Digital health interventions for physical activity in people with chronic conditions: A component network meta-analysis

Background
Digital interventions are generally safe and can enhance physical activity. However, it is less known which components and delivery modes are promoting the largest improvement.

Purpose
To estimate the effect of different components and modes of delivery of digital interventions targeting physical activity in people with chronic conditions by performing a component network meta-analysis.

Methods
We searched four databases for randomised control trials (RCTs) using digital interventions to promote physical activity for people with one or more of 13 predefined chronic conditions. The primary outcome was overall physical activity at the end of treatment follow-up. We employed a component network meta-analysis with a random effects model and conducted subgroup, sensitivity, and meta-regression analyses exploring the effect of different components and modes of delivery of digital interventions. Certainty of the evidence was assessed using the CINeMA framework. Protocol (https://osf.io/ftvya/).

Results
We included 114 RCT’s (15,586 participants). Compared to usual care, self-management proved more efficacious (SMD 0.27 [95%CI 0.17–0.37; moderate certainty]), as did exercise combined with self-management (SMD 0.39 [95%CI 0.19–0.58; low certainty]). Interventions primarily delivered through combined digital modes such as an app plus phone calls or a web platform and a device (SMD 0·36 [95% CI 0·27–0·45; moderate certainty]) were more efficacious than usual care (i.e., providing information about the importance of physically activity).

Conclusions
The optimal digital interventions to promote physical activity may include self-management and exercise components delivered via combined digital delivery modes.

Practical implications
When recommending digital tools to improve physical activity clinicians should guide patients in selecting digital tools that incorporate both self-management strategies and exercise components which can be delivered with at least two digital tools.

Funding
European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (MOBILIZE, grant agreement No 801790) and Region Zealand (Exercise First).