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

Abstract

Background 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. Objective 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). Methods 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. Results 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 relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). Conclusions The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.

Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review

“…The mixed findings of this review are in contrast with two other reviews examining the relationship between DHI engagement and other health behaviours [ 8 , 20 ]. The first review, conducted by Donkin et al, reported a consistent positive association between DHI usage and physical health outcomes including fruit-and-vegetable intake, physical activity, weight management and reductions in smoking and smokeless tobacco use [ 8 ].…”

“…This review was conducted alongside another review aiming to describe the association between DHI engagement and physical activity and sedentary behaviour with findings reported in separate publications (PROSPERO CRD 42018110657). Therefore, ‘physical activity’ and ‘sedentary behavior’ search terms were also included in the search and the results reported elsewhere [ 20 ]. We used modified versions of published search filters and used Medical Subject Headings (MeSH) or free text words for physical activity [ 21 ], dietary intake [ 22 ], DHI engagement [ 15 ] and DHIs [ 15 , 23 , 24 ].…”

Online Exercise Classes during the COVID-19 Related Lockdown in Germany: Use and Attitudes

“…We are not aware of previous reports on the use of and attitudes towards OEC during the first COVID-19 related lockdown, and comparison with other forms of technologysupported approaches are limited. Digital health interventions and internet-delivered interventions have been shown to lead to a small but significant increase in PA [45,46]. These studies and interventions typically provide participants with various forms of support, but even so Davies and colleagues caution about the generalizability of the results if widely disseminated [45].…”

Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study

“…The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. Although other digital health interventions targeting physical activity have often suffered with issues of engagement [ 6 , 10 , 46 ], the website delivering implementation support for the PA4E1 program does not appear to have impaired the potential of the program to have a positive impact. As discussed by Sebire et al [ 47 ], embracing technology in school physical activity interventions may be an effective way to efficiently deliver content, for example, by reducing challenges related to limited time for training.…”

“…A lack of engagement with digital technologies [ 4 ] may, in part, explain the modest impact of physical activity interventions that have relied on such technologies to support population-wide scale-up [ 4 , 6 , 9 ]. A recent meta-analysis of digital health interventions targeting physical activity found that higher usage engagement is associated with targeted behavior changes [ 10 ]. Perski et al [ 9 ] have conceptualized engagement with digital health interventions to include both amount, duration and depth of usage , and user subjective experience , characterized by attention, interest, and affect [ 9 ].…”