Smartphone applications for physical activity and sedentary behaviour change in people with cardiovascular disease: A systematic review and meta-analysis

Abstract

Background: Smartphone applications provide new opportunities for secondary prevention healthcare. This systematic review and meta-analysis aimed to determine if smartphone applications are effective at changing physical activity and sedentary behaviour in people with cardiovascular disease.

Methods: Six electronic databases (Medline, CINAHL Plus, Cochrane Library, SCOPUS, Sports Discus and EMBASE) were searched from 2007 to October 2020. Cardiovascular disease secondary prevention physical activity or sedentary behaviour interventions were included where the primary element was a smartphone or tablet computer application (excluding SMS-only text-messaging). Study quality was assessed using validated tools appropriate for each study design. Random effects model was used and the pooled mean difference between post scores were calculated. Subgroup analyses were conducted to examine differences based on diagnosis, sample size, age, intervention duration, activity tracker use, target behaviour, and self-report versus device-measured outcome.

Results: Nineteen studies with a total of 1,543 participants were included (coronary heart disease, n = 10; hypertension, n = 4; stroke, n = 3; heart failure, n = 1; peripheral artery disease, n = 1). Risk of bias was rated as high. Thirteen studies were included in the meta-analysis. Only two controlled studies reported on sedentary behaviour. Smartphone applications produced a significant increase of 40.35 minutes of moderate-to-vigorous intensity physical activity per week (7 studies; p = 0.04; 95% CI 1.03 to 79.67) and 2,390 steps per day (3 studies; p = 0.0007; 95% CI 1,006.9 to 3,791.2). Subgroup analyses found no difference when comparing diagnoses, sample size, activity tracker use, target behaviour and self-report versus device-measured outcome. Larger improvements in physical activity were noted in intervention durations of ≤3-months and participants ≥60yrs (95.35 mins.week-1; p = 0.05).

Conclusions: Smartphone applications were effective in increasing physical activity in people with cardiovascular disease. Caution is warranted for the low-quality evidence, small sample and larger coronary heart disease representation. More rigorous research is needed to investigate the effect of smartphone applications across diagnoses and in sedentary behaviour.

Fig 1. PRISMA flow diagram demonstrating the flow of studies through the review.

Fig 2. Randomised controlled trials appraised using the Revised Cochrane risk-of-bias (RoB-2).

Fig 3. Quasi-experimental and non-randomised studies, appraised using the ROBIN-I tool.

Fig 4. Studies without control groups, appraised using the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group.

Fig 5. Mean differences and 95% confidence intervals between groups for MVPA mins.week^-1.

Fig 6. Mean differences and 95% confidence intervals between groups for steps.day^-1.

Note: For graphical purposes, the steps data was divided by 10.