Nutrition and Physical Activity: Community-based Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity

The CPSTF finding is based on evidence from a systematic review of 31 studies (search period: January 2009- June 2020).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to nutrition, physical activity and obesity prevention and control.

Digital health interventions have the potential to reach a large number of people (Beleigoli et al., 2019) to foster or support behavior change (Michie et al, 2018). In the United States, 93% of adults use the internet (Pew Research Center, 2021a); 85% have access to a smartphone (Pew Research Center, 2021b); and 77% have home broadband (Pew Research Center, 2021a).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 31 studies.

Physical Activity

• Physical activity increased by a median of 24 minutes per week (12 studies).

Dietary Behaviors

• Fruit and vegetable intake increased by a median of 0.55 servings per day (12 studies).
• Energy intake decreased by a median of 134 kilocalories per day (9 studies).
• Intake of energy dense, nutrient poor foods decreased (4 studies).

Weight-related

• Body mass index decreased by a median of 0.33 kilograms per meter squared (12 studies).

A systematic review of economic evidence has not been conducted.

The finding should be applicable to adults in high income countries who are interested in improving these behaviors in a variety of community settings regardless of gender, income level, race, or ethnicity.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• What are the effects of digital health interventions among adults with a follow-up period extending past six months?
• What are the effects of incorporating wearable devices or trackers in the intervention?
• What are the effects of adding social media to the intervention?

• Included studies were conducted in high-income countries.
• Ten studies reported on population density, six were conducted in urban settings, three were conducted in rural areas, one was conducted in urban and rural areas.
• Across all studies, participants had a mean age of 46.4 years. Studies reported higher proportions of females than males (on average, 63% were female).
• Fourteen studies reported socioeconomic status (SES) indicators and found similar effectiveness among low- and mixed-income populations.
• The 15 U.S. studies reported racial and ethnic distributions. Studies included participants who self-identified as White (13 studies), Black or African American (6 studies), Hispanic or Latino (7 studies), or Asian (6 studies). Two studies only recruited participants who identified as Black or African American.
• Intervention duration ranged from two weeks to 12 months, with a median duration of 3.5 months. Most of the interventions were implemented for less than six months (22 studies).

Effectiveness Review

• Logic Model
• Text Description

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Anand SS, Samaan Z, Middleton C, Irvine J, Desai D, et al. A digital health intervention to lower cardiovascular risk: a randomized clinical trial. JAMA Cardiology 2016;1(5):601-6.

Ashton LM, Morgan PJ, Hutchesson MJ, Rollo ME, Collins CE. Feasibility and preliminary efficacy of the ‘HEYMAN’ healthy lifestyle program for young men: a pilot randomised controlled trial. Nutrition Journal 2017;16(1):2.

Bus K, Peyer KL, Bai Y, Ellingson LD, Welk GJ. Comparison of in-person and online motivational interviewing-based health coaching. Health Promotion Practice 2018;19(4):513-21.

Celis-Morales C, Livingstone KM, Marsaux CF, Macready AL, Fallaize R, et al. Effect of personalized nutrition on health-related behaviour change: evidence from the Food4Me European randomized controlled trial. International Journal of Epidemiology 2017;46(2):578 88.

Cheung KL, Schwabe I, Walthouwer MJL, Oenema A, Lechner L, et al. Effectiveness of a video-versus text-based computer-tailored intervention for obesity prevention after one year: a randomized controlled trial. International Journal of Environmental Research & Public Health [Electronic Resource] 2017;14(10):23.

Das SK, Brown C, Urban LE, O’Toole J, Gamache MMG, et al. Weight loss in videoconference and in-person iDiet weight loss programs in worksites and community groups. Obesity 2017;25(6):1033-41.

Dennison L, Morrison L, Lloyd S, Phillips D, Stuart B, et al. Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial. Journal of Medical Internet Research 2014;16(3):e95.

Doets EL, de Hoogh IM, Holthuysen N, Wopereis S, Verain MCD, et al. Beneficial effect of personalized lifestyle advice compared to generic advice on wellbeing among Dutch seniors – An explorative study. Physiology & Behavior 2019;210:112642.

