Meta-Analysis

. 2025 Jan 4;59(1):kaaf043.

doi: 10.1093/abm/kaaf043.

Digital versus nondigital behavioral interventions on cardiovascular risk reduction: systematic review and meta-analysis

Fentaw Tadese Berhe¹, Desalegn Markos Shifti², J Lennert Veerman¹, Leopold Aminde¹, Kedir Yimam Ahmed³, Yonatan Moges Mesfin⁴, Kelemu Tilahun Kibret⁵, Habtamu Mellie Bizuayehu⁶, Daniel Bekele Ketema⁷, Daniel Bogale Odo⁸, Subash Thapa³, Abel Dadi⁹, Sewunet Admasu Belachew⁶, Meless Gebrie Bore¹⁰, Zemenu Yohannes Kassa¹⁰, Abdulbasit Musa Seid¹¹, Tahir Ahmed Hassen¹², Erkihun Amsalu¹³, Teketo Kassaw Tegegne¹⁴

Affiliations

¹ School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
² Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
³ Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
⁴ Immunity and Global Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁵ Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
⁶ First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
⁷ The George Institute for Global Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
⁸ National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
⁹ Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
¹⁰ School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia.
¹¹ Australian Living Evidence Collaborations, School of Public Health and Preventive Medicine, Monash University, Melboune, Australia.
¹² Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia.
¹³ Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.

PMID: 40576235
PMCID: PMC12203340
DOI: 10.1093/abm/kaaf043

Meta-Analysis

Digital versus nondigital behavioral interventions on cardiovascular risk reduction: systematic review and meta-analysis

Fentaw Tadese Berhe et al. Ann Behav Med. 2025.

. 2025 Jan 4;59(1):kaaf043.

doi: 10.1093/abm/kaaf043.

Authors

Affiliations

¹ School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
² Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
³ Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
⁴ Immunity and Global Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁵ Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
⁶ First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
⁷ The George Institute for Global Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
⁸ National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
⁹ Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
¹⁰ School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia.
¹¹ Australian Living Evidence Collaborations, School of Public Health and Preventive Medicine, Monash University, Melboune, Australia.
¹² Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia.
¹³ Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.

PMID: 40576235
PMCID: PMC12203340
DOI: 10.1093/abm/kaaf043

Abstract

Objectives: We aimed to assess whether digital behavioral interventions improve cardiovascular risk factors more effectively than nondigital behavioral interventions.

Methods: We searched 7 electronic databases from January 1, 1990, to April 4, 2024. We performed a random-effects meta-analysis to pool the effects of digital versus nondigital interventions on body composition, blood pressure, blood glucose, and lipid concentrations. We also conducted subgroup analyses based on intervention duration, risk of bias, and intervention types. We reported outcomes as mean differences with their 95% confidence intervals (CIs). We assessed the quality of the included studies using the Cochrane Risk of Bias 2 tool.

Results: We included 34 randomized controlled trials with 17 389 participants. The meta-analysis found no significant differences between digital and nondigital behavioral interventions for 11 cardiovascular risk factors. However, subgroup analyses showed that digital dietary interventions significantly reduced body weight (MD = -0.66, 95% CI [-1.26, -0.06]), body mass index-BMI (MD = -0.25, 95% CI [-0.43, -0.07]), and fasting blood glucose (MD = -0.31, 95% CI [-0.57, -0.05]) compared to nondigital interventions. Digital physical activity interventions lowered total cholesterol (MD = -3.55, 95% CI [-4.63, -2.46]) compared to nondigital interventions. Combined digital interventions (dietary, physical activity, and smoking cessation) significantly decreased BMI (MD = -0.20, 95% CI [-0.36, -0.04]) compared to nondigital interventions. No significant differences were found by risk of bias or intervention duration.

Conclusions: Digital behavioral interventions are as effective as nondigital interventions in reducing cardiovascular risk factors, making both essential components of cardiovascular disease prevention and management.

Keywords: behavioral intervention; cardiovascular disease; cardiovascular risk reduction; digital interventions.

Plain language summary

This study compared digital health interventions, such as mHealth and telehealth, wearable devices, virtual reality, web-based platforms, and social networking apps, with nondigital approaches, including face-to-face programs and printed educational materials, to evaluate the effects of these interventions in reducing heart disease risk factors. We conducted a comprehensive electronic search of peer-reviewed research studies published between January 1, 1990, and April 4, 2024. We systematically extracted each study’s intervention details. Then, we summarized and compared the effects of digital and nondigital intervention approaches across key heart-health measures, such as weight, blood pressure, blood sugar, and cholesterol. The results showed that digital and nondigital interventions had similar effects on improving cardiovascular disease risk factors. However, in detailed comparisons, digital diet interventions achieved greater weight loss and better blood-sugar control, and digital physical activity interventions lowered cholesterol levels more effectively than nondigital interventions, on average. Moreover, digital interventions that combined diet, exercise, and smoking cessation also showed significant weight reduction. Overall, our study highlights that digital behavioral interventions are as effective as nondigital ones at reducing heart disease risk factors. Both methods offer valuable options for preventing and managing heart disease.

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Conflict of interest statement

None declared.

Figures

**Figure 1.**
The PRISMA 2020 study selection flow diagram.

**Figure 2.**
Cochrane risk of bias for the included studies.

**Figure 3.**
Body weight panel plot (A–C: Subgroup analysis forest plots; D: funnel plot).

**Figure 4.**
BMI panel plot (A–C: Subgroup analysis forest plots; D: funnel plot).

**Figure 5.**
Fasting blood glucose panel plot (A–C: Subgroup analysis forest plots; D: funnel plot).

**Figure 6.**
Total cholesterol panel plot (A–C: Subgroup analysis forest plots; D: funnel plot).

See this image and copyright information in PMC

References

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Digital versus nondigital behavioral interventions on cardiovascular risk reduction: systematic review and meta-analysis

Affiliations

Digital versus nondigital behavioral interventions on cardiovascular risk reduction: systematic review and meta-analysis

Authors

Affiliations

Abstract

Plain language summary

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous