There was no significant between group difference in six-minute walk test distance .
Conclusions Our meta- analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use .
Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count .
WPAM with exercise prescription or advice did not change sedentary time .
Background Physical activity ( PA ) is a component of cardiac rehabilitation ( CR ) .
However , life-long engagement in PA is required to maintain benefits gained .
Wearable PA monitoring devices ( WPAM ) are thought to increase PA .
There appear to be no review s which investigate the effect of WPAM in cardiac population s. We firstly aim ed to systematic ally review r and omised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR .
We specifically examined the effect on cardiorespiratory fitness ( CRF ) , amount and intensity of daily PA , and sedentary time .
Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial.
BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore
There was no significant between group difference in six-minute walk test distance .
Conclusions Our meta- analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use .
Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count .
WPAM with exercise prescription or advice did not change sedentary time .
Background Physical activity ( PA ) is a component of cardiac rehabilitation ( CR ) .
However , life-long engagement in PA is required to maintain benefits gained .
Wearable PA monitoring devices ( WPAM ) are thought to increase PA .
There appear to be no review s which investigate the effect of WPAM in cardiac population s. We firstly aim ed to systematic ally review r and omised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR .
We specifically examined the effect on cardiorespiratory fitness ( CRF ) , amount and intensity of daily PA , and sedentary time .