Abstract

Background: Sedentary behavior (SB) negatively impact health and is highly prevalent in the population. Digital behavior change interventions (DBCIs) have been developed to modify behaviors such as SB by technologies. However, it is unknown which behavior change techniques (BCTs) are most frequently employed in SB as well as the effect associated with DBCIs in this field. The aim of this systematic review was: (a) to evaluate the BCT most frequently employed in digital health including all technologies available and interventions aimed at increasing physical activity (PA), reducing sedentary time, and improving adherence to exercise in the clinical population, and (b) to review the effect associated with DBCIs in this field.Methods: The database used was Medline, as well as Scopus, Scielo, and Google Scholar. For the search strategy, we considered versions of behavior/behavioral, mHealth/eHealth/telemedicine/serious game/gamification. The terms related to PA and SB were included, the criteria for inclusion were randomized clinical trials (RCTs), adults, intervention based on digital media, and outcome variable lifestyle modification; a last 5 years filter was included. Michie's Taxonomy was used to identify BCTs. The study was registered under the number PROSPERO CRD42019138681.Results: Eighteen RCTs were included in the present systematic review, 5 of them healthy adults, and 13 of them with some illness. Studies included 2298 sedentary individuals who were followed up for 5 weeks−3 years. The most used BCTs were goal setting, problem solving, review outcomes/goals, feedback on behavior and outcomes of behavior, self-monitoring of behavior, social support, information about health consequences, and behavior practice/rehearsal. The effect associated with DBCIs showed improvements, among several related to PA and physiologic self-reported and anthropometric outcomes.Conclusion: The BCTs most used in digital health to change outcomes related to SB were goals and planning, feedback and monitoring, social support, natural consequences, repetition, and substitution. Besides these findings, DBCIs are influenced by several factors like the type of intervention, patients' preferences and values, or the number of BCTs employed. More research is needed to determine with precision which DBCIs or BCTs are the most effective to reduce SB in the clinical population.

Highlights

  • Our daily behavior heavily influences our health

  • This study aimed to do a systematic review of the evidence concerning the most frequently used behavior change techniques (BCTs) in digital health and the effect associated with Digital behavior change interventions (DBCIs) for reducing sedentary behavior” (SB) by increasing physical activity (PA) levels, reducing sedentary time, and improving adherence to exercise in adults

  • We analyzed individual data from the 18 RCTs with the PEDro internal validity scale (Table 1). They all provided data on BCTs used in DBCIs to change SB

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Summary

Introduction

Our daily behavior heavily influences our health. According to the County Health Rankings, a 30% variation in health can be accounted for by healthy behaviors, such as smoking, alcohol intake, diet, and physical activity (PA) levels (1). The latest research has shown that prolonged SB is positively associated with a range of health concerns including all-cause mortality, cardiovascular disease, type 2 diabetes, metabolic syndrome, and several types of cancers (4, 5) Despite this harmful effect to health, modern society provides many opportunities for prolonged sitting (6) and SB is highly prevalent in the majority of people’s time (55–69% of the day) (7). The aim of this systematic review was: (a) to evaluate the BCT most frequently employed in digital health including all technologies available and interventions aimed at increasing physical activity (PA), reducing sedentary time, and improving adherence to exercise in the clinical population, and (b) to review the effect associated with DBCIs in this field

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