The compliance of digital exercise with smart tools in subjects with cardiac arrythmias
Authors: Guo Y , Zhang H , Li L , Chen M , Jia Z , Tu X 
Published: October 2022

Abstract

Background
The exercise has well-documented health benefits on cardiovascular disease, and the use of mobile health (mHealth) may promote physical activity to reduce the risk.

Objective
The present study aimed to investigate the compliance of exercise dose and pattern through wearables and mHealth in subjects with cardiac arrhythmia in a real-world setting.

Method
The photoplethysmography (PPG)-algorithms with wearables to detect the ectopic and AF have been developed in the HUAWE HEART STUDY. Using the PPG-based smart devices, the adult subjects with identified arrhythmia received the personalized App-based lifestyle and exercise package was proposed. The V̇O2 peak (mL kg–1 min–1)was estimated from a non-exercise prediction model. The metabolic equivalent (MET)/week and Borg scale were utilized for the assessment of intensity of exercise. All subjects followed up for 3 months for the compliance to the exercise package.

Results
There were 7419 subjects (mean age ± standard deviation, SD, 35±12 years old, 92.1% male) who identified with the arrhythmia between April 1, 2021 and Dec 31, 2021. Among them, there were 165 subjects with identified AF, and 5277 subjects with the ectopic. The obstructive sleep apnea was the most reported risk profile (2643, 35.6%), while 1326 (17.9%) subjects were overweight.
Upon the baseline assessment, the personalized exercise package for cardiovascular disease prevention were proposed for 2864 subjects, exercise package to control the weight for 2510 subjects, and exercise package to reduce the weight for 1886 subjects.
Among 6366 subjects who took the exercise packages, 1867 (29.3%) subjects achieved target exercise, 395 (6.2%) subjects over target exercise, and 4104 (64.5%) under target exercise. The V̇O2 peak (mL kg–1 min–1, SD)in subjects who achieved the target exercise package, under target exercise, and over target exercise were (47.36±5.12, 32.14±22.47, and 65.99±10.38, p&lt;0.001).
For subjects who achieved target exercise, the intensity of exercise was as follows: 0.4% with low-intensity exercise, 95.8% with moderate-intensity exercise, and 3.7% with high-intensity exercise. Nonetheless, there were 37.7% of low-intensity, 60.6% of moderate-intensity exercise, and 1.7% with high-intensity exercise in subjects who didn't achieve exercise target.
77.9% subjects under target exercise had less than 1/week of physical activity, while there was only 12.9% in subjects with target exercise (p&lt;0.001).
Compared to randomly selected 8000 subjects (mean age ± SD, 39±13 years, 80.8% male) without exercise package, the proportion of steps/day over 10000 of 20% was significantly increased in subjects (37±13 years, 91.3% male) receiving the personalized App-based exercise package (31.2%, vs. 12.2%, p&lt;0.001).

Conclusion
The wearables facilitated the improvement of physical activity habit in subjects with cardiac arrhythmia, but subjects-centered self-management would be enhanced to the target exercise.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China