How Apps and Wearable Tech Improve Life After Stroke: Shervin Badihian, MD

Digital health tools are playing a growing role in stroke recovery, but their real-world impact is still coming into focus. At the International Stroke Conference 2026, Shervin Badihian, MD, a neuroscientist at Cleveland Clinic, discusses a systematic review evaluating whether mobile apps, wearable activity trackers, goal setting, and tele-coaching can improve physical activity and weight outcomes after stroke or transient ischemic attack.

The review found consistent gains in physical activity—especially in programs that paired reminders, goal setting, and feedback—but far less consistent results for weight management. Badihian outlines how these interventions varied across studies, why certain features appear more effective than others, and how digital tools may best complement, rather than replace, traditional stroke rehabilitation and follow-up care.

This transcript was lightly edited; captions were auto-generated.

Transcript

Can you walk us through how the mix of mobile apps, wearable trackers, goal setting, and tele-coaching varied across the interventions, and which components seemed most promising?

Yeah, absolutely. One of the challenges with this kind of intervention is that there is a lot of variation, which makes it very difficult for us to have a pooled analysis or a combination of effects model, basically. So as you said, there are different types of models that have been used so far in the stroke patient [population]. Some of them are tele-coaching. Some of them use mobile applications for reinforcement reminders. Some of them use activity trackers, like an Apple Watch or Fitbit or some other sort of activity tracker, or pedometers, or something else.

What we found is that the most impressive results, or the most meaningful results, come where there is an active reinforcement or reminder to the patient and there is goal setting, meaning that they have to meet certain goals based on how much they can be active every week, for example. And then there is feedback in place, meaning that the data is being reviewed by a health team, whether it is a physician or nurses or whoever, like coordinators, and they provide some sort of feedback for the patients, whether they are doing good or if they have to do better.

For the physical activity part, specifically, gamification looks to be working pretty well. So this one study that used a gamified application for people to be active and see their “fish” grow and have more features showed more promising results. For weight management overall, I don't think there is enough evidence to support that it's helpful. Just using digital health tools for weight management after the stroke, I don't believe that's a promising area, at least for now.

How do you see digital health tools fitting alongside traditional rehabilitation and follow-up care rather than replacing them?

I don't see it replacing the traditional models. I think these digital health tools will probably perform best when they are integrated into the traditional models that we have. We still need our traditional models of office visits and nurses and all of those people who care for the patients. And by integrating digital health, we can add more reminders or more reinforcement of behavioral changes, basically, and also gather more digital data, which brings on its own complications of who is going to review all of that digital data, and what are the time allocations and compensation for that? But I see that some sort of integrated feature for the traditional models, rather than replacing them completely, [would be useful]. There are also a lot of payment issues, like, based on the current policies, who is going to pay for the time and energy that is put into reviewing that data, and also who is going to pay for the devices if the patients are not able to afford them?

The age and sex distributions differed between the physical activity and weight studies—how do you think those demographic differences may have influenced the outcomes you observed?

It definitely affects the outcome, because I don't think those patients are representative of all stroke survivors. Many of these interventions are in both physical activity and weight, where they tend to enroll patients with lower disability. So a lot of stroke patients that have a lot of disabilities after a stroke don't end up getting enrolled in these studies, or a lot of those with cognitive barriers or mobility issues. For physical activity specifically… some of these studies were focused on young stroke survivors, so it doesn't span the entire age range of stroke survivors, which can be actually more in the elderly rather than the younger ages. So that's the main difference. There are certain limitations, so that's why we have to interpret the results with caution that this is not applicable to every single stroke patient, but to those with a lower disability and likely younger than what we see in the hospital, mainly.

Reference

Badihian S, Fedorova M, Ong BA, Nero N, Man S, Uchino K. Digital health tools and wearable technologies for secondary stroke prevention: effects on physical activity and weight outcomes. Presented at: International Stroke Conference 2026. February 3-6, 2025; New Orleans, LA. Poster WP307.