The Effect of Physical Activity Interventions Comprising Wearables and Smartphone Applications on Physical Activity: a Systematic Review and Meta-analysis

Roxanne Gal, Anne M May, Elon J van Overmeeren, Monique Simons, Evelyn M Monninkhof, Roxanne Gal, Anne M May, Elon J van Overmeeren, Monique Simons, Evelyn M Monninkhof

Abstract

Background: Worldwide physical activity levels of adults are declining, which is associated with increased chronic disease risk. Wearables and smartphone applications offer new opportunities to change physical activity behaviour. This systematic review summarizes the evidence regarding the effect of wearables and smartphone applications on promoting physical activity.

Methods: PubMed, EMBASE and Cochrane databases were searched for RCTs, published since January 2008, on wearables and smartphone applications to promote physical activity. Studies were excluded when the study population consisted of children or adolescents, the intervention did not promote physical activity or comprised a minor part of the intervention, or the intervention was Internet-based and not accessible by smartphone. Risk of bias was assessed by the Cochrane collaboration tool. The primary outcome was changed in physical activity level. Meta-analyses were performed to assess the pooled effect on (moderate-to-vigorous) physical activity in minutes per day and daily step count.

Results: Eighteen RCTs were included. Use of wearables and smartphone applications led to a small to moderate increase in physical activity in minutes per day (SMD = 0.43, 95% CI = 0.03 to 0.82; I2 = 85%) and a moderate increase in daily step count (SMD = 0.51, 95% CI = 0.12 to 0.91; I2 = 90%). When removing studies with an unclear or high risk of bias, intervention effects improved and statistical heterogeneity was removed.

Conclusions: This meta-analysis showed a small to moderate effect of physical activity interventions comprising wearables and smartphone applications on physical activity. Hence, wearables and smartphone applications are likely to bring new opportunities in delivering tailored interventions to increase levels of physical activity.

Keywords: Physical activity; Smartphone applications; Wearables.

Conflict of interest statement

Ethics Approval and Consent to Participate

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Consent for Publication

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Competing Interests

The authors, Roxanne Gal, Anne M. May, Elon J. van Overmeeren, Monique Simons and Evelyn M. Monninkhof, declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of trial selection, adapted from PRISMA. PA physical activity, RCT randomized controlled trial
Fig. 2
Fig. 2
Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies
Fig. 3
Fig. 3
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study. Green symbols represent a low risk of bias, yellow symbols represent an unclear risk of bias and the red symbols indicate a high risk of bias
Fig. 4
Fig. 4
Forest plot of the effect of wearables and smartphone applications versus control on moderate-to-vigorous physical activity (MVPA) in minutes per day. CI confidence interval, IV inverse variance, RoB risk of bias, SD standard deviation, Std standardized
Fig. 5
Fig. 5
Forest plot of the effect of wearables and smartphone applications versus control on daily step count. CI confidence interval, IV inverse variance, RoB risk of bias, SD standard deviation, Std standardized
Fig. 6
Fig. 6
Forest plot of the effect of wearables and smartphone applications versus control on other outcomes. CI confidence interval, IV inverse variance, MET metabolic equivalent of task, SD standard deviation, Std standardized

