Wearable Devices to Improve Physical Activity and Reduce Sedentary Behaviour: An Umbrella Review

Abstract

Background: Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic.

Objective: We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults.

Methods: We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size.

Results: Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as 'critically low methodological quality'. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627-1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals).

Conclusions: Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components.

Keywords: Activity monitors; Frailty; Hypertension; Low back pain; Musculoskeletal; Obesity; Osteoarthritis; Physical activity; Sedentary behaviour; Wearable devices.

Fig. 1

Eligibility criteria

Fig. 2

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; CINAHL, Cumulative Index to Nursing and Allied Health Literature

Fig. 3

Methodological quality of the 51 SRs according to the 16 items of AMSTAR 2. Item 1 (Did the research questions and inclusion criteria for the review include the components of PICO?); 2: item 2 (Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?); 3: item 3 (Did the review authors explain their selection of the study designs for inclusion in the review?); 4: item 4 (Did the review authors use a comprehensive literature search strategy?) 5: item 5 (Did the review authors perform study selection in duplicate?); 6: item 6 (Did the review authors perform data extraction in duplicate?); 7: item 7 (Did the review authors provide a list of excluded studies and justify the exclusions?); 8: item 8 (Did the review authors describe the included studies in adequate detail?); 9: item 9 (Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?); 10: item 10 (Did the review authors report on the sources of funding for the studies included in the review?); 11: item 11 (If meta-analysis was performed, did the review authors use appropriate methods for statistical combination of results?); 12: item 12 (If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?); 13: item 13 (Did the review authors account for RoB in primary studies when interpreting/discussing the results of the review?); 14: item 14 (Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?); 15: item 15 (If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?); 16: item 16 (Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?)

Fig. 4

Overlapping of primary studies across SRs in A step per day, B MVPA, C SB, and D composite measurements. White, slight overlap (< 5%), green moderate overlap (5% to < 10%), yellow high overlap (10% to < 15%), orange very high overlap (≥ 15%). MVPA, moderate to vigorous physical activity; SB, sedentary behaviour. Step per day is measured in number of steps, MVPA and SB are measured in minutes, composite measurements is measured in standardized mean difference (SMD) as standardized measure of physical activity (e.g., metabolic equivalent for task (MET), min/week, intensity, time spent walking)

Fig. 5

Summary of results of steps per day. Red line refers to the clinical relevance (Larsen 2021 [31]). Step per day is measured in number of steps per day. When effect sizes were reported in SMD, back-translation were obtained using the standard deviation of the control group of the RCT with the highest number of participants of each meta-analysis

Fig. 6

Summary of results for minutes of MVPA per week. Red line refers to the clinical relevance (Larsen 2021 [31]). MVPA, moderate to vigorous physical activity. MVPA is measured in minutes per week. When effect sizes were reported in SMD, back-translation were obtained using the standard deviation of the control group of the RCT with the highest number of participants of each meta-analysis