Effects of mobile app interventions on sedentary time, physical activity and fitness in older adults: systematic review and meta-analysis (Preprint)

Background: High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living. Objective: We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults. Methods: We systematically searched 5 electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment. Results: Overall, 6 trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (5 of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=-0.49; 95% CI -1.02 to 0.03), increases in PA (506 steps/day; 95% CI -80 to 1092), and increases in fitness (SMD=0.31; 95% CI -0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI -147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness. Conclusions: mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.