Du H, Venkatakrishnan A, Youngblood GM, Ram A, Pirolli P. A group-based mobile application to increase adherence in exercise and nutrition programs: a factorial design feasibility study. JMIR MHealth and UHealth 2016;4(1):e4.

Du H, Youngblood M, Pirolli P. Efficacy of a smartphone system to support groups in behavior change programs. Proceedings of the Wireless Health 2014 on National Institutes of Health, October 2014:1-8. doi.org/10.1145/2668883.2668887

Duncan M, Vandelanotte C, Kolt GS, Rosenkranz RR, Caperchione CM, et al. Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study. Journal of Medical Internet Research 2014;16(6):e136.

Hageman PA, Pullen CH, Hertzog M, Boeckner LS. Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial. International Journal of Behavioral Nutrition & Physical Activity 2014;11:148.

Jacobs N, Clays E, De Bacquer D, De Backer G, Dendale P, et al. Effect of a tailored behavior change program on a composite lifestyle change score: a randomized controlled trial. Health Education Research 2011;26(5):886-95.

Kanaya AM, Santoyo-Olsson J, Gregorich S, Grossman M, Moore T, et al. The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults. American Journal of Public Health 2012;102(8):1551-8.

Kelders SM, Van Gemert-Pijnen JE, Werkman A, Nijland N, Seydel ER. Effectiveness of a web-based intervention aimed at healthy dietary and physical activity behavior: a randomized controlled trial about users and usage. Journal of Medical Internet Research 2011;13(2):e32.

Levin ME, Pierce B, Schoendorff B. The acceptance and commitment therapy matrix mobile app: A pilot randomized trial on health behaviors. Journal of Contextual Behavioral Science 2017;6(3):268-75.

Lombard C, Harrison C, Kozica S, Zoungas S, Ranasinha S, et al. Preventing weight gain in women in rural communities: a cluster randomised controlled trial. PLoS Medicine / Public Library of Science 2016;13(1):e1001941.

Mailey EL, Irwin BC, Joyce JM, Hsu W-W. Independent but not alone: a web-based intervention to promote physical and mental health among military spouses. Applied Psychology: Health and Well-Being 2019; 11(3),562 83.

Oftedal S, Burrows T, Fenton S, Murawski B, Rayward AB, et al. Feasibility and preliminary efficacy of an m-health intervention targeting physical activity, diet, and sleep quality in shift-workers. International Journal Environmental Research and Public Health 2019;16(20):3810.

Quinn E, O’Hara BJ, Ahmed N, Winch S, McGill B, et al. Enhancing the get healthy information and coaching service for Aboriginal adults: evaluation of the process and impact of the program. International Journal for Equity in Health 2017;16(1):168.

Rabbi M, Pfammatter A, Zhang M, Spring B, Choudhury T. Automated personalized feedback for physical activity and dietary behavior change with mobile phones: a randomized controlled trial on adults. JMIR MHealth and UHealth 2015;3(2):e42.

Risica PM, Gans KM, Kumanyika S, Kirtania U, Lasater TM. SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women. International Journal of Behavioral Nutrition & Physical Activity 2013;10:141.

Safran Naimark J, Madar Z, Shahar DR. The impact of a Web-based app (eBalance) in promoting healthy lifestyles: randomized controlled trial. Journal of Medical Internet Research 2015;17(3):e56.

Spring B, Pellegrini C, McFadden HG, Pfammatter AF, Stump TK, et al. Multicomponent mHealth intervention for large, sustained change in multiple diet and activity risk behaviors: the Make Better Choices 2 Randomized Controlled Trial. Journal of Medical Internet Research 2018;20(6):e10528.

Spring B, Schneider K, McFadden HG, Vaughn J, Kozak AT, et al. Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology. Archives of Internal Medicine 2012;172(10):789 96.

Toro-Ramos T, Michaelides A, Anton M, et al. Mobile delivery of the Diabetes Prevention Program in people with prediabetes: randomized controlled trial. JMIR Mhealth Uhealth. 2020;8(7):e17842.

