腕戴式可穿戴设备引导的心脏康复通过完全远程或混合模式对心血管疾病患者的有效性：随机对照试验的系统评价与荟萃分析。
完整摘要 · 中文译文
背景：心血管疾病（CVD）仍是全球主要死亡原因，但心脏康复（CR）的参与率仍不理想。腕戴式可穿戴设备可能通过活动监测和个体化反馈支持完全远程或混合式CR，但其有效性和获益的一致性仍不确定。 目的：本研究旨在评估在心血管疾病患者于II期或III期CR期间启动的、通过完全远程或混合式项目实施腕戴式可穿戴设备指导的CR的有效性。 方法：共检索8个数据库，纳入2015年1月1日至2026年8月7日发表的随机对照试验。符合条件的试验纳入患有心血管疾病的成人，并将腕戴式可穿戴设备整合到完全远程或混合式CR中。主要针对心力衰竭或以可穿戴设备仅用于结局测量的研究被排除。主要结局为峰值氧耗量（VO2）、6分钟步行距离（6MWD）和每日步数。随机效应荟萃分析使用均数差（MD），生活质量除外，其使用标准化MD。研究间方差采用DerSimonian-Laird法估计，合并效应置信区间采用Knapp-Hartung校正，95%预测区间（PI）采用Nagashima-Noma-Furukawa参数自举法。偏倚风险采用Cochrane偏倚风险2工具评估。亚组和单变量荟萃回归分析探讨了研究和干预特征。 结果：共纳入18项试验，涉及1993名随机分组参与者，报道于20篇出版物中；17 参与荟萃分析。合并估计值支持可穿戴设备引导的心脏康复（CR）对峰值摄氧量（VO2）（10项研究；591名受试者；MD 1.69，95% CI 0.46-2.92，95% PI -2.21至5.39 mL/kg/min）、6分钟步行距离（6MWD）（9项研究；1094名受试者；MD 31.03，95% CI 7.66-53.92，95% PI -62.11至123.18 m）和每日步数（8项研究；474名受试者；MD 1062.8，95% CI 383.5-1825.0，95% PI -503.0至2860.0步/天）的改善。所有3项PI均包含无效值，表明对未来可比环境下一致性的不确定性。对于无氧阈值、BMI、腰围、握力或生活质量，未观察到明确的合并效应。亚组差异无统计学意义。在单变量荟萃回归中，女性参与者比例较高与峰值VO2改善较大相关，尽管这一聚合水平的发现具有探索性。 结论：通过完全远程或混合模式实施的手腕佩戴式可穿戴设备引导的CR可能改善心血管疾病（CVD）患者的平均运动能力和身体活动。然而，PI均包含无效值，表明对未来环境下一致性的不确定性。这些项目可将活动监测、个体化反馈和行为支持延伸至中心式CR之外，但其多组分性质使得无法将效应单独归因于可穿戴设备。更大规模、严格设计、采用标准化方案和结局指标的试验应识别最可能获益的患者和项目组分。未来研究还应评估长期依从性、安全性、公平性以及在常规多学科中的实施情况。 y 跨多种卫生系统的结直肠癌（CRC）筛查。
完整摘要 · 英文原文
BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: A total of 18 trials involving 1993 randomized participants, reported in 20 publications, were included; 17 contributed to meta-analysis. Pooled estimates favored wearable-guided CR for peak VO2 (10 studies; 591 participants; MD 1.69, 95% CI 0.46-2.92, 95% PI -2.21 to 5.39 mL/kg/min), 6MWD (9 studies; 1094 participants; MD 31.03, 95% CI 7.66-53.92, 95% PI -62.11 to 123.18 m), and daily steps (8 studies; 474 participants; MD 1062.8, 95% CI 383.5-1825.0, 95% PI -503.0 to 2860.0 steps/day). All 3 PIs included the null, indicating uncertainty about consistency across future comparable settings. No clear pooled effects were observed for anaerobic threshold, BMI, waist circumference, grip strength, or quality of life. Subgroup differences were not statistically significant. In univariable meta-regression, a higher proportion of female participants was associated with greater peak VO2 improvement, although this aggregate-level finding was exploratory. CONCLUSIONS: Wrist-worn wearable-guided CR delivered through fully remote or hybrid programs may improve average exercise capacity and physical activity in patients with CVD. However, PIs included the null, indicating uncertainty about consistency across future settings. These programs may extend activity monitoring, individualized feedback, and behavioral support beyond center-based CR, but their multicomponent nature prevents attributing effects to wearables alone. Larger, rigorously designed trials with standardized protocols and outcomes should identify the patients and program components most likely to benefit. Future research should also evaluate long-term adherence, safety, equity, and implementation within routine multidisciplinary CR across diverse health systems.