Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis

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Abstract

Background

High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living.

Objective

We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults.

Methods

We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment.

Results

Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness.

Conclusions

mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.

Related collections

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Cardiorespiratory fitness (CRF) has been one of the most widely examined physiological variables, particularly as it relates to functional capacity and human performance. Over the past three decades, CRF has emerged as a strong, independent predictor of all-cause and disease-specific mortality. The evidence supporting the prognostic use of CRF is so powerful that the American Heart Association recently advocated for the routine assessment of CRF as a clinical vital sign. Interestingly, the continuity of evidence of the inverse relationship between CRF and mortality over the past decade exists despite a wide variation of methods used to assess CRF in these studies, ranging from the gold-standard method of directly measured maximal oxygen uptake (VO2max) during cardiopulmonary exercise testing to estimation from exercise tests and non-exercise prediction equations. This review highlights new knowledge and the primary advances since 2009, with specific reference to the impact variations in CRF have on all-cause and disease-specific mortality.

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mHealth programs offer potential for practical and cost-effective delivery of interventions capable of reaching many individuals.

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Author and article information

Contributors

Dharani Yerrakalva:

ORCID: https://orcid.org/0000-0003-1830-5315

Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeInstitute of Public HealthCambridge, United Kingdom44 1223 330300dharaniyerrakalva@googlemail.com

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: November 2019

Publication date (Electronic): 28 November 2019

Volume: 21

Issue: 11

Electronic Location Identifier: e14343

Affiliations

[1 ] Primary Care Unit Department of Public Health and Primary Care University of Cambridge Cambridge United Kingdom

[2 ] Medical Research Council Epidemiology Unit University of Cambridge Cambridge United Kingdom

[3 ] Barking, Havering, and Redbridge University Hospitals Trust London United Kingdom

Author notes

Corresponding Author: Dharani Yerrakalva dharaniyerrakalva@ 123456googlemail.com

Author information

Dharani Yerrakalva https://orcid.org/0000-0003-1830-5315

Dhrupadh Yerrakalva https://orcid.org/0000-0003-0175-9601

Samantha Hajna https://orcid.org/0000-0002-0431-2787

Simon Griffin https://orcid.org/0000-0002-2157-4797

Article

Publisher ID: v21i11e14343

DOI: 10.2196/14343

PMC ID: 6908977

PubMed ID: 31778121

SO-VID: cd9596d2-a411-4915-a350-e0d24e3f3b5d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 17 April 2019

Date revision requested : 19 June 2019

Date revision received : 1 August 2019

Date accepted : 24 September 2019

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