Heart Rehab at Home: How Smartwatches and Apps Are Transforming Cardiac Care
Cardiovascular disease remains the world’s leading killer. Yet fewer than 30% of eligible patients ever attend traditional centre-based cardiac rehabilitation. A new scoping review maps the explosive growth of digital health technologies — from smartphone apps to AI-powered wearables — that are bringing life-saving cardiac rehab directly into patients’ homes.
You’ve survived a heart attack or heart surgery. Your doctor prescribes cardiac rehabilitation — exercise, nutrition counselling, stress management — proven to reduce mortality by nearly 25%. But the nearest rehab centre is an hour away. You can’t take more time off work. Or you’re simply too fatigued to make the trip three times a week. For millions of patients worldwide, this is the reality that keeps them from life-saving care.
A comprehensive scoping review published in DIGITAL HEALTH by researchers at Peking Union Medical College maps how digital health technologies (DHTs) are closing this gap. After systematically screening over 1,000 records and analysing 22 studies from 12 countries published between 2019 and 2024, the findings reveal a field rapidly evolving — but with critical gaps that demand attention.
The bottom line: smartphone apps, smartwatches, and remote monitoring are making home-based cardiac rehabilitation (HBCR) not just feasible, but potentially as effective as centre-based programmes. However, significant challenges remain around long-term follow-up, diverse population inclusion, and the integration of artificial intelligence.
Why Cardiac Rehabilitation Matters — And Why Patients Don’t Go
Cardiovascular diseases (CVDs) claim at least 19 million lives annually — more than any other cause worldwide. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary intervention proven to improve exercise capacity, quality of life, and psychological wellbeing while reducing hospitalisation, disability, and mortality.
Core CR components include:
- Patient assessment and risk stratification
- Aerobic and strength exercise training
- Nutritional and weight management counselling
- Psychosocial support and stress management
- Medication adherence and risk factor control
Despite overwhelming evidence of benefit — including a 25-30% reduction in cardiovascular mortality — participation rates remain stubbornly low. Fewer than 30% of eligible patients attend traditional centre-based CR programmes. Women, older adults, ethnic minorities, patients with lower socioeconomic status, and those in rural areas are least likely to participate.
Barriers are numerous: distance to CR centres, transportation difficulties, work conflicts, caregiving responsibilities, low patient motivation, and — during the COVID-19 pandemic — facility closures and infection concerns. Home-based cardiac rehabilitation (HBCR) has emerged as a powerful alternative, and digital technologies are making it more effective than ever.
How This Scoping Review Was Conducted
The research team followed Arksey and O’Malley’s established framework for scoping reviews. They searched ten databases (PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, IEEE Xplore, CNKI, Wanfang, and VIP) for studies published from January 2019 to January 2025.
- 22 studies included from Europe (n=10), Asia (n=6), North America (n=5), and Oceania (n=1)
- 2,996 total participants — sample sizes ranging from 8 to 449
- Mean participant age: 61.5 ± 10.1 years — predominantly middle-aged and older adults
- 12 RCTs (54.5%) — the remainder quasi-experimental or observational
- 17 studies (77.3%) used multidisciplinary teams (physicians, nurses, exercise specialists, dietitians, psychologists)
Primary diagnoses included coronary artery disease (CAD), post-percutaneous coronary intervention (PCI), post-coronary artery bypass graft (CABG), myocardial infarction (MI), heart failure (HF), and valve repair/replacement.
Notably, only 31.8% of studies reported using theories, models, or frameworks (such as the Health Action Process Approach or Self-Determination Theory), and just 9.1% explicitly used Behaviour Change Techniques (BCTs) — a significant gap in evidence-based intervention design.
The Digital Toolkit: What Technologies Are Being Used?
The 22 studies employed a range of digital health technologies, often in combination. Here is how the landscape breaks down:
Other technologies included heart rate monitor chest straps (18%), activity trackers (14%), pedometers (9%), portable ECG monitors (9%), and muscle oxygen monitors (4.5%).
