The effectiveness of digital tools to maintain physical activity in people with long-term condition/s: A systematic review and meta-analysis

The aim of this review was to synthesise the evidence from randomised and quasi randomised controlled trials (RCT) on the effectiveness of digital interventions compared with non-digital or inactive (for example, usual care, waitlist) controls in supporting the maintenance of PA among adults with one or more LTC and explore which intervention design elements are associated with effectiveness.

Objectives:

1. To investigate the effects of digital interventions in people with ≥1 health condition on objectively and subjectively-measured PA at post-intervention and its maintenance at least three months after the end of the intervention compared with controls. 
2. To explore intervention design elements considered key for PA maintenance in effective interventions.

A protocol was registered  on Prospero (CRD42022299967). Searches were conducted in seven electronic databases, for randomised controlled trials (RTCs) including adults with ≥1 long-term conditions. Searches took place from Jan 2009 to Aug 2023. Screening, data extraction and quality assessment was undertaken by two independent reviewers. Study methods, participant characteristics, intervention characteristics (digital/non-digital elements) and PA outcomes were extracted at intervention end and maintenance time points; data pooling and meta-analyses were planned.  Search results were imported into Covidence systematic review software and meta-analyses conducted in Cochrane Collaboration Review Manager (RevMan version 5.4).  

Twenty-three studies (n=5350 participants) were included, with the majority at unclear/high risk of bias. Web-based tools were commonly used (18 studies), ten monitored PA with a sensor, and digital interventions were often combined with supervised exercise/walks. Human support was a common component of interventions. The majority were designed to support people with single LTCs, with metabolic, musculoskeletal and cardiorespiratory being most commonly included. The overall meta-analysis showed no significant difference in PA between digital interventions compared with any type of control (device-based outcomes: SMD=-0.07, 95% CI -0.35, 0.21; self-reported outcomes: SMD=0.11, 95% CI -0.01, 0.24). However, this was moderated by type of control group with subgroup analyses suggesting digital interventions were more effective than inactive/minimal control at post-intervention (SMD=0.29) and maintenance timepoints (SMD=0.24). 

This review provides some preliminary evidence that interventions incorporating digital tools may be more effective than minimal controls at supporting people with LTCs to increase and maintain PA levels up to 12 months after the main intervention ends. Notably, digital tools were often used within multicomponent interventions, either simultaneously with or following in-person exercise interventions.   Few were designed for people with multiple LTCs.

Future research should explore effective intervention components and consider the interplay of the need for human support versus the scalability of digital interventions. Confidence in the findings of this review is very low given the quality of the evidence and we expect that future research will change these findings.