Objective To explore the application effect of risk pre-control under smart wearable devices monitoring combined with staged rehabilitation training in patients with acute cerebral infarction (ACI). Methods A retrospective selection was made of 205 patients with ACI who visited Xiayi County People’s Hospital from May 2022 to March 2024. These patients were divided into the conventional group (without wearing, n＝102) and the combined group (wearing, n＝103) based on whether they wore smart devices. The conventional group received conventional rehabilitation intervention, while the combined group adopted the intervention of risk precontrol assisted by the smart wearable monitoring equipment combined with phased rehabilitation training on this basis. The neurological and functional rehabilitation, health status, quality of life, length of stay, and the incidence of complications during the intervention period were compared between the two groups. Results After 4 weeks of intervention, the scores of Barthel index (BI), functional independence measure (FIM), overall health, physiological function, and mental health in both groups were higher than those before intervention (all P＜0.05), the above indexes in the combined group were significantly higher than those in the conventional group (all P＜0.05); the scores of National Institutes of Health Stroke Scale (NIHSS), chronic health status, and acute physiology score in both groups were lower than those before intervention (all P＜0.05), the above indexes in the combined group were significantly lower than those in the conventional group (all P＜0.05). The complication rate in the combined group was lower than that in the conventional group (P＜0.05), but there was no statistically significant difference in length of stay between the two groups (P＞0.05). Conclusion The combination of risk prevention through intelligent wearable devices and phased rehabilitation training can effectively improve the neurological function and daily living ability of patients with ACI, enhance their quality of life, and reduce the risk of complications during the rehabilitation process.