Short-term engagement with a smartwatch-linked gamified smartphone app is achievable in cardiac telerehabilitation after acute coronary syndrome, though adherence to predefined gamified exercise standards was lower than app use rates, suggesting that refinement of reward rules and target HR thresholds may be necessary.
The overall app use rate (primary endpoint) was 59.9% across the intervention period.
The target heart rate exercise adherence rate was 50%, lower than the overall app use rate.
Peak oxygen consumption increased from 18.4 to 21.1 mL/kg/min over the 1-month intervention.
Perceived exercise-related hassle decreased substantially, with mean visual analog scale scores dropping from 57 to 32.
No adverse events related to app use were identified during the study period.
The gamification mechanism awarded points to participants only when exercising within their target anaerobic threshold heart rate range (±10 bpm).
The study identified that refinement of reward rules and target HR thresholds may be necessary to improve adherence to gamified exercise standards.
This research studied whether a gamified smartphone app paired with a smartwatch could help heart attack patients stick to a home-based exercise rehabilitation program. Sixteen patients who had recently suffered a heart attack and undergone a procedure to open blocked arteries were given a smartwatch and smartphone loaded with an app called Shin-po Kei. The app rewarded patients with points when they exercised at the right intensity — measured by their heart rate — for at least 30 minutes on multiple days per week. The study ran for about one month after patients were discharged from the hospital. The researchers found that patients logged into the app on about 60% of intervention days, and half of patients consistently met the full gamified exercise standard of exercising at the target heart rate for 30 minutes at least three days per week. Physical fitness, measured by peak oxygen uptake, improved from about 18 to 21 mL/kg/min, and patients reported less hassle and difficulty associated with exercising by the end of the program. Importantly, no safety problems related to using the app were identified. This research suggests that combining a smartwatch with a gamified app is a feasible and safe approach to help heart attack patients exercise at home after leaving the hospital. However, the gap between simply opening the app and actually meeting the full exercise targets points to a need to refine how the app rewards patients — for example, by adjusting the heart rate target ranges or the point-earning rules — to better encourage protocol-compliant exercise. Larger studies with control groups would be needed to confirm whether this approach is more effective than standard care.
Arima Y, Kaihara T, Nakamura M, Sone K, Yoshida T, Utsugi Y, et al.. (2026). Cardiac Telerehabilitation Using a Smartwatch and a Gamified Smartphone App: Single-Arm Pre-Post Feasibility Study.. JMIR cardio. https://doi.org/10.2196/85808