Impact of a combined care ambulatory and home-based aerobic exercise program using wearables on anxiety and depression in patients with metabolic syndrome

Background Anxiety and depressive symptoms are more common in individuals with metabolic syndrome (MetS), which is characterized by abdominal obesity, subclinical atherosclerosis, and impaired glucose metabolism. Although aerobic exercise training (aET) with direct medical staff supervision improves cardiometabolic health, its implementation remains limited in this population. Technology-assisted physical activity (PA) interventions may enhance adherence, but their impact on mental health in MetS is not well established. Therefore, the aim of this study was to evaluate whether a supervised ambulatory aET program followed by a device-supported home-based aET program improves anxiety and depression levels in individuals with MetS. Methods In this prospective study (NCT05592704), 132 adults with MetS (mean age 52.4 ± 6.3 years; 54.6% female) completed a 2-month supervised ambulatory aET program (40 min, 5 days/week). Participants were then randomized to: (1) a control group receiving only standard PA recommendations for 6 months, or (2) a intervention group receiving an individualized 6-month home-based aET program supported by the dedicated smartphone application and a Polar H10 heart-rate monitor. Anxiety and depression were assessed at baseline, after 2 and 8 months using the Hospital Anxiety and Depression Scale. Results Linear Mixed Model analysis revealed significant Group × Time interactions for anxiety ( p = 0.020) and depression ( p = 0.049) after the 8-month combined care aEP. While groups remained comparable following the initial 2-month supervised ambulatory aET program (anxiety: p = 0.461; depression: p = 0.174), significant divergence occurred during the 6-month home-based aEP phase. By month 8, the intervention group achieved significantly lower scores than the control group for both anxiety ( p = 0.005) and depression ( p = 0.018). Notably, the intervention group demonstrated continued symptom reduction during the home-based phase (anxiety Δ = −1.09, −21.2%; depression Δ = −0.23, −9.7%), whereas the control group experienced symptomatic regression (anxiety Δ = + 0.18, +4.2%; depression Δ = + 0.21, +9.0%). Conclusion A 2-month supervised ambulatory aET program followed by a 6-month home-based aET program with remote supervision using wearables significantly reduced both anxiety and depression levels in individuals with MetS. These findings demonstrate that combined care aET models not only initiate symptom reduction but also facilitate the long-term maintenance of mental health gains, highlighting the potential of technology-assisted interventions to enhance psychological outcomes in this population.