JMIR Publications

ABSTRACT

Background:

Digital exercise interventions are increasingly popular in addressing the obesity epidemic. However, there remains uncertainty on the 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.

Objective:

This systematic review aimed to evaluate the effectiveness of digital exercise interventions based on PA guidelines in reducing BW and fat in overweight/obese adults, as well as their impact on PA-related factors.

Methods:

This review was prospectively registered in PROSPERO (CRD42024620020) and conducted following PRISMA guidelines. A series of comprehensive searches was performed in October 2024 across PubMed, Cochrane Library, Web of Science, and OVID Medline. Eligible studies included adults (≥18 years) with objectively confirmed overweight or obesity who utilized digital interventions aligned with international PA guidelines. Risk of bias was evaluated using the Cochrane RoB 2 tool for randomized controlled trials and the ROBINS-I tool for non-randomized studies.

Results:

Out of 4,948 studies identified through the Boolean search strategy, 188 were retrieved for full-text screening, and 30 studies met the predefined eligibility criteria. Intervention durations ranged from eight weeks to 24 months (average: 6.6 months). Fourteen studies used structured exercise programs, while other studies incorporated flexible PA/exercise routines based on international guidelines. Digital exercise intervention programs resulted in significant reductions in BW (22/25 studies, range: -1.3 to -8.4 kg), body mass index (19/23 studies, range: -0.4 to -3.4 kg/m2), waist circumference (15/16 studies, range: -2.1 to -9.2 cm), body fat percentage (9/9 studies, range: -0.3% to -4.1%), and fat mass (7/7 studies, range: -0.4 to -6.5 kg). Results for waist-to-hip ratio and PA outcomes were inconsistent. Compared to passive controls, results revealed a clear pattern of digital exercise interventions significantly reducing weight- and fat-related outcomes, while results were inconsistent when measured against active or usual care controls. No clear trend was observed between the duration or type of interventions and improvements in the outcome variables.

Conclusions:

Guideline-based digital PA/exercise interventions show potential in reducing excess body weight and body fat in adults with overweight or obesity, although there remains uncertainty regarding their superiority over traditional methods. Substantial variations in study designs also contribute to challenges in drawing definitive conclusions on specific characteristics of effective digital exercise tools. Clinical Trial: PROSPERO (CRD42024620020)