References

    1. Andersen LB, Mota J, Di Pietro L. Update on the global pandemic of physical inactivity. Lancet. 2016;388(10051):1255–1256. doi: 10.1016/S0140-6736(16)30960-6.
    1. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247–257. doi: 10.1016/S0140-6736(12)60646-1.
    1. Kohl HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305. doi: 10.1016/S0140-6736(12)60898-8.
    1. Tremblay MS, Aubert S, Barnes JD, et al. Sedentary Behavior Research Network (SBRN) - terminology consensus project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75. doi: 10.1186/s12966-017-0525-8.
    1. Ding D, Lawson KD, Kolbe-Alexander TL, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388(10051):1311–1324. doi: 10.1016/S0140-6736(16)30383-X.
    1. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–229. doi: 10.1016/S0140-6736(12)61031-9.
    1. Kyu HH, Bachman VF, Alexander LT, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ. 2016;354:i3857. doi: 10.1136/bmj.i3857.
    1. Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015;162(2):123–132. doi: 10.7326/M14-1651.
    1. Organisation WH . Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2015.
    1. Proper KI, Singh AS, van Mechelen W, Chinapaw MJ. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med. 2011;40(2):174–182. doi: 10.1016/j.amepre.2010.10.015.
    1. Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–2905. doi: 10.1007/s00125-012-2677-z.
    1. Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015;175(6):959–967. doi: 10.1001/jamainternmed.2015.0533.
    1. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388(10051):1302–1310. doi: 10.1016/S0140-6736(16)30370-1.
    1. McDermott MS, Oliver M, Iverson D, Sharma R. Effective techniques for changing physical activity and healthy eating intentions and behaviour: a systematic review and meta-analysis. Br J Health Psychol. 2016;21(4):827–841. doi: 10.1111/bjhp.12199.
    1. Murray JM, Brennan SF, French DP, Patterson CC, Kee F, Hunter RF. Effectiveness of physical activity interventions in achieving behaviour change maintenance in young and middle aged adults: a systematic review and meta-analysis. Soc Sci Med. 2017;192:125–133. doi: 10.1016/j.socscimed.2017.09.021.
    1. Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act. 2017;14(1):42. doi: 10.1186/s12966-017-0494-y.
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi: 10.1037/a0016136.
    1. Direito A, Pfaeffli Dale L, Shields E, Dobson R, Whittaker R, Maddison R. Do physical activity and dietary smartphone applications incorporate evidence-based behaviour change techniques? BMC Public Health. 2014;14:646. doi: 10.1186/1471-2458-14-646.
    1. Kang M, Marshall SJ, Barreira TV, Lee JO. Effect of pedometer-based physical activity interventions: a meta-analysis. Res Q Exerc Sport. 2009;80(3):648–655.
    1. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. doi: 10.2196/jmir.1376.
    1. Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mummery WK. Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act. 2012;9:52–62. doi: 10.1186/1479-5868-9-52.
    1. Sanders JP, Loveday A, Pearson N, et al. Devices for self-monitoring sedentary time or physical activity: a scoping review. J Med Internet Res. 2016;18(5):e90. doi: 10.2196/jmir.5373.
    1. Number of smartphone users worldwide from 2014 to 2020 (in billions). Accessed Apr 2018. Available from:
    1. Android Statistics Top categories. Accessed Apr 2018. Available from: .
    1. Rabin C, Bock B. Desired features of smartphone applications promoting physical activity. Telemed J E Health. 2011;17(10):801–803. doi: 10.1089/tmj.2011.0055.
    1. Middelweerd A, Mollee JS, van der Wal C, Brug J, te Velde SJ. Apps to promote physical activity among adults: a review and content analysis. Int J Behav Nutr Phys Act. 2014;11(1):97. doi: 10.1186/s12966-014-0097-9.
    1. Coughlin SS, Whitehead M, Sheats JQ, Mastromonico J, Smith SA. Review of smartphone applications for promoting physical activity. Jacobs J Community Med. 2016;2(1):021.
    1. Schoeppe S, Alley S, Van Lippevelde W, et al. Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review. Int J Behav Nutr Phys Act. 2016;13(1):127. doi: 10.1186/s12966-016-0454-y.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. Available from .
    1. Vanhees L, Lefevre J, Philippaerts R, et al. How to assess physical activity? How to assess physical fitness? Eur J Prev Cardiol. 2005;12(2):102–114. doi: 10.1097/00149831-200504000-00004.
    1. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre The Cochrane Collaboration; 2014. .
    1. Cohen J. Statistical power analysis for the behavioral sciences. New York: NY. Routledge Academic; 1988.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560. doi: 10.1136/bmj.327.7414.557.
    1. Allen JK, Stephens J, Dennison Himmelfarb CR, Stewart KJ, Hauck S. Randomized controlled pilot study testing use of smartphone technology for obesity treatment. J Obes. 2013;2013:151597. doi: 10.1155/2013/151597.
