Effect of Components and Delivery Modes of Digital Health Interventions Targeting Physical Activity in People With a Chronic Condition or Multimorbidity: A Systematic Review and Component Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Digital health interventions targeting physical activity in individuals with chronic conditions are increasingly common. However, the effectiveness of their components and delivery modes remains unclear. This review assessed the effects of intervention components to guide future approaches.

METHODS: A systematic review and component network meta-analysis of randomized controlled trials was conducted. MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials were searched up to March 14, 2024. Random effects models, subgroup analyses, sensitivity analyses, and meta-regression were performed. The Confidence in Network Meta-Analysis framework was used to assess the certainty of the evidence.

RESULTS: A total of 137 randomized controlled trials (18,443 participants) were included. Exercise combined with self-management was more effective than usual care (standardized mean differences [SMD]: 0.39; 95% CI, 0.20-0.58) and minimal self-management (SMD: 0.41; 95% CI, 0.23-0.60), as was self-management alone compared with usual care (SMD: 0.27; 95% CI, 0.17-0.37), and minimal self-management (SMD: 0.29; 95% CI, 0.17-0.42). Interventions using mixed technologies (eg, apps with phone calls or devices) (SMD: 0.35; 95% CI, 0.26-0.44), web/app platforms (SMD: 0.32; 95% CI, 0.18-0.45), and phone calls (SMD: 0.21; 95% CI, 0.07-0.36) were more effective than minimal or in-person controls. Type 2 diabetes patients showed the greatest increase in physical activity, while musculoskeletal conditions showed the least. Certainty of evidence was moderate for most comparisons, except for phone calls, which had low certainty.

CONCLUSIONS: The most effective digital health interventions for promoting physical activity in individuals with chronic conditions include exercise combined with self-management, delivered via mixed technologies, or web/app platforms.