Key result
Digital health interventions fail to improve objectively measured physical activity over usual care after cardiac rehabilitation.
Why the study?
To evaluate the effectiveness of digital health interventions for maintaining physical activity, physical function, fitness, and health-related quality of life after completion of phase II cardiac rehabilitation.
Does a digital health intervention maintain or increase physical activity levels in adults after completing phase II cardiac rehabilitation?
Meta-Analysis (n=1,801)
Does a digital health intervention maintain or increase physical activity levels in adults after completing phase II cardiac rehabilitation?
Digital health maintenance interventions show a small benefit for self-reported physical activity but do not significantly improve objectively measured physical activity or fitness after cardiac rehabilitation.
Answers are grounded in this paper and cite their sources.
Digital health interventions should not be relied upon to sustain objective physical activity after cardiac rehabilitation; challenges assumptions from subjective measures in prior trials.
Objective To summarise the effectiveness of digital health maintenance interventions for subjectively and objectively measured physical activity level (PA) and physical function, fitness and health-related quality of life (HRQoL) after completion of phase II cardiac rehabilitation (CR). Methods We conducted a search for studies in MEDLINE, Embase, CENTRAL, and CINAHL (inception to May 2024). Independent reviewers selected and included randomised controlled trials (RCTs) using digital health interventions to maintain PA in patients with cardiovascular disease after phase II CR. Independent reviewers conducted data extraction, assessed the risk of bias using the Cochrane Risk of Bias 2 tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation – registered at PROSPERO: CRD42023396629. Results From 17,455 hits, 20 RCTs with 1801 participants were included. Risk of bias for most studies reporting on PA outcomes was rated as ‘some concerns’. Comparing digital health intervention with minimal intervention/usual care showed no effect of objective PA (standardised mean difference (SMD) 0.85, 95% CI: −0.07 to 1.77) and a small effect of subjective PA (SMD 0.37, 95% CI: 0.05 to 0.69) at the end of intervention both graded as very low certainty of evidence. We found very low certainty of evidence for moderate effects on physical function (SMD 0.63, 95% CI: 0.03 to 1.24), and low certainty of evidence for no effect on physical fitness (SMD 0.19, 95% CI: 0.05 to 0.34) and HRQoL (SMD 0.13, 95% CI: −0.02 to 0.28), I 2 = 0.00%) at the end of intervention. Conclusion Digital health interventions showed a small effect on subjectively measured PA, and no effect on objective PA, physical fitness and HRQoL, but may increase physical function after CR completion. Yet, the certainty of evidence is low and higher quality studies with longer follow-up duration are needed to guide this area further.
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Luijk et al. (2024) conducted a meta-analysis in Cardiovascular disease post-phase II cardiac rehabilitation (n=1,801). Digital health interventions vs. Usual care or minimal intervention was evaluated on Objectively measured physical activity at the end of intervention (SMD 0.85, 95% CI -0.07 to 1.77). Digital health interventions showed no significant effect on objectively measured physical activity compared to usual care after cardiac rehabilitation.
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