Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 26, 2024
Date Accepted: Apr 15, 2025
Effectiveness of digital health interventions on sedentary behavior among patients with chronic diseases: a systematic review and meta-analysis
ABSTRACT
Background:
Individuals with chronic diseases commonly engage in a sedentary lifestyle, which may exacerbate poor disease progression and increase the burden of care. Digital health interventions have been broadly used in promoting healthy lifestyles in recent decades, while its effectiveness on sedentary behavior (SB) remains inconsistent and inconclusive.
Objective:
This review` aimed to evaluate the effectiveness of digital health interventions in reducing SB among patients with chronic diseases.
Methods:
PubMed, Embase, Scopus, Web of Science, CINAHL Complete, Cochrane Library, and ACM Digital Library were searched for randomized controlled trials published from January 2000 to October 2023. Two researchers independently screened studies and evaluated study quality. The revised Cochrane risk-of-bias tool was used to assess the risk of bias. Mean differences (MD) were calculated for intervention effect comparison.
Results:
Twenty-six trials were selected and 3800 participants were included. The mean age was 57.32 ± 9.91 years. The typical chronic diseases reported in the studies including obesity (n=6), arthritis (n=5), coronary artery disease (n=4), cancer (n=4), type 2 diabetes mellitus (n=3), metabolic syndrome (n=2), and stroke (n=2). Phone, web, and activity trackers were three digital technologies adopted in the interventions, they were used in combination in most studies (18/26, 69.2%). The functions included facilitating self-monitoring of SB, reminding interruption of long undisturbed sitting, and promoting goal-attainment. Approaches targeting SB reduction included standing (n=6), walking (n=9), light physical activity (n=5), moderate to vigorous physical activity (n=4), screen time limitation (n=2), and contextual-related activities based on patients’ preference (n=4). The majority (80.8%) of studies had a low to moderate risk of bias. Meta-analysis revealed significant decreases in overall sitting time (MD=-30.8; 95% CI: -49.79, -11.82; I2=65%; P=.001), pre-post sitting time changes (MD=-50.28; 95% CI: -92.99, -7.57; I2=92%; P=.02), and SB proportions (MD=-4.36%; 95% CI: -6.39, -2.32; I2=20%; P<.001), with a small effect size (Cohen’s d: -0.27 to -0.47). No significant difference in the length of sedentary bouts and breaks were found. Subgroup analyses showed that studies with objective SB measurements and those under 65 years old had significant reductions in sitting time.
Conclusions:
Digital health interventions significantly reduced the SB among patients with chronic illness. More researches with rigorous design to promote long-term decrease of siting time, differentiate primary and compensatory SB reductions, and explore the underlying mechanisms are needed. Clinical Trial: PROSPERO CRD42023477958; https://www.crd.york.ac.uk/pros pero/display_record.php?RecordID=477958
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