A systematic review and network meta-analysis cited by the authors confirmed that wearable devices combined with smartphone apps are the most effective intervention for improving peak oxygen uptake in remote cardiac rehabilitation. Smartphone apps and instant messaging tools are most effective for improving patient compliance.
What Home-Based Cardiac Rehabilitation Looks Like in Practice
The core component of HBCR interventions was overwhelmingly exercise training (21 of 22 studies, 95.5%). Only one study included comprehensive dietary management alongside exercise.
Intervention characteristics:
- Duration: Typically 12 weeks (50% of studies), ranging from 6 to 50 weeks
- Setting: Primarily home-based (59%), with some hybrid models (rehab centre + home, hospital + home, home + community)
- Delivery mode: eHealth-only (68%), face-to-face only (9%), or hybrid (23%)
- Target: Individual participants (77%) rather than groups
A critical limitation: Nearly 55% of studies had no follow-up period after the intervention ended. Among those with follow-up, periods ranged from 12 to 52 weeks, with 24 weeks being most common. This means we know relatively little about whether the benefits of digital HBCR are sustained over the long term.
While short-term (12-week) outcomes are well-documented, long-term maintenance of rehabilitation benefits remains understudied. Future research must prioritise extended follow-up periods to understand whether digital HBCR produces lasting behaviour change and clinical improvement.
What Outcomes Are Being Measured?
The studies covered a comprehensive range of outcomes, demonstrating that digital HBCR can be evaluated across multiple dimensions:
- Physical Activity: Step count, MVPA, 6-minute walk distance (6MWD), VO₂ peak, accelerometer data, IPAQ questionnaires
- Physiological Indicators: Heart rate, blood pressure, BMI, waist circumference, LVEF, lipids, blood glucose, flow-mediated dilation (FMD)
- Psychological Health: Anxiety (GAD-7, HADS), depression (PHQ-9), self-efficacy (ESE)
- Quality of Life: MLHFQ (heart failure), HeartQoL, EQ-5D, SF-12, WHOQOL-BREF
- Safety: Adverse events, non-elective hospital admissions, all-cause mortality
- Adherence: Exercise prescription adherence, device wearing time (≥10 hours/day), app usage frequency
- Feasibility: Recruitment rates, retention rates, system usability (SUS), cost-effectiveness
Notably, only a few studies reported data accuracy, wearing adherence, or economic benefits — important gaps for future research.
The Theory Gap: Why Behavioural Science Matters
One of the review’s most striking findings is how rarely digital HBCR interventions are grounded in established behavioural science. Only 7 of 22 studies (31.8%) reported using theories, models, or frameworks. Only 2 studies explicitly used Behaviour Change Techniques (BCTs) — the smallest observable, replicable active components of interventions.
Closer collaboration and interaction between the fields of behavioural science and technology are required. This may help enhance the effectiveness of digital technologies in modifying health behaviours and deepen the understanding of the relationship between behaviour change strategies and persuasive techniques.
— Taj et al., 2019, cited in Huang et al., 2026When BCTs were used, they included action planning, social support, self-monitoring, positive reinforcement, goal setting, feedback and monitoring, shaping knowledge, and repetition/substitution. These are evidence-based techniques that help patients translate intention into action — critical for maintaining exercise habits over months and years.
Future digital HBCR interventions should explicitly specify their theoretical foundations and BCTs to improve reproducibility, scalability, and effectiveness.
Wearable Devices: Promise and Peril
Intelligent wearable sensors — empowered by machine learning and innovative smart materials — enable rapid, accurate health monitoring without disrupting daily life. They can collect real-time physiological data, provide deep analysis, and generate actionable insights for personalised therapy.
However, several factors limit their clinical use:
- Data accuracy concerns — consumer-grade devices may not match medical-grade equipment
- Cost-effectiveness uncertainty — who pays for these devices and the staff time to monitor them?
