Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 12, 2024
Date Accepted: May 26, 2025
Digital behavior change interventions to promote physical activity and reduce sedentary behavior among breast cancer survivors: A systematic review and meta-analysis of randomized controlled trials
ABSTRACT
Background:
Breast cancer survivors (BCSs) often face challenges in maintaining physical activity (PA) and reducing sedentary behavior (SB), which are crucial for recovery and long-term health. Digital behavior change interventions (DBCIs) have emerged as promising tools to address these behavioral targets.
Objective:
This systematic review and meta-analysis aimed to assess the effectiveness of DBCIs in promoting PA and reducing SB among BCSs.
Methods:
A comprehensive search of ten databases, including PubMed, Embase, PsycINFO, the Cochrane Library, CINAHL, Web of Science, the China National Knowledge Infrastructure database, the Wanfang database, the VIP database, and the Sedentary Behavior Research Database, was performed to identify eligible randomized controlled trials (RCTs) that investigated the effectiveness of DBCIs in promoting PA and reducing SB among BCSs. Study quality was assessed using the Cochrane risk-of-bias tool. Data synthesis was conducted via Review Manager (version 5.4; The Cochrane Collaboration). Owing to anticipated heterogeneity, a random-effects meta-analysis was employed. The evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results:
Twenty-nine RCTs involving 2,229 participants met the inclusion criteria. Most DBCIs were delivered at the interpersonal level, with common behavior change techniques, including social support (unspecified), instruction on how to perform the behavior, demonstration of the behavior, action planning, and problem-solving. Meta-analysis revealed that DBCIs significantly improved the shoulder range of motion across all planes (flexion: SMD = 2.08, 95% CI [1.14, 3.01]; P < .001; extension: SMD = 1.74, 95% CI [0.79, 2.70]; P < .001; abduction: SMD = 2.32, 95% CI [1.35, 3.28]; P < .001; external rotation: SMD = 2.29, 95% CI [0.96, 3.62]; P < .001; internal rotation: SMD = 2.98, 95% CI [1.08, 4.87]; P = .002; adduction: SMD = 2.09, 95% CI [1.16, 3.02]; P < .001), finger climbing wall height (SMD = 1.65, 95% CI [1.35, 1.95]; P < .001), upper extremity function (SMD = −0.96, 95% CI [−1.50, −0.42]; P < .001), quality of life (SMD = 1.83, 95% CI [0.44, 3.22]; P = .01), and reduced pain (SMD = −0.58, 95% CI [−0.93, −0.22]; P = .002). However, no significant differences were found in steps, time spent in light physical activity, time spent in moderate-to-vigorous physical activity, sedentary time, or physical function.
Conclusions:
DBCIs effectively improve upper body mobility, function, quality of life, and pain management in BCSs. Future research should explore multilevel DBCIs specifically designed to address whole-body PA and SB reduction, with effectiveness evaluated through methodologically rigorous, large-scale trials. Clinical Trial: PROSPERO (CRD42023448098); https://www.crd.york.ac.uk/PROSPERO/view/CRD42023448098
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