UNSTRUCTURED
BACKGROUND: The literature on whether physical activity (PA) and PA and diet (PA+D) mobile applications (APPs) improve cardiovascular disease (CVD) risk factors is promising. OBJECTIVE: We performed this meta-review to provide an evidence synthesis of systematic reviews (SR) and meta-analysis (MA) examining the influence of PA and PA+D APPs on the major CVD risk factors. METHODS: We systematically searched five databases until January 12, 2022. Included SRs and MAs: 1) reported the CVD risk factor outcomes of body mass index (BMI), waist circumference (WC), body weight (BW), blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose (FBG), blood lipids, and/or PA; 2) enrolled healthy subjects ≥18 years who may or may not have the Metabolic Syndrome and/or Diabetes Mellitus; 4) reviewed PA or PA+D APP interventions integrating behavioral change techniques (BCT) to deliver their information; and 5) had a non-APP control. RESULTS: In total, 17 reviews (9 SRs and 8 MAs) published between 2012-2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1-24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA APP SRs (n=4), these CVD risk factors improved: BW and BMI (n=2, 50%), BP (n=1, 25%), HbA1c (n=1, 25%), and blood lipids (n=1, 25%) decreased, while PA (n=4, 100%) increased. Of the PA+D APP SRs (n=5), these CVD risk factors improved: BW and BMI (n=3, 60%), BP (n=1, 20%), and HbA1c (n=3, 60%) decreased, while PA (n=3, 60%) increased. Of the PA APP MAs (n=1), these CVD risk factors improved: BW decreased (-0.73 kg, 95%CI [-1.45, -0.01], p=0.05) and PA increased by 25 min/wk (95%CI [0.58, 1.68], p<0.0001), while BMI (-0.09 kg/m2, 95% CI [-0.29, 0.10, p=0.35]) and WC (-1.92 cm, 95%CI [-3.94, 0.09], p=0.06) tended to decrease. Of the PA+D APP MAs (n=4), these CVD risk factors improved: BW (n=4, 100%; from -1.79 kg (95%CI [-3.17, -0.41, p=0.01] to -2.80 kg 95%CI [-4.54, -1.06], p=0.002), BMI (n=1, 25%; -0.64 kg/m2, 95%CI [-1.09, -0.18], p=0.01), WC (n=1, 25%; -2.46 cm, 95%CI [-4.56, -0.36]), p=0.02), systolic/diastolic BP (n=1, 25%; -4.22/-2.87 mmHg, 95%CI [-6.54, -1.91]/ [-4.44, -1.29], p<0.01), and HbA1c (n=1, 25%; -0.43%, 95%CI [-0.68, -0.19], p=0.0004) decreased. CONCLUSION: PA and PA+D APPs appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+D APPs on CVD risk factors.
TRIAL REGISTRATION: The protocol is registered at PROSPERO # CRD42023392359.