Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis
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Abstract
Background: The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users’ subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. Objective: This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). Methods: Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non–digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. Results: Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). Conclusions: The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.
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This finding is consistent with previous research highlighting the role of continuous engagement in the effectiveness of digital health interventions.
“This finding is consistent with previous research that has highlighted the role of continuous engagement in the effectiveness of digital health interventions25–27.”
From Impact of digital health interventions on glycemic control and weight management. (2025) · cites this paper as [27]
The Abstract (Conclusions; page unavailable) reports a weak but consistent positive association between engagement with physical-activity digital health interventions and physical-activity outcomes. The Results (Objective 2; page unavailable) find mixed associations for time spent using an intervention. The review therefore supports a role for engagement, but does not establish that continuous engagement improves intervention effectiveness generally. (LLM, conf=0.84)
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- Authors
- Mclaughlin, M., Delaney, T., Hall, A., Byaruhanga, J., Mackie, P., Grady, A., Reilly, K., Campbell, E., Sutherland, R., Wiggers, J., & Wolfenden, L.
- Affiliations
- Hunter Medical Research Institute (AU)
- Florey Institute of Neuroscience and Mental Health (AU)
- Corresponding author
- Mclaughlin, Matthew
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2021-02-19
- Volume
- 23
- Issue
- 2
- Pages
- e23180
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC8011420
- OpenAlex
- W3166581595
- Cited by
- 105
- References
- 66
- Citations by year
- 2026: 24 · 2025: 22 · 2024: 19 · 2023: 19 · 2022: 14 · 2021: 7
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- digital health interventions, user engagement, physical activity, sedentary behavior, subjective experience, login frequency, usage time, adults, health behavior change, mobile health apps, eHealth apps, wearable devices, remote patient monitoring, telecare, telemedicine
- MeSH terms
- Internet-Based Intervention, Female, Humans, Male, Prospective Studies, Health Behavior, Exercise, Sedentary Behavior
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