Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People with Chronic Conditions: A Systematic Review and Meta-analysis (Preprint)

BACKGROUND Digital health interventions to manage chronic conditions have large potential. However, the benefits and harms are still questioned. Objective: This systematic review and meta-analysis investigated the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. OBJECTIVE This systematic review and meta-analysis investigated the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. METHODS We searched MEDLINE, Embase, CINAHL, and CENTRAL from the inception to Oct. 2021. Eligible RCTs were included if they used a digital component in physical activity promotion in adults with one or more 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 (e.g., walk or step tests). We used a random-effects model (REML) for the meta-analyses and meta-regressions analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2, and the certainty of the evidence was assessed using GRADE. RESULTS Of 10 967 hits, 99 RCTs were included. Compared to usual care/minimal intervention, digital health interventions increased objectively measured physical activity in the short-term (SMD 0.33, 95% CI 0.22 to 0.43) and long-term (SMD 0.21, 95% CI 0.04 to 0.38), but not physical function (short-term: SMD 0.26, 95% CI -0.07 to 0.59, long-term: SMD 0.35; 95% CI -0.03 to 0.73). Secondary outcomes favored the digital interventions for subjectively measured physical activity and physical function, depression, and health-related quality of life (HRQOL) in the short-term. The risk of non-serious adverse events, but not serious, was higher in the digital interventions in the short-term. CONCLUSIONS Digital health interventions improved physical activity across various chronic conditions, while short-term effects on physical function, depression, and HRQOL were observed. Future studies should compare the effects of different digital solutions. CLINICALTRIAL PROSPERO CRD42020189028.