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Meta-Analysis
. 2023 Jul 6:25:e46439.
doi: 10.2196/46439.

Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis

Graziella Zangger  1   2 , Alessio Bricca  1   2 , Behnam Liaghat  2   3 , Carsten B Juhl  2   4 , Sofie Rath Mortensen  1   5 , Rune Martens Andersen  1   6 , Camma Damsted  1   2 , Trine Grønbek Hamborg  1 , Mathias Ried-Larsen  5   7 , Lars Hermann Tang  1   6 , Lau Caspar Thygesen  8 , Søren T Skou  1   2
Affiliations
Meta-Analysis

Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis

Graziella Zangger et al. J Med Internet Res. .

Abstract

Background: Digital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear.

Objective: This systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions.

Methods: We searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following 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 (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation.

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

Conclusions: Digital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention.

Trial registration: PROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028.

Keywords: chronic conditions; digital health; eHealth; mHealth; meta-analysis; mobile health; physical activity; physical function; randomized controlled trials; systematic review; wearables.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare that STS is an associate editor of the Journal of Orthopaedic & Sports Physical Therapy; has received personal fees from Munksgaard and TrustMe-Ed outside the submitted work; and is a cofounder of GLA:D, a not-for-profit initiative hosted at the University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. Furthermore, STS is currently funded by a program grant from Region Zealand (Exercise First) and 2 grants from the European Union’s Horizon 2020 Research and Innovation Program, one from the European Research Council (MOBILIZE, grant agreement 801790) and the other under grant agreement 945377 (ESCAPE). In addition, LHT was funded by a grant from the Danish Regions and the Danish Health Confederation through the Development and Research Fund for financial support (project 2703) and a grant from Region Zealand (Exercise First). None of the authors had financial relationships with any organizations that might have an interest in the submitted work or other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the study selection process.
Figure 2
Figure 2
Overall forest plot of objectively measured physical activity, objectively measured physical function, and moderate to vigorous physical activity (MVPA) at the end of the intervention. Obj PA: objectively measured physical activity; Obj PF: objectively measured physical function.
Figure 3
Figure 3
Overall forest plot of subjectively measured physical activity, physical function, and health-related quality of life (HRQOL) at the end of the intervention. Subj PA: subjectively measured physical activity; Subj PF: subjectively measured physical function.
Figure 4
Figure 4
Overall forest plot of depression and anxiety at the end of the intervention. ANX: anxiety; DEP: depression.
Figure 5
Figure 5
Overall forest plot of objectively measured physical activity, physical function, and moderate to vigorous physical activity (MVPA) at follow-up. Obj PA: objectively measured physical activity; Obj PF: objectively measured physical function.
Figure 6
Figure 6
Overall forest plot of subjectively measured physical activity, physical function, and health-related quality of life (HRQOL) at follow-up. Subj PA: subjectively measured physical activity; Subj PF: subjectively measured physical function.
Figure 7
Figure 7
Overall forest plot of depression and anxiety at follow-up. ANX: anxiety; DEP: depression.
Figure 8
Figure 8
Risk of bias for objectively measured physical activity given as percentages.
Figure 9
Figure 9
Risk of bias with objectively measured physical function given as percentages.
See this image and copyright information in PMC

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