Application of wearable devices to monitor activity in post-operative cardiac surgery settings: a commentary

This invited commentary refers to ‘Use of wearable devices to monitor post-operative activity following cardiac surgery: a systematic scoping review’, by J. Edney et al., https://doi.org/10.1093/eurjcn/zvae054. Physical activity post-cardiac surgery results in better quality of life and decreased mortality.1,2 Yet physical activity engagement remains to be difficult with barriers including pain, feeling unwell, lack of time, comorbidities, lack of education, etc.3,4 Wearable devices can help promote physical activity among users and have been increasingly adopted in clinical settings.5 With a lack of research evaluating the use of wearable devices post-cardiac surgery in acute care settings, it is meaningful to review the status of science regarding this topic. In the paper by Edney et al.,6 the authors evaluate current literature regarding the use of wearable activity trackers/accelerometers to monitor patient activity levels in the first 30 days following cardiac surgery. After synthesizing included articles from two databases (CINAHL and MEDLINE), the authors review and summarize study characteristics, acceptability and usability of wearable activity trackers, accuracy of wearable activity trackers, measurement of exercise participation in acute care, exercise participating following acute care discharge, and impact of exercise participation on acute care length of stay and readmissions.6 This scoping review adds to the current literature with several key perspectives regarding wearable device use. First of all, the authors conclude that the wearable devices used to monitor physical activity are feasible and acceptable. This is in accordance to previous evidence that reported different populations’ acceptance of wearable devices to track physical activity.5,7,8 In addition, low levels of activity on the second day post-surgery and at discharge are associated with increased 30-day readmission and risk of requiring readmission within 12 months, respectively. The authors call for the use of wearable devices to track and coach patient physical activity to help assist their function recovery during acute care admission post-cardiac surgery. With the findings of this scoping review, the authors not only demonstrate the importance of early activity post-cardiac surgery among patients in acute care settings but also underscore the value of wearable devices in monitoring physical activity in this setting.6 In addition to the key perspectives, this scoping review also touches on important aspects of wearable devices; for instance, the ability to provide continuous data from an individual patient. With this functionality, nurses and allied health professionals can obtain accurate trend data on physical activity and sedentary behaviour among patients in acute care settings. This may help promote the quality of health care and health service. Additionally, this scoping review discussed the accuracy of wearable devices. Although only one study investigated accuracy, it is still an imperative point to discuss when studying wearable device measurements. The lack of accurate measure of activity as indicated by the review indicates that there is a need to develop wearable devices with more accurate measures. One thing that needs to be clarified is the difference between physical activity and exercise. The World Health Organization (WHO) defined physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure, including movements during leisure time, transferring from place to place, etc.9 Exercise is physical activity that is planned, structured, repetitive, and purposive with the goal of maintaining or improving one or more components of physical fitness.10 Therefore, exercise is a subcategory of physical activity. A distinction of the two concepts may help with a better interpretation of the study results. Overall, this study provides a meaningful and insightful systematic scoping review of wearable devices used in post-cardiac surgery settings. It highlights the value of wearable devices in cardiac surgical care, particularly in improving the accuracy and efficiency of patient activity level monitoring. By identifying the potential benefits of monitoring patient activity levels using wearable devices, this review motivates both clinicians and researchers to implement these technologies in cardiac surgery care. The findings of this study have important implications for developing more effective post-operative rehabilitation programmes and prompt policy makers to consider incorporating these devices into practice. No new data were generated or analysed in support of this research.