The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: A systematic review of randomised controlled trials

Abstract

Background: We conducted a systematic review to assess the effectiveness of smoking cessation, physical activity (PA), diet, and alcohol reduction interventions delivered by mobile technology to prevent non-communicable diseases (NCDs).

Methods: We searched for randomised controlled trials (RCTs) of mobile-based NCD prevention interventions using MEDLINE, EMBASE, Global Health, CINAHL (Jan 1990-Jan 2016). Two authors extracted data.

Findings: 71 trials were included: smoking cessation (n = 18); PA (n = 15), diet (n = 3), PA and diet (n = 25); PA, diet, and smoking cessation (n = 2); and harmful alcohol consumption (n = 8). 4 trials had low risk of bias. The effect of SMS-based smoking cessation support on biochemically verified continuous abstinence was pooled relative risk [RR] 2.19 [95% CI 1.80-2.68], I2 = 0%) and on verified 7 day point prevalence of smoking cessation was pooled RR 1.51 [95% CI 1.06-2.15], I2 = 0%, with no reported adverse events. There was no difference in peak oxygen intake at 3 months in a trial of an SMS-based PA intervention. The effect of SMS-based diet and PA interventions on: incidence of diabetes was pooled RR 0.67 [95% CI 0.49, 0.90], I2 = 0.0%; end-point weight was pooled MD -0.99Kg [95% CI -3.63, 1.64] I2 = 29.4%; % change in weight was pooled MD -3.1 [95%CI -4.86- -1.3] I2 0.3%; and on triglyceride levels was pooled MD -0.19 mmol/L [95% CI -0.29, -0.08], I2 = 0.0%. The results of other pooled analyses of the effect of SMS-based diet and PA interventions were heterogenous (I2 59-90%). The effects of alcohol reduction interventions were inconclusive.

Conclusions: Smoking cessation support delivered by SMS increases quitting rates. Trials of PA interventions reporting outcomes ≥3 months showed no benefits. There were at best modest benefits of diet and PA interventions. The effects of the most promising SMS-based smoking, diet and PA interventions on morbidity and mortality in high-risk groups should be established in adequately powered RCTs.

Fig 1. PRISMA flow diagram.

Fig 2. Risk of bias summary–smoking cessation trials.

Fig 3. Risk of bias summary–physical activity.

Fig 4. Risk of bias summary–diet.

Fig 5. Risk of bias summary–physical activity and diet.

Fig 6. Risk of bias summary–physical activity/diet/smoking.

Fig 7. Risk of bias summary–alcohol reduction trials.

Fig 8. Smoking cessation trials using SMS function–continuous abstinence (biochemically verified).

Fig 9. Smoking cessation trials using SMS function– 7 day point prevalence abstinence (biochemically verified).

Fig 10. Physical activity interventions using SMS function–change in daily step count.

Fig 11. Physical activity and diet interventions using SMS function–BMI.

Fig 12. Physical activity and diet interventions using SMS function–change in weight (kg).

Fig 13. Physical activity and diet interventions using SMS function–change in weight (%).

Fig 14. Physical activity and diet interventions using SMS function–weight endpoint (kg).

Fig 15. Physical activity and diet interventions using SMS function–waist circumference endpoint (cm).

Fig 16. Physical activity and diet interventions using SMS function–triglycerides (mmol/L).

Fig 17. Physical activity and diet interventions using SMS function–total cholesterol (mmol/L).

Fig 18. Physical activity and diet interventions using SMS function–high density lipoprotein cholesterol (mmol/L).

Fig 19. Physical activity and diet interventions using SMS function–systolic blood pressure (mmHg).

Fig 20. Physical activity and diet interventions using SMS function–diastolic blood pressure (mmHg).

Fig 21. Physical activity and diet interventions using SMS function–cumulative incidence of diabetes.

Fig 22. Physical activity and diet interventions using application function–change in weight (kg).