Digital versus nondigital behavioral interventions on cardiovascular risk reduction: systematic review and meta-analysis

Objectives: We aimed to assess whether digital behavioral interventions improve cardiovascular risk factors more effectively than nondigital behavioral interventions. Methods: We searched 7 electronic databases from January 1, 1990, to April 4, 2024. We performed a random-effects meta-analysis to pool the effects of digital versus nondigital interventions on body composition, blood pressure, blood glucose, and lipid concentrations. We also conducted subgroup analyses based on intervention duration, risk of bias, and intervention types. We reported outcomes as mean differences with their 95% confidence intervals (CIs). We assessed the quality of the included studies using the Cochrane Risk of Bias 2 tool. Results: We included 34 randomized controlled trials with 17 389 participants. The meta-analysis found no significant differences between digital and nondigital behavioral interventions for 11 cardiovascular risk factors. However, subgroup analyses showed that digital dietary interventions significantly reduced body weight (MD = -0.66, 95% CI [-1.26, -0.06]), body mass index - BMI (MD = -0.25, 95% CI [-0.43, -0.07]), and fasting blood glucose (MD = -0.31, 95% CI [-0.57, -0.05]) compared to nondigital interventions. Digital physical activity interventions lowered total cholesterol (MD = -3.55, 95% CI [-4.63, -2.46]) compared to nondigital interventions. Combined digital interventions (dietary, physical activity, and smoking cessation) significantly decreased BMI (MD = -0.20, 95% CI [-0.36, -0.04]) compared to nondigital interventions. No significant differences were found by risk of bias or intervention duration. Conclusions: Digital behavioral interventions are as effective as nondigital interventions in reducing cardiovascular risk factors, making both essential components of cardiovascular disease prevention and management.