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

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

Efficacy of digital interventions on physical activity promotion in individuals with noncommunicable diseases: An overview of systematic reviews.

“…The ndings of this study focused primarily on populations in developed countries, and future research should investigate the applicability and cultural adaptability of these interventions in diverse settings. In addition, it seems essential to determine the safety aspects of DI application, as some nonserious adverse events have been reported in the use of DIs to improve PA among patients with chronic conditions [91].…”

Association between digital health literacy and physical activity levels among individuals with and without long-term health conditions: Data from a cross-sectional survey of 19,231 individuals

“…12 Digital health interventions that promote physical activity among people with long-term health conditions have shown potential. 13 Studies have also shown that individuals who use digital health tools reach higher physical activity levels. 14 However, a recognized and essential problem is inadequate uptake, acceptance, adoption, and adherence to digital health interventions.…”

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

“…Thus, this type of intervention may also help overcome current barriers for accessing physical activity interventions for people living with CKD by providing an accessible platform for service delivery [ 23 ]. A 2023 meta-analysis found that digital physical activity interventions improved health-related quality of life, physical function and symptoms of mental illness (i.e., depression and anxiety) for people with various chronic conditions, including type 2 diabetes and cardiovascular disease [ 24 ]. However, the analysis did not include people living with CKD and to our knowledge there has been no systematic review of digital health interventions for physical activity in CKD.…”