{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:24:32Z","timestamp":1791523472617,"version":"4.3.4"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Cardiac rehabilitation (CR) is effective in preventing cardiovascular diseases; however, participation in CR programs remains limited due to the associated challenges. The integration of wearable devices and real-time monitoring offers a potential solution to enhance adherence to remote CR programs and their outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate the efficacy of a remote CR program using wearable devices and real-time monitoring with or without online coaching (OLC) in improving exercise capacity in patients with coronary artery disease (CAD).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We enrolled 50 patients with CAD in a remote CR program in this randomized, open-label, single-center pilot trial (phase III). After baseline cardiopulmonary exercise tests (CPETs), all patients were assigned a CPET-based home exercise program and were provided with a wearable device (Fitbit Sense; Fitbit, Inc) with a real-time monitoring system (Recoval; SapplyM, Inc). The patients were randomly assigned to an intervention group with OLC (n=25) or a control wearable device (CON; n=25) group. The primary outcomes were changes in\n \n peak oxygen consumption (peak VO\n 2<\/jats:sub>\n ) and anaerobic threshold VO\n 2<\/jats:sub>\n (oxygen consumption) at 12 weeks. The secondary outcomes were changes in CPET parameters, daily activity, anxiety levels, and health-related quality of life.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n \n Peak VO\n 2<\/jats:sub>\n and anaerobic threshold VO\n 2<\/jats:sub>\n increased significantly from baseline to 12 weeks in the OLC (+1.6 mL\/kg\/min,\n P<\/jats:italic>\n <.001; +1.0 mL\/kg\/min,\n P<\/jats:italic>\n =.001) and CON (+0.6 mL\/kg\/min,\n P<\/jats:italic>\n =.008; +1.3 mL\/kg\/min,\n P<\/jats:italic>\n =.002) groups with no significant between-group differences (\n P<\/jats:italic>\n =.65 and\n P<\/jats:italic>\n =.90). In the latter half of the intervention, the daily distance and highly active time in the OLC group were significantly increased compared with those in the CON group (all\n P<\/jats:italic>\n <.05). Mental status and health-related quality of life scores showed no significant differences between the groups. No major adverse cardiac events were reported. One patient in the OLC group dropped out due to lower limb muscle strain.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Remote CR using wearable devices and a real-time monitoring system significantly improved exercise capacity in patients with CAD over a 12-week intervention program. The addition of regular OLC to the intervention program further enhanced the physical activity levels, particularly in high-intensity activities. Future studies are warranted to validate these findings in more diverse populations and over longer intervention periods to optimize the benefits and safety of remote CR programs.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/63797","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T18:55:06Z","timestamp":1740509706000},"page":"e63797-e63797","source":"Crossref","is-referenced-by-count":18,"title":["Wearable Devices in Remote Cardiac Rehabilitation With and Without Weekly Online Coaching for Patients With Coronary Artery Disease: Randomized Controlled Trial"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7864-3207","authenticated-orcid":false,"given":"Ryota","family":"Nishio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6646-468X","authenticated-orcid":false,"given":"Tomotaka","family":"Dohi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8795-2095","authenticated-orcid":false,"given":"Miho","family":"Yokoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9491-3286","authenticated-orcid":false,"given":"Taisuke","family":"Nakade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7817-5973","authenticated-orcid":false,"given":"Norihito","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8550-4125","authenticated-orcid":false,"given":"Yuichi","family":"Chikata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0220-7473","authenticated-orcid":false,"given":"Hirohisa","family":"Endo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4138-8463","authenticated-orcid":false,"given":"Hiroki","family":"Nishiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5710-9224","authenticated-orcid":false,"given":"Iwao","family":"Okai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7098-9406","authenticated-orcid":false,"given":"Hiroshi","family":"Iwata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9128-6881","authenticated-orcid":false,"given":"Shinya","family":"Okazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9553-466X","authenticated-orcid":false,"given":"Katsumi","family":"Miyauchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3867-0961","authenticated-orcid":false,"given":"Hiroyuki","family":"Daida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1627-6151","authenticated-orcid":false,"given":"Tohru","family":"Minamino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"issue":"24","key":"R1","doi-asserted-by":"publisher","first-page":"2564","DOI":"10.1016\/j.jacc.2012.07.012","article-title":"2012 ACCF\/AHA\/ACP\/AATS\/PCNA\/SCAI\/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons","volume":"60","author":"Fihn","journal-title":"J Am Coll Cardiol"},{"issue":"38","key":"R2","doi-asserted-by":"publisher","first-page":"2949","DOI":"10.1093\/eurheartj\/eht296","article-title":"2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology","volume":"34","author":"Task