Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis

• Published in: Journal of medical Internet research 2021-02, Vol.23 (2), p.e23180-e23180
• Main Authors: Mclaughlin, Matthew, Delaney, Tessa, Hall, Alix, Byaruhanga, Judith, Mackie, Paul, Grady, Alice, Reilly, Kathryn, Campbell, Elizabeth, Sutherland, Rachel, Wiggers, John, Wolfenden, Luke
• Format: Article
• Language: English
• Subjects: Adults; Cellular telephones; Citations; Counting; Exercise; Exercise - physiology; Female; Health behavior; Health Behavior - physiology; Health status; Humans; Internet-Based Intervention - trends; Intervention; Male; Meta-analysis; Physical activity; Portable computers; Prospective Studies; Public health; Random effects; Review; Search strategies; Sedentary; Sedentary Behavior; Smartphones; Systematic review; Telemedicine; Time use
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/23180

The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users' subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non-digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relations