The effectiveness of digital physical activity interventions in older adults: a systematic umbrella review and meta-meta-analysis

Key points

1. 0122 systematic reviews covering 185 primary studies and 28,198 participants were synthesised
2. 02Meta-meta-analysis found a significant moderate effect for steps (SMD 0.52) and significant small effects for total PA (SMD 0.28) and MVPA (SMD 0.42)
3. 03Effectiveness did not vary by intervention type (tracker, app, SMS, web-based), population (primary vs secondary prevention), or outcome measurement method
4. 04Most included reviews (95%) were rated low or critically low quality on AMSTAR-2, limiting confidence in the evidence
5. 05Long-term follow-up data are scarce; only 3 of 22 reviews reported outcomes after intervention end, with mixed results

How it was conducted

Design

Umbrella systematic review and meta-meta-analysis of systematic reviews and meta-analyses

Databases searched

9 databases (CINAHL, SPORTDiscus, Web of Science, MEDLINE, PubMed, PsycINFO, Embase, Scopus, Cochrane Library), January 2010 to December 2023

Included reviews

22 systematic reviews and meta-analyses covering 185 primary research papers

Participants

28,198 total across all primary studies

Population

Community-dwelling older adults (overall mean age 60 years or over, or each included study mean age 50 years or over); both healthy adults and those with chronic conditions

Primary outcomes

Steps, total physical activity, and moderate-to-vigorous physical activity (MVPA), measured by self-report or device

What they found

• Steps: SMD 0.52 (95% CI 0.39-0.65), p < .05, significant moderate effect
• MVPA: SMD 0.42 (95% CI 0.27-0.57), p < .05, significant small effect
• Total PA: SMD 0.28 (95% CI 0.16-0.40), p < .05, significant small effect
• Moderation analysis: no significant difference in effect by intervention component, outcome measurement type, population (primary vs secondary prevention), or control group type
• Only moderation effect found: digital interventions with a face-to-face component had a slightly smaller effect on total PA (estimate -0.25, 95% CI -0.49 to -0.01), though overall moderation model was not statistically significant
• 78% (7/9) of narrative syntheses found strong or moderate evidence for a positive effect on physical activity; 100% (3/3) found moderate or strong evidence for steps
• 21 of 22 (95%) included reviews were rated low or critically low confidence on AMSTAR-2; 1 (5%) rated high

Limitations

• The vast majority of included reviews (95%) were rated low or critically low quality on AMSTAR-2, which limits the trustworthiness of the overall evidence
• Only 3 of 22 reviews reported long-term follow-up outcomes, and results were mixed, so durability of effects is unknown
• Many reviews included participants as young as 50 years, so it is unclear whether findings apply specifically to adults aged 65 and over
• Significant unexplained heterogeneity remained across studies, suggesting unmeasured moderators (e.g., behaviour change techniques, intervention length, baseline activity) may be important

Why it matters

For patients

Older adults can expect modest but real improvements in their daily step counts and overall activity levels from using digital tools such as activity trackers, apps, or SMS programmes, regardless of whether they have a chronic health condition.

For clinicians

Prescribing any type of digital physical activity intervention is a reasonable strategy for older adult patients; no single technology type has proven superior, so patient preference and accessibility should guide selection.

For readers

This is currently the most comprehensive synthesis of the digital physical activity literature for older adults, but the low methodological quality of most underlying reviews means findings should be interpreted with caution pending higher-quality primary research, particularly in adults 65 years and over.