Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jun 19, 2026
Open Peer Review Period: Jun 22, 2026 - Aug 17, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Deconstructing Digital Interventions for Physical Activity in Cardiovascular Disease: A Systematic Review, Network Meta-Analysis, and Component Meta-Analysis of Behaviour Change Techniques
ABSTRACT
Background:
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Physical activity reduces cardiovascular mortality by 20-30% and is central to secondary prevention, yet most patients remain insufficiently active. Digital interventions have emerged as scalable tools to address this gap.
Objective:
This study aimed to identify which digital delivery model is most effective and which behaviour change techniques (BCTs) drive physical activity outcomes in adults with CVD.
Methods:
We conducted a systematic review, network meta-analysis (NMA), and component network meta-analysis (CNMA) of randomised controlled trials (RCTs) testing digital interventions to promote physical activity behaviour in adults with CVD (PROSPERO: CRD420261325826). Databases searched included Cochrane Library, PubMed, Scopus and Web of Science (6,545 records identified) published until April 2026. Primary outcomes were daily steps, sedentary time and moderate-to-vigorous physical activity (MVPA); secondary outcomes included peak oxygen uptake (VO2peak). BCTs were coded with BCT Taxonomy v1
Results:
Sixteen trials (n = 1643) were included. Digital interventions increased steps/day by 1,112 (95% CI: 763-1,460; I² = 27%; GRADE: Moderate). Unsupervised mHealth (mobile health) applications ranked highest in the network (MD = 1,386 steps/day), ahead of supervised telerehabilitation (MD = 825 steps/day); the indirect comparison was not significant (MD = 561 steps/day, 95% CI: −88 to 1,211). Sedentary time and MVPA showed no meaningful change, with longer interventions paradoxically associated with increased sedentary time. In an exploratory analysis, each additional 1,000 daily steps corresponded to a 0.741 ml/kg/min increase in VO2peak. The CNMA explained no between-study variance.
Conclusions:
digital interventions can increase daily steps in individuals with CVD. The mHealth interventions did not differ significantly from telerehabilitation interventions in daily steps improvements. Benefits were limited to ambulatory volume and did not extend to sedentary time or MVPA. The exploratory association between daily step count and VO2peak suggests potential cardiorespiratory benefits but requires verification in adequately powered trials. Future research should prioritise adaptive digital architectures, broader BCT variation, and direct comparisons between delivery modalities. Clinical Trial: PROSPERO: CRD420261325826
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