Abstract
OBJECTIVE: To summarise the effectiveness of digital health maintenance interventions for subjectively and objectively measured physical activity level (PA) and physical function, fitness and health-related quality of life (HRQoL) after completion of phase II cardiac rehabilitation (CR).
METHODS: We conducted a search for studies in MEDLINE, Embase, CENTRAL, and CINAHL (inception to May 2024). Independent reviewers selected and included randomised controlled trials (RCTs) using digital health interventions to maintain PA in patients with cardiovascular disease after phase II CR. Independent reviewers conducted data extraction, assessed the risk of bias using the Cochrane Risk of Bias 2 tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation - registered at PROSPERO: CRD42023396629.
RESULTS: From 17,455 hits, 20 RCTs with 1801 participants were included. Risk of bias for most studies reporting on PA outcomes was rated as 'some concerns'. Comparing digital health intervention with minimal intervention/usual care showed no effect of objective PA (standardised mean difference (SMD) 0.85, 95% CI: -0.07 to 1.77) and a small effect of subjective PA (SMD 0.37, 95% CI: 0.05 to 0.69) at the end of intervention both graded as very low certainty of evidence. We found very low certainty of evidence for moderate effects on physical function (SMD 0.63, 95% CI: 0.03 to 1.24), and low certainty of evidence for no effect on physical fitness (SMD 0.19, 95% CI: 0.05 to 0.34) and HRQoL (SMD 0.13, 95% CI: -0.02 to 0.28), I 2= 0.00%) at the end of intervention.
CONCLUSION: Digital health interventions showed a small effect on subjectively measured PA, and no effect on objective PA, physical fitness and HRQoL, but may increase physical function after CR completion. Yet, the certainty of evidence is low and higher quality studies with longer follow-up duration are needed to guide this area further.
| Original language | English |
|---|---|
| Article number | 20552076241286641 |
| Number of pages | 29 |
| Journal | Digital Health |
| Volume | 10 |
| DOIs | |
| Publication status | Published - 2024 |
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Region Zealand funded the project (Exercise First research program), but was not involved in any part of designing, conducting or reporting the study. Luijk, Dr Tang and Dr Skou were funded by a grant from Region Zealand (Project: Exercise First). Dr Tang was further funded by The Danish Health Confederation through the Development and Research Fund (project no. 2703) and the Naestved-Slagelse-Ringsted Hospitals research fund, Denmark (project no. A1277). Dr Skou was further funded by two grants from the European Union's Horizon 2020 research and innovation program - one from the European Research Council (MOBILIZE, grant agreement no. 801790) and the other under grant agreement no. 945377 (ESCAPE).
| Funders | Funder number |
|---|---|
| Danish Health Confederation | 2703 |
| Naestved-Slagelse-Ringsted Hospitals research fund, Denmark | A1277 |
| European Research Council under the EU's Horizon 2020 research and innovation program | 801790, 945377 |
Keywords
- Cardiac rehabilitation
- Digital health
- eHealth
- Maintenance
- Meta-analysis
- Systematic review
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