Motevalli Mohamad, Drenowatz Clemens, Tanous Derrick, Ruedl Gerhard, Kirschner Werner, Schauer Markus, Rosemann Thomas, Wirnitzer Katharina
Department of Sport Science, University of Innsbruck, Innsbruck, Austria.
Department of Secondary Education, University College of Teacher Education Tyrol, Innsbruck, Austria.
Interact J Med Res. 2025 Aug 7;14:e73656. doi: 10.2196/73656.
Digitally delivered physical exercise interventions are becoming increasingly popular in addressing the obesity epidemic. However, there remains uncertainty on their efficacy regarding the reduction of body weight (BW) and body fat, which may, at least partly, be due to variations in study designs and inconsistent adherence to international physical activity (PA) guidelines.
This study aimed to evaluate the effectiveness of digital exercise interventions based on PA guidelines in reducing BW and fat in adults with overweight or obesity, as well as their impact on PA-related factors.
This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Comprehensive searches were performed in October 2024 across PubMed, Cochrane Library, Web of Science, and Ovid MEDLINE databases. Eligible studies included adults (aged ≥18 years) with objectively confirmed overweight or obesity who used digital interventions aligned with international PA guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias (version 2) tool for randomized controlled trials and the Risk of Bias in Nonrandomized Studies of Interventions tool for nonrandomized studies. A random-effects meta-analysis with Hartung-Knapp adjustment was performed using R software.
Out of 4948 studies identified, 188 (3.8%) were screened in full and 30 (0.6%) met the eligibility criteria. Intervention durations ranged from 8 weeks to 24 months (average 6.4, SD 5.5 months). Meta-analysis showed that guideline-based digital exercise interventions significantly reduced BW compared to controls (mean difference [MD]=-1.17 kg; P=.003; I=0.0%), with subgroup analysis revealing greater effects in active (nondigital) controls (MD=-1.23 kg; I=7.5%) compared to passive (waitlist) controls (MD=-0.52 kg; I=0.0%). A significant reduction in BMI was observed (MD=-0.50 kg/m; P=.003), although with substantial heterogeneity (I=70.0%), and subgroup analysis showed greater effects compared to passive controls (MD=-0.70 kg/m; I=43.1%) rather than to active controls (MD=-0.45 kg/m; I=74.5%). No significant effect was observed for body fat percentage overall (MD=-0.08%; P=.84; I=7.4%). Qualitative analysis (including findings from noncomparative studies) showed that guideline-based digital exercise interventions led to significant reductions in BW (22/25, 88% studies; range -1.3 to -8.4 kg); BMI (19/23, 83% of studies; range -0.4 to -3.4 kg/m); waist circumference (15/16, 94% of studies; range -2.1 to -9.2 cm), body fat percentage (9/9, 100% of studies; range -0.3% to -4.1%); and fat mass (7/7, 100% of studies; range -0.4 to -6.5 kg), while findings for waist-to-hip ratio and PA outcomes were inconsistent.
Guideline-based digital PA and exercise interventions show potential in reducing excess BW in adults with overweight or obesity, with stronger effects when compared to nondigital interventions. However, their superiority over traditional methods is uncertain for BMI and body composition. Substantial variations in study designs present challenges in drawing definitive conclusions on specific characteristics of effective digital exercise tools.
PROSPERO CRD42024620020; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024620020.
数字交付的体育锻炼干预措施在应对肥胖流行方面越来越受欢迎。然而，关于其在减轻体重（BW）和体脂方面的功效仍存在不确定性，这可能至少部分归因于研究设计的差异以及对国际身体活动（PA）指南的不一致遵循。
本研究旨在评估基于PA指南的数字锻炼干预措施对超重或肥胖成年人减轻BW和脂肪的有效性，以及它们对与PA相关因素的影响。
本综述按照PRISMA（系统评价和荟萃分析的首选报告项目）指南进行。2024年10月在PubMed、Cochrane图书馆、科学网和Ovid MEDLINE数据库中进行了全面检索。符合条件的研究包括客观确认超重或肥胖的成年人（年龄≥18岁），他们使用了与国际PA指南一致的数字干预措施。使用Cochrane偏倚风险（第2版）工具对随机对照试验进行偏倚风险评估，使用非随机干预研究中的偏倚风险工具对非随机研究进行评估。使用R软件进行了带有Hartung-Knapp调整的随机效应荟萃分析。
在识别出的4948项研究中，188项（3.8%）进行了全文筛选，30项（0.6%）符合纳入标准。干预持续时间从8周到24个月不等（平均6.4，标准差5.5个月）。荟萃分析表明，与对照组相比，基于指南的数字锻炼干预措施显著降低了BW（平均差异[MD]=-1.17 kg；P=.003；I²=0.0%），亚组分析显示，与被动（等待名单）对照组（MD=-0.52 kg；I²=0.0%）相比，主动（非数字）对照组的效果更大（MD=-1.23 kg；I²=7.5%）。观察到BMI显著降低（MD=-0.50 kg/m²；P=.003），尽管存在很大的异质性（I²=70.0%），亚组分析显示，与被动对照组相比效果更大（MD=-0.70 kg/m²；I²=43.1%），而与主动对照组相比效果较小（MD=-0.45 kg/m²；I²=74.5%）总体体脂百分比未观察到显著影响（MD=-0.08%；P=.84；I²=7.4%）。定性分析（包括非对照研究的结果）表明，基于指南的数字锻炼干预措施导致BW显著降低（22/25，88%的研究；范围-1.3至-8.4 kg）；BMI（19/23，83%的研究；范围-0.4至-3.4 kg/m²）；腰围（15/16，94%的研究；范围-2.1至-9.2 cm），体脂百分比（9/9，100%的研究；范围-0.3%至-4.1%）；以及脂肪量（从7/7，100%的研究；范围-0.4至-6.5 kg），而腰臀比和PA结果的发现不一致。
基于指南的数字PA和锻炼干预措施在减轻超重或肥胖成年人的多余BW方面显示出潜力，与非数字干预措施相比效果更强。然而，它们在BMI和身体成分方面相对于传统方法的优越性尚不确定。研究设计的巨大差异给就有效数字锻炼工具的具体特征得出明确结论带来了挑战。
PROSPERO CRD42024620020；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024620020 。
