Abstract
BackgroundSmartphone applications provide new opportunities for secondary prevention healthcare. This systematic review and meta-analysis aimed to determine if smartphone applications are effective at changing physical activity and sedentary behaviour in people with cardiovascular disease.MethodsSix electronic databases (Medline, CINAHL Plus, Cochrane Library, SCOPUS, Sports Discus and EMBASE) were searched from 2007 to October 2020. Cardiovascular disease secondary prevention physical activity or sedentary behaviour interventions were included where the primary element was a smartphone or tablet computer application (excluding SMS-only text-messaging). Study quality was assessed using validated tools appropriate for each study design. Random effects model was used and the pooled mean difference between post scores were calculated. Subgroup analyses were conducted to examine differences based on diagnosis, sample size, age, intervention duration, activity tracker use, target behaviour, and self-report versus device-measured outcome.ResultsNineteen studies with a total of 1,543 participants were included (coronary heart disease, n = 10; hypertension, n = 4; stroke, n = 3; heart failure, n = 1; peripheral artery disease, n = 1). Risk of bias was rated as high. Thirteen studies were included in the meta-analysis. Only two controlled studies reported on sedentary behaviour. Smartphone applications produced a significant increase of 40.35 minutes of moderate-to-vigorous intensity physical activity per week (7 studies; p = 0.04; 95% CI 1.03 to 79.67) and 2,390 steps per day (3 studies; p = 0.0007; 95% CI 1,006.9 to 3,791.2). Subgroup analyses found no difference when comparing diagnoses, sample size, activity tracker use, target behaviour and self-report versus device-measured outcome. Larger improvements in physical activity were noted in intervention durations of ≤3-months and participants ≥60yrs (95.35 mins.week-1; p = 0.05).ConclusionsSmartphone applications were effective in increasing physical activity in people with cardiovascular disease. Caution is warranted for the low-quality evidence, small sample and larger coronary heart disease representation. More rigorous research is needed to investigate the effect of smartphone applications across diagnoses and in sedentary behaviour.
Highlights
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide [1,2,3]
Smartphone applications produced a significant increase of 40.35 minutes of moderate-to-vigorous intensity physical activity per week (7 studies; p = 0.04; 95% CI 1.03 to 79.67) and 2,390 steps per day (3 studies; p = 0.0007; 95% CI 1,006.9 to 3,791.2)
Smartphone applications were effective in increasing physical activity in people with cardiovascular disease
Summary
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide [1,2,3]. Increasing physical activity and decreasing sedentary behaviour are important secondary prevention strategies for people with CVD and contribute to reducing their risk of allcause mortality [4]. With the increase of smartphones and applications (apps) across generations, mHealth provides the unique opportunity to influence and be integrated into patients’ daily life from ‘the pocket’. This is especially relevant during the COVID-19 pandemic where in-person delivery of secondary prevention strategies may not be possible [5]. This systematic review and meta-analysis aimed to determine if smartphone applications are effective at changing physical activity and sedentary behaviour in people with cardiovascular disease
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