Force Members","journal-title":"Eur Heart J"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent st-segment elevation of the European Society of Cardiology (ESC)","volume":"37","author":"Roffi","journal-title":"Eur Heart J"},{"issue":"5","key":"R4","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.hlc.2014.11.013","article-title":"Narrative review comparing the benefits of and participation in cardiac rehabilitation in high-, middle- and low-income countries","volume":"24","author":"Turk-Adawi","journal-title":"Heart Lung Circ"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1253\/circj.CJ-22-0234","article-title":"JCS\/JACR 2021 guideline on rehabilitation in patients with cardiovascular disease","volume":"87","author":"Makita","journal-title":"Circ J"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.mayocp.2016.10.014","article-title":"Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the million hearts cardiac rehabilitation collaborative","volume":"92","author":"Ades","journal-title":"Mayo Clin Proc"},{"issue":"22","key":"R7","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1136\/heartjnl-2014-305783","article-title":"Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial","volume":"100","author":"Varnfield","journal-title":"Heart"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00676-9","article-title":"Wearable accelerometer-derived physical activity and incident disease","volume":"5","author":"Khurshid","journal-title":"NPJ Digit Med"},{"issue":"12","key":"R9","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.1038\/s41591-022-02100-x","article-title":"Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality","volume":"28","author":"Stamatakis","journal-title":"Nat Med"},{"issue":"14","key":"R10","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.025689","article-title":"Association of smartphone-recorded steps over years and change in cardiovascular risk factors among working-age adults","volume":"11","author":"Hamaya","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"R11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-069966","article-title":"Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials","volume":"13","author":"Heizmann","journal-title":"BMJ Open"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1093\/ehjdh\/ztab007","article-title":"Effect of a pragmatic home-based mobile health exercise intervention after transcatheter aortic valve replacement: a randomized pilot trial","volume":"2","author":"Lindman","journal-title":"Eur Heart J Digit Health"},{"issue":"11","key":"R13","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1016\/j.apmr.2012.06.015","article-title":"Determination of the effectiveness of accelerometer use in the promotion of physical activity in cardiac patients: a randomized controlled trial","volume":"93","author":"Izawa","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"R14","doi-asserted-by":"publisher","first-page":"e237","DOI":"10.1016\/j.pec.2011.03.018","article-title":"Innovative program to increase physical activity following an acute coronary syndrome: randomized controlled trial","volume":"85","author":"Houle","journal-title":"Patient Educ Couns"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.02.001","article-title":"Effects of a 12-week mHealth program on peak VO and physical activity patterns after completing cardiac rehabilitation: a randomized controlled trial","volume":"199","author":"Duscha","journal-title":"Am Heart J"},{"key":"R16","unstructured":"Recoval. m3.com. URL: https:\/\/m3comlp.m3.com\/lp\/sapplym\/recoval [Accessed 05-04-2025]"},{"issue":"8","key":"R17","doi-asserted-by":"publisher","first-page":"655","DOI":"10.5551\/jat.17152","article-title":"Diagnostic criteria for dyslipidemia","volume":"20","author":"Teramoto","journal-title":"J Atheroscler Thromb"},{"issue":"6","key":"R18","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1053\/j.ajkd.2008.12.034","article-title":"Revised equations for estimated GFR from serum creatinine in Japan","volume":"53","author":"Matsuo","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"R19","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1536\/ihj.17-264","article-title":"Cardiopulmonary exercise test","volume":"58","author":"Adachi","journal-title":"Int Heart J"},{"issue":"8","key":"R20","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1007\/s00421-018-3884-1","article-title":"Characteristics of patients with a relatively greater minimum VE\/VCO2 against peak VO2% and impaired exercise tolerance","volume":"118","author":"Nakade","journal-title":"Eur J Appl Physiol"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1152\/jappl.1986.60.2.472","article-title":"Bicarbonate buffering of lactic acid generated during exercise","volume":"60","author":"Beaver","journal-title":"J Appl Physiol (1985)"},{"issue":"11","key":"R22","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/s0895-4356(98)00095-x","article-title":"Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan","volume":"51","author":"Fukuhara","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"R23","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1016\/s0895-4356(98)00096-1","article-title":"Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey","volume":"51","author":"Fukuhara","journal-title":"J Clin Epidemiol"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1111\/j.1600-0838.2010.01133.x","article-title":"Effects of exercise training on oxygen uptake in coronary heart disease: a systematic review and meta-analysis","volume":"20","author":"Valkeinen","journal-title":"Scand