BACKGROUND
The benefits of physical activity (PA) and exercise in people with chronic health conditions are well documented. However, there are barriers to accessing services and providing ongoing support for activity-based interventions over the duration of the condition. Digital health interventions, especially those with minimal human contact, offer a potential solution.
OBJECTIVE
The aim of this systematic review was to determine the effectiveness of self-guided web-based PA and exercise interventions to improve health outcomes for people living with chronic health conditions.
METHODS
A comprehensive and systematic search was conducted through CINAHL, MEDLINE, SPORTSDiscus, AMED, EBM, PsychINFO, and Scopus and Web of Science libraries for randomized trials up to September 2020 that evaluated the effect of self-guided web- or internet-based PA or exercise interventions on any health outcome. Only studies whose interventions had minimal human contact and whose interaction was automatically generated were included. All studies were screened for eligibility and relevant data was extracted. Two independent reviewers assessed the risk of bias using the Cochrane risk of bias tool. Standardized mean differences and 95% confidence intervals were calculated. PA data were pooled, and forest plots were generated.
RESULTS
Of the 7549 papers identified, 13 met the eligibility criteria and included a total of 1886 participants. There was wide variation in health conditions and intervention characteristics with regards to mode and parameters of delivery and in the use of theory and behavioral strategies applied. Self-reported PA in the intervention group was greater than controls at the end of the intervention (standardized mean difference (SMD) 0.18 95% CI=0.05, 0.31) and at follow up (SMD 0.29, 95% CI 0.13 to 0.45). The difference in objectively measured PA was moderate and non-significant (SMD 0.43 95% CI ‐0.16 to 1.02). All interventions included behavioral strategies and seven of the thirteen were underpinned by theory.
CONCLUSIONS
Self-guided web-based PA and exercise interventions provided a positive effect on PA immediately after the intervention. An unexpected and positive finding was a sustained increase in PA at follow-up, particularly in those interventions that used behavioral strategies underpinned by a theoretical framework. Interventions with minimal contact have the potential to support sustained PA engagement at least as well as interventions with supervision.
CLINICALTRIAL
Protocol registration PROSPERO CRD42019132464