Effectiveness Of Physical Activity And Diet Applications On Cardiovascular Disease Risk Factors: A Meta-analysis

Limited quantitative evidence exists directly comparing the influence of physical activity (PA) to PA plus diet (PA + D) applications (APPs) on cardiovascular disease (CVD) risk factors. PURPOSE: We performed a series of meta-analyses of randomized controlled trials (RCTs) examining the effectiveness of PA versus PA + D APPs on CVD risk factors. METHODS: We systematically searched 5 databases to May 2024, for RCTs published in English containing PA or PA + D APP interventions that enrolled healthy participants ≥18 yr who may or may not have had the metabolic syndrome and/or diabetes mellitus; reported the CVD risk factors of body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), fasting blood lipids-lipoproteins and glucose (BG), and/or PA; and had a non-APP control. We calculated standardized mean effect sizes within and between the PA and PA + D APPs with adjustment for small sample size bias (hedges g). RESULTS: In the 76 qualifying RCTs, participants (n = 18,893, range 20-585) were mostly middle-aged (48.6 ± 12.1 yr) women (62.4%). Interventions lasted from 4-72 (18.5 ± 11.6) wk. With PA APPs, steps increased by 1,588 steps/d and low-density lipoprotein by 5.3 mg/dL, while BMI decreased by 0.46 kg/m2 and HbA1c by 0.26% vs control (ps < 0.05). With PA + D APPs, steps increased by 761 steps/d and total PA by 46 min/d, while BMI decreased by 1.7 kg/m2, WC by 2.9 cm, SBP by 2.2 mmHg, DBP by 1.0 mmHg, HbA1c by 0.15%, BG by 5.9 mg/dL, and total cholesterol (TCHOL) by 5.5 mg/dL vs control (ps < 0.05). When directly compared, PA + D APPs decreased DBP by 1.3 mmHg, BG by 10.7 mg/dL, and TCHOL by 6.1 mg/dL more than PA APPs (ps < 0.05). CONCLUSION: When quantitatively compared, the use of PA + D APPs elicited more favorable improvements for DBP, BG, and TCHOL than PA APPs. Nonetheless, they both lead to improvements in daily steps, BMI, and HbA1c, with additional favorable effects of PA + D APPs only on total PA, SBP, and WC. These results are promising, however, future RCTs are needed to more definitively establish the clinical utility of using PA and PA + D APPs to impact heart health.