J Med Sci Sports"},{"issue":"11","key":"R25","doi-asserted-by":"publisher","first-page":"e563","DOI":"10.1161\/CIR.0000000000000677","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"140","author":"Arnett","journal-title":"Circulation"},{"issue":"3","key":"R26","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1161\/01.cir.83.3.778","article-title":"Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure","volume":"83","author":"Mancini","journal-title":"Circulation"},{"issue":"7","key":"R27","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.jacc.2015.11.050","article-title":"Variables measured during cardiopulmonary exercise testing as predictors of mortality in chronic systolic heart failure","volume":"67","author":"Keteyian","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"R28","doi-asserted-by":"publisher","first-page":"2268","DOI":"10.1253\/circj.cj-14-0047","article-title":"Targeting of high peak respiratory exchange ratio is safe and enhances the prognostic power of peak oxygen uptake for heart failure patients","volume":"78","author":"Nakanishi","journal-title":"Circ J"},{"issue":"31-33","key":"R29","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.ijcard.2015.05.134","article-title":"The value of cardiorespiratory fitness and exercise-induced ST segment depression in predicting death from coronary heart disease","volume":"196","author":"Hagn\u00e4s","journal-title":"Int J Cardiol"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.ahj.2006.04.029","article-title":"Maximum oxygen uptake at peak exercise in elderly patients with coronary artery disease and preserved left ventricular function: the role of inflammation on top of tissue Doppler-derived systolic and diastolic function","volume":"152","author":"Van de Veire","journal-title":"Am Heart J"},{"issue":"4","key":"R31","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1002\/clc.23579","article-title":"Prognostic impact of peak oxygen uptake and heart rate reserve in patients after off-pump coronary artery bypass grafting","volume":"44","author":"Abulimiti","journal-title":"Clin Cardiol"},{"issue":"18","key":"R32","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1016\/j.jacc.2010.05.043","article-title":"Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study","volume":"56","author":"Laukkanen","journal-title":"J Am Coll Cardiol"},{"issue":"24","key":"R33","doi-asserted-by":"publisher","first-page":"3079","DOI":"10.1161\/01.cir.0000041428.99427.06","article-title":"Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death","volume":"106","author":"Gitt","journal-title":"Circulation"},{"issue":"4","key":"R34","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1152\/jappl.1995.79.4.1134","article-title":"Gas exchange, blood lactate, and plasma catecholamines during incremental exercise in hypoxia and normoxia","volume":"79","author":"Hughson","journal-title":"J Appl Physiol"},{"issue":"5","key":"R35","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1253\/jcj.56.504","article-title":"Changes in oxygen uptake-work rate relationship as a compensatory mechanism in patients with heart failure","volume":"56","author":"Itoh","journal-title":"Jpn Circ J"},{"issue":"5","key":"R36","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1378\/chest.121.5.1581","article-title":"Prognostic power of ventilatory responses during submaximal exercise in patients with chronic heart disease","volume":"121","author":"Koike","journal-title":"Chest"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1177\/2047487313514018","article-title":"Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients","volume":"22","author":"Frederix","journal-title":"Eur J Prev Cardiol"},{"issue":"2","key":"R38","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.smhs.2021.05.001","article-title":"2020 WHO guidelines on physical activity and sedentary behavior","volume":"3","author":"Okely","journal-title":"Sports Med Health Sci"},{"issue":"9","key":"R39","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1038\/s41591-020-1012-3","article-title":"Wearable-device-measured physical activity and future health risk","volume":"26","author":"Strain","journal-title":"Nat Med"},{"issue":"5","key":"R40","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1177\/2047487320939671","article-title":"The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology","volume":"28","author":"Scherrenberg","journal-title":"Eur J Prev Cardiol"},{"issue":"5","key":"R41","first-page":"842","volume":"26","author":"Daskapan","journal-title":"Saudi Med J"},{"issue":"10","key":"R42","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1007\/s00392-009-0049-6","article-title":"Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters","volume":"98","author":"Karapolat","journal-title":"Clin Res Cardiol"},{"issue":"11","key":"R43","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1016\/s0002-9149(02)02323-8","article-title":"Effectiveness of three models for comprehensive cardiovascular disease risk reduction","volume":"89","author":"Gordon","journal-title":"Am J Cardiol"}],"container-title":["JMIR mHealth and uHealth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mhealth.jmir.org\/2025\/1\/e63797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:30:49Z","timestamp":1785537049000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhealth.jmir.org\/2025\/1\/e63797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":43,"URL":"https:\/\/doi.org\/10.2196\/63797","relation":{},"ISSN":["2291-5222"],"issn-type":[{"value":"2291-5222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]},"article-number":"v13i24e63797"}}