    1. Bickmore TW, Silliman RA, Nelson K, et al. A randomized controlled trial of an automated exercise coach for older adults. J Am Geriatr Soc. 2013;61(10):1676–1683. doi: 10.1111/jgs.12449.
    1. Demeyer H, Louvaris Z, Frei A, et al. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax. 2017;72(5):415–423. doi: 10.1136/thoraxjnl-2016-209026.
    1. Fukuoka Y, Gay CL, Joiner KL, Vittinghoff E. A novel diabetes prevention intervention using a mobile app: a randomized controlled trial with overweight adults at risk. Am J Prev Med. 2015;49(2):223–237. doi: 10.1016/j.amepre.2015.01.003.
    1. Glynn LG, Hayes PS, Casey M, et al. Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial. Br J Gen Pract. 2014;64(624):e384–e391. doi: 10.3399/bjgp14X680461.
    1. Harries T, Eslambolchilar P, Rettie R, Stride C, Walton S, van Woerden HC. Effectiveness of a smartphone app in increasing physical activity amongst male adults: a randomised controlled trial. BMC Public Health. 2016;16:925. doi: 10.1186/s12889-016-3593-9.
    1. Hartman SJ, Nelson SH, Cadmus-Bertram LA, Patterson RE, Parker BA, Pierce JP. Technology and phone based weight loss intervention: pilot RCT in women at elevated breast cancer risk. Am J Prev Med. 2016;51(5):714–721. doi: 10.1016/j.amepre.2016.06.024.
    1. King AC, Hekler EB, Grieco LA, et al. Effects of three motivationally targeted mobile device applications on initial physical activity and sedentary behavior change in midlife and older adults: a randomized trial. PLoS One. 2016;11(6):e0156370. doi: 10.1371/journal.pone.0156370.
    1. Li LC, Sayre EC, Xie H, Clayton C, Feehan LM. A community-based physical activity counselling program for people with knee osteoarthritis: feasibility and preliminary efficacy of the track-OA study. JMIR Mhealth Uhealth. 2017;5(6):e86. doi: 10.2196/mhealth.7863.
    1. Lyons EJ, Swartz MC, Lewis ZH, Martinez E, Jennings K. Feasibility and acceptability of a wearable technology physical activity intervention with telephone counseling for mid-aged and older adults: a randomized controlled pilot trial. JMIR Mhealth Uhealth. 2017;5(3):e28. doi: 10.2196/mhealth.6967.
    1. Martin SS, Feldman DI, Blumenthal RS, et al. MActive: a randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc. 2015;4(11):e002239. doi: 10.1161/JAHA.115.002239.
    1. Paul L, Wyke S, Brewster S, et al. Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study. Top Stroke Rehabil. 2016;23(3):170–177. doi: 10.1080/10749357.2015.1122266.
    1. Recio-Rodriguez JI, Agudo-Conde C, Martin-Cantera C, et al. Short-term effectiveness of a mobile phone app for increasing physical activity and adherence to the Mediterranean diet in primary care: a randomized controlled trial (EVIDENT II study) J Med Internet Res. 2016;18(12):e331. doi: 10.2196/jmir.6814.
    1. Safran Naimark J, Madar Z, Shahar DR. The impact of a web-based app (eBalance) in promoting healthy lifestyles: randomized controlled trial. J Med Internet Res. 2015;17(3):e56. doi: 10.2196/jmir.3682.
    1. Shin DW, Yun JM, Shin JH, et al. Enhancing physical activity and reducing obesity through smartcare and financial incentives: a pilot randomized trial. Obesity (Silver Spring) 2017;25(2):302–310. doi: 10.1002/oby.21731.
    1. Uhm KE, Yoo JS, Chung SH, et al. Effects of exercise intervention in breast cancer patients: is mobile health (mHealth) with pedometer more effective than conventional program using brochure? Breast Cancer Res Treat. 2017;161(3):443–452. doi: 10.1007/s10549-016-4065-8.
    1. Vorrink SN, Kort HS, Troosters T, Zanen P, Lammers JJ. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation. Eur Respir J. 2016;48(4):1019–1029. doi: 10.1183/13993003.00083-2016.
    1. Walsh JC, Corbett T, Hogan M, Duggan J, McNamara A. An mHealth intervention using a smartphone app to increase walking behavior in young adults: a pilot study. JMIR Mhealth Uhealth. 2016;4(3):e109. doi: 10.2196/mhealth.5227.
    1. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298(19):2296–2304. doi: 10.1001/jama.298.19.2296.
    1. Chan CB, Ryan DA, Tudor-Locke C. Health benefits of a pedometer-based physical activity intervention in sedentary workers. Prev Med. 2004;39(6):1215–1222. doi: 10.1016/j.ypmed.2004.04.053.
    1. Locke E, Latham G. New directions in goal-setting theory. Curr Dir Psychol Sci. 2006;15(5):265–268. doi: 10.1111/j.1467-8721.2006.00449.x.
    1. Althoff T, White RW, Horvitz E. Influence of Pokemon Go on physical activity: study and implications. J Med Internet Res. 2016;18(12):e315. doi: 10.2196/jmir.6759.
    1. Howe KB, Suharlim C, Ueda P, Howe D, Kawachi I, Rimm EB. Gotta catch’em all! Pokemon GO and physical activity among young adults: difference in differences study. BMJ. 2016;355:i6270. doi: 10.1136/bmj.i6270.
    1. Rasche P, Schlomann A, Mertens A. Who is still playing Pokemon Go? A web-based survey. JMIR Serious Games. 2017;5(2):e7. doi: 10.2196/games.7197.

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