The impact of health apps on lifestyle behaviours and cardiovascular risk factors in patients with cardiovascular risk factors or established cardiovascular disease: a systematic review

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme Background Adequate levels of physical activity (PA) and a healthy diet can contribute to weight loss, improved blood pressure, improved lipid levels and higher insulin sensitivity and thus decrease the risk for the development of cardiovascular disease (CVD). Recently, mobile technologies, such as mobile applications (apps) have been developed for supporting adherence to a healthy lifestyle in an individualized and interactive manner. Purpose The aim of this systematic review was to summarize the effectiveness of such mobile apps targeting PA and/or dietary behavior and cardiovascular risk factors in primary and secondary prevention. Methods Four databases (Pubmed, Sportdiscus, Cinahl, Embase) were searched to identify prospective studies evaluating mobile apps targeting healthy diet and/or PA. Rayyan software was used for screening articles. Only interventional trials that assessed the effectiveness of health apps on diet, PA and/or cardiovascular risk factors were included. Quality assessment was performed using the MINORS tool. Qualitative synthesis was performed providing data summaries according to different subgroups: healthy adults, adults who are overweight, have obesity, hypertension, CVD or diabetes. Results Out of 7073 records identified, 52 articles, reporting on 44 studies with variable study designs, could be included in qualitative synthesis. Interventions targeted diet, PA and/or adherence to therapy/healthy lifestyle and reported on at least one cardiovascular risk factor. In 20 studies, weight loss was a target of the mobile intervention, the vast majority (17/20 studies) reported weight loss following app usage of at least similar extent as usual care. Twenty-six mobile interventions targeted PA and/or exercise training and 23 of them resulted in an increase in PA in the short term. Four studies performed in patients with CVD showed that health app usage could be related to increased PA and improved diet, resulting in similar health benefits as usual care. The most commonly employed behavioural change methods were goal setting and self-monitoring, the use of financial incentives for inducing beneficial lifestyle changes yielded inconclusive results. Main limitations of the studies were small sample sizes, short follow-up duration and lack of controlled trial design. Conclusion Mobile apps targeting healthy lifestyle for the management of cardiovascular risk factors seem to be valuable tools to add to current practice in preventive medicine. However, larger, controlled studies with longer follow-up duration are needed to confirm these early findings.