Effectiveness of digital health interventions to increase cardiorespiratory fitness: A systematic review and meta-analysis

Background: Interventions using commercial digital health tools do favorably affect health outcomes. However, the effect of digital tools on cardiorespiratory fitness, a more novel indicator cardiovascular risk, is unclear.

Purpose: Synthesize the digital health intervention literature and answer the following question: What is the effect of interventions using mobile health apps, wearable activity trackers, and/or text messaging on cardiorespiratory fitness?

Methods: A systematic review and a meta-analysis (PROSPERO CRD42023423925) were conducted to evaluate the immediate digital health intervention effect on adult cardiorespiratory fitness. In March 2023, a search of databases Embase, MEDLINE, CINHAL, and Cochrane Library was completed. Studies were included if the intervention used a mobile health app, text messaging, and/or activity tracker. Studies were excluded if an objective measure of fitness was not used; the sample included children; the setting was hospital-based; and the digital health technology was only used for data collection or described as virtual reality. Using a random-effects model, two separate meta-analyses were completed: one for single-group studies and one for multi-group studies. Standardized mean difference effect sizes (Cohen's d) were calculated. Study quality was evaluated with the Cochrane Risk of Bias tool and ROBINS-I tool.

Results: Fifty-three studies (3657 individuals) with pre-post designs (12 single-group, 41 multi-group) were included. Most studies targeted participants with a specific chronic health condition. Digital health interventions in the single-group studies had a moderate-to-large effect size (d = 0.62, 95% confidence interval (CI) [0.41-0.84], p < 0.001), and multi-group studies had small-to-moderate effect size (d = 0.38, 95% CI 0.21-0.55, p < 0.001). Significant heterogeneity of effects was observed in both the single-group and multi-group studies.

Conclusions: Interventions using text messaging, a mobile app, or activity tracker alone or in combination are effective in improving cardiorespiratory fitness in adults, particularly for those with a chronic health condition.