A Cardiopulmonary Exercise Testing-Based Assessment: Can Wearable-Assisted Cardiac Rehabilitation Improve Functional Capacity in Patients With Chronic Heart Failure?

Background Cardiac rehabilitation is a cornerstone of chronic heart failure management and has consistently been associated with enhanced exercise performance and better health-related quality of life. Despite these benefits, access to conventional center-based rehabilitation remains limited in many low-resource settings. Wearable technologies offer the possibility of extending rehabilitation beyond specialized facilities through continuous physiological monitoring and individualized exercise guidance. Objective This study aimed to compare the effects of wearable-assisted and conventional cardiac rehabilitation on functional capacity evaluated through cardiopulmonary exercise testing (CPET) among individuals with chronic heart failure. Methods This prospective randomized monocentric study included patients with chronic heart failure enrolled in a structured 12-week cardiac rehabilitation program between January 2025 and February 2026. A total of 143 patients were randomized to wearable-assisted rehabilitation (n = 66) or conventional rehabilitation (n = 77). Twenty-two patients did not complete the follow-up assessment, resulting in a final analysis population of 121 patients: 54 in the wearable-assisted group and 67 in the conventional rehabilitation group. Functional capacity was assessed before and after rehabilitation using CPET-derived parameters, including peak oxygen consumption (VO₂peak) and first ventilatory threshold (SV1). Results The study population exhibited marked baseline exercise limitation, with a mean VO₂peak of 11.75 ± 1.36 mL/kg/min and a mean SV1 of 9.92 ± 1.11 mL/kg/min. Following rehabilitation, substantial physiological improvements were observed across the entire cohort. The mean VO₂peak increased to 16.75 ± 1.01 mL/kg/min (p < 0.001), corresponding to an average gain of approximately 5 mL/kg/min. The mean SV1 increased to 11.92 ± 0.86 mL/kg/min (p < 0.001), reflecting improved aerobic efficiency and delayed onset of anaerobic metabolism. When rehabilitation modalities were analyzed separately, functional gains were remarkably similar. Patients undergoing wearable-assisted rehabilitation demonstrated a mean VO₂peak increase of 5.01 mL/kg/min compared with 5.00 mL/kg/min in the conventional rehabilitation group (p = 0.902). Improvements in SV1 were likewise comparable between groups (+2.02 vs. +2.00 mL/kg/min; p = 0.902). Conclusions Cardiac rehabilitation resulted in meaningful gains in exercise capacity in individuals with chronic heart failure. Wearable-assisted rehabilitation achieved physiological benefits comparable to those observed with conventional rehabilitation, supporting its potential as a practical alternative in settings where access to specialized rehabilitation facilities is limited.