day) and higher daily activity time (nine studies; mean difference, 9.75 min/day; 95% CI, 0.65-18.84 min/day). WAT interventions were associated with improved physical function (four studies), though there was no association with pain (three studies), mental health (three studies), or clinical efficiency outcomes.
Conclusions:
WAT interventions have the potential for clinical benefits given their association with higher PA and lower sedentary behavior during the hospitalization period; however, caution should be exercised when interpreting these findings given significant heterogeneity across studies.
Perspective:
WATs have previously been shown to be a low-cost tool with the potential to address physical inactivity (Ferguson T, et al., Lancet Digit Health 2022;4:e615-26), though most studies of WAT interventions have been in community and outpatient settings. While studies looking at WAT interventions in hospitalized patients have been limited, this meta-analysis suggests that WAT interventions have the potential to increase PA levels and physical function.
While the step count increases observed in this meta-analysis have previously been associated with improved clinical outcomes, additional research is needed to determine the impact of WAT interventions on longer-term clinical outcomes, including those most important to patients, and as a tool to extend behavioral modification post-discharge. Additional research is also warranted in cardiovascular disease populations, with the current study only including three stroke rehabilitation studies, with the remaining populations surgical or mixed medical or rehabilitation cohorts. It is also unknown whether the results observed in this meta-analysis pertain to current-generation commercial smartwatches, with most studies using pedometers and accelerometers. Overall, however, these results suggest that WAT interventions have the potential to impact PA levels and physical function, although results also suggest opportunities for improvement through greater use of behavioral health theory and individual-level intervention tailoring.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Exercise
Keywords: Cardiac Rehabilitation, Exercise, Fitness Trackers, Length of Stay, Mental Health, Patient Care Team, Patient Discharge, Patient Readmission, Primary Prevention, Sedentary Behavior, Walking
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