Effects of digital health interventions on daily physical activity and long-term clinical outcomes in patients with COPD: a systematic review and meta-analysis

Digital health interventions (DHIs) have become an important complement to conventional pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of DHIs on physical activity, functional capacity, quality of life, and long-term clinical outcomes in patients with COPD. PubMed, Web of Science, Embase, the Cochrane Library, and other Chinese and English databases were systematically searched through October 23, 2025. Randomized controlled trials (RCTs) involving exercise training or physical activity promotion were included. The primary outcomes were daily step count, 6-minute walk distance (6MWD), and quality-of-life scores. The GRADE approach was used to assess the certainty of evidence. A total of 26 RCTs were included. Short-term analyses at 3 months showed that DHIs significantly increased daily step count (684.80 steps/day, p = 0.005) and improved quality of life (SGRQ: p = 0.01), whereas no significant improvement was observed in 6MWD. Regarding safety, no signal of serious adverse events attributable to the interventions was reported, providing preliminary clinical reassurance regarding the use of DHIs in home-based settings. DHIs may serve as a potential complementary strategy for improving short-term physical activity and quality of life in patients with COPD. Given that the certainty of evidence for most outcomes was low or very low, these findings should be interpreted with caution. Future studies should use more rigorous randomized controlled trials to further establish the long-term benefits of DHIs and identify the optimal intervention models.