JMIR Publications

ABSTRACT

Background:

Digital health interventions to manage chronic conditions have large potential. However, the benefits and harms are still questioned.

Objective:

This systematic review and meta-analysis investigated the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions.

Methods:

We searched MEDLINE, Embase, CINAHL, and CENTRAL from the inception to Oct. 2022. Eligible randomized controlled trials (RCTs) were included if they used a digital component in physical activity promotion in adults with one or more conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (e.g., walk or step tests). We used a random-effects model (restricted maximum likelihood) for the meta-analyses and meta-regression analyses to assess the impact of study-level covariates. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using GRADE.

Results:

Of 14 078 hits, 130 RCTs were included. Compared to usual care/minimal intervention, digital health interventions increased objectively measured physical activity (end-of-intervention: SMD 0.29, 95% CI 0.21 to 0.37 and follow-up: SMD 0.17, 95% CI 0.04 to 0.31), and physical function (end-of-intervention: SMD 0.36, 95% CI 0.12 to 0.59, and follow-up: SMD 0.29; 95% CI 0.01 to 0.57). Secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life (HRQOL) at end-of-intervention, but only objectively measured physical activity at follow-up. The risk of non-serious adverse events, but not serious, was higher in the digital health interventions in the end-of-intervention, but no difference was seen at follow-up.

Conclusions:

Digital health interventions improved physical activity and physical function across various chronic conditions, while only end-of-intervention effects on depression, anxiety, and HRQOL were observed. The risk of non-serious adverse events is present during the intervention and should be addressed. Future studies should focus on better reporting, comparing different digital solutions' effects, and investigating if interventions are sustained at follow-up. Clinical Trial: PROSPERO CRD42020189028.