- Privacy and data security risks — sensitive health data transmitted through consumer platforms
- Regulatory and reimbursement gaps — unclear pathways for clinical adoption
- Staff capacity constraints — lack of specialised clinicians to monitor, interpret, and respond to large data volumes
Only 2 of 22 studies incorporated machine learning algorithms. Conversational AI and personalised, adaptive interventions remain largely unexplored in HBCR. This represents a major opportunity for future innovation.
Who Is Being Left Behind?
The review raises important equity concerns. Study populations were:
- Predominantly male — potentially reflecting insufficient attention to women’s cardiac rehabilitation needs
- Middle-aged to older adults — no studies led by young populations (under 45) or the oldest-old (over 80)
- Under-representative of vulnerable groups — few studies focused on low educational levels, unemployed individuals, retirees, or rural populations
Digital health technologies risk widening the digital divide if they are not designed for and tested among the populations who need them most. Older adults, those with limited digital literacy, and low-income populations may struggle to access or use smartphone apps and wearables effectively.
As the authors note: “Digital health holds enormous potential in transforming CR and reducing the burden of CVDs.” But realising that potential requires intentional inclusion of diverse populations.
What Patients Say: The Qualitative Perspective
While this scoping review focused on quantitative studies, the authors highlight qualitative research showing that digital cardiac rehabilitation provides patients with the knowledge, tools, and support necessary for rehabilitation — enhancing their sense of empowerment and control.
However, limited opportunities for social interaction may pose challenges for patients seeking peer support. Some patients miss the camaraderie and shared experience of centre-based programmes. Future digital interventions should consider how to build community and connection into remote rehabilitation.
Recommendations for Practice and Research
Based on this comprehensive scoping review, here are actionable recommendations for clinicians, programme developers, and researchers:
Building Better Digital Home-Based Cardiac Rehabilitation
- Incorporate behavioural science explicitly — use established theories (SDT, HAPA) and report BCTs (goal setting, self-monitoring, feedback) to improve effectiveness and replicability
- Design for diverse populations — include women, younger and older adults, low-SES groups, rural residents, and those with limited digital literacy from the outset
- Extend follow-up periods — short-term (12-week) outcomes are insufficient; we need data on 6-month, 12-month, and longer maintenance of benefits
- Expand beyond exercise-only interventions — comprehensive CR includes nutrition, weight management, psychosocial support, and medication adherence; digital tools should support all core components
- Investigate AI and personalisation — machine learning could enable just-in-time adaptive interventions, personalised exercise prescriptions, and early warning of deterioration
- Address implementation barriers — data accuracy, privacy, reimbursement, and staff training must be solved for digital HBCR to scale
- Include economic evaluations — cost-effectiveness data are needed to support reimbursement decisions and equitable access
The authors also call for collaborative, multidisciplinary approaches involving patients, clinicians, scientists, policymakers, and industry leaders to transform the digital health landscape and fully leverage the clinical benefits of wearable devices.
Limitations of This Review
Several limitations should be noted. The search, while comprehensive across ten databases, may have missed studies where DHTs appeared only in full text rather than titles or abstracts. The review did not formally assess methodological quality, potentially including lower-quality studies. Only Chinese and English literature were included, possibly omitting important research from other languages. The search concluded in January 2025, meaning very recent studies may not be captured.
The Future of Cardiac Rehabilitation Is Digital — and Home-Based
Cardiovascular disease remains the world’s leading killer, but we have proven interventions that save lives and improve quality of life. The challenge has always been access. Digital health technologies — from simple text message programmes to sophisticated AI-powered wearable systems — are dissolving the barriers of distance, cost, and time that have kept millions from life-saving care.
This scoping review shows that the field is growing rapidly, with strong evidence for short-term effectiveness, good adherence, and promising safety profiles. But critical gaps remain: long-term follow-up, inclusion of diverse populations, integration of comprehensive CR components, application of behavioural science, and harnessing of artificial intelligence.
For the patient recovering from a heart attack who can’t drive to a rehab centre three times a week — or the older adult with heart failure who lives in a rural community with no CR programme — digital home-based cardiac rehabilitation is not a luxury. It is a lifeline. With continued research and thoughtful implementation, that lifeline can reach everyone who needs it.