Valle CG, Deal AM, Tate DF. Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study. Journal of Cancer Survivorship 2017;11(1):133-48.

van Doorn-van Atten MN, Haveman-Nies A, van Bakel MM, Ferry M, Franco M, et al. Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults. British Journal of Nutrition 2018;119(10):1185-94.

van Keulen HM, Mesters I, Ausems M, van Breukelen G, Campbell M, et al. Tailored print communication and telephone motivational interviewing are equally successful in improving multiple lifestyle behaviors in a randomized controlled trial. Annals of Behavioral Medicine 2011;41(1):104-18.

Winett RA, Anderson ES, Wojcik JR, Winett SG, Moore S, et al. Guide to health: a randomized controlled trial of the effects of a completely WEB-based intervention on physical activity, fruit and vegetable consumption, and body weight. Translational Behavioral Medicine 2011;1(1):165-74.

Werkman A, Hulshof PJ, Stafleu A, Kremers SP, Kok FJ, et al. Effect of an individually tailored one-year energy balance programme on body weight, body composition and lifestyle in recent retirees: a cluster randomised controlled trial. BMC Public Health 2010;10:110.

Effectiveness Review

The following outlines the search strategy used for systematic reviews of digital health and telephone interventions in community settings, worksites, and institutions of higher education.

Database: Ovid MEDLINE

1 exp “Physical Education and Training”/ or exp Sports/ or exp Exercise/ or exp Physical Fitness/ or exp Exercise Therapy/ or exp Motor Activity/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diet/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Body Weight Maintenance/

9 exp Obesity Management/

10 exp Weight Reduction Programs/

11 exp body weight changes/

12 OR/8-11

13 ((Weight adj2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

14 12 OR 13

15 exp Feedback/

16 exp Health Education/

17 exp Teaching/

18 exp Reminder Systems/

19 Goals/

20 Intention/

21 Mentoring/

22 Counseling/

23 Social Support/

24 OR/15-23

25 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

26 24 OR 25

27 (6 OR 7 OR 14) AND 26

28 exp Telemedicine/ or exp Computer-Assisted Instruction/ or exp Blogging/ or exp Cell Phone/ or exp Computer Graphics/ or Computers/ or exp Computers, Handheld/ or Educational Technology/ or Electronic Mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Games/ or Webcasts as Topic/ or Wireless Technology/

29 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or FB or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

30 28 OR 29

31 27 AND 30

32 Evaluation Studies/ or Program Evaluation/

33 (evaluation or randomly or placebo* or trial* or group*).ab. or (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

34 (“controlled clinical trial” or “randomized controlled trial”).pt.

35 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

36 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

37 32 OR 33 OR 34 OR 35 OR 36

38 31 AND 37

39 exp Adult/ or Young Adult/

40 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

41 ((college adj2 student*) or (university adj2 student*)).ti,ab.

42 aged.sh.

43 39 OR 40 OR 41 OR 42

44 38 AND 43

Database: Ovid Embase

1 exp “Physical Education”/ or exp Sport/ or exp Exercise/ or exp Fitness/ or exp Kinesiotherapy/ or exp Motor Activity/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diet/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Body Weight Maintenance/

9 exp Obesity Management/

10 exp Weight Reduction Programs/

11 exp body weight changes/

12 OR/8-11

13 ((Weight adj2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

14 12 OR 13

15 exp Feedback/

16 exp Health Education/

17 exp Teaching/

18 exp Reminder Systems/

19 Goals/

20 Intention/

21 Mentoring/

22 Counseling/

23 Social Support/

24 OR/15-23

25 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

26 24 OR 25

27 (6 OR 7 OR 14) AND 26

28 exp Telemedicine/ or exp Blogging/ or exp Mobile Phone/ or exp Computer Graphics/ or Computers/ or exp Personal Digital Assistant/ or Educational Technology/ or e-mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Game/ or Webcast/ or Wireless Communication/

29 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or ‘FB’ or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

30 28 OR 29

31 27 AND 30

32 evaluation study/ or program evaluation/

33 (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

34 (random* or placebo* or double-blind*).ti,ab,kw.

35 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

36 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

37 32 OR 33 OR 34 OR 35 OR 36

38 31 AND 37

39 exp Adult/ or Young Adult/ or exp College student/ or exp University student/

40 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

41 ((college adj2 student*) or (university adj2 student*)).ti,ab,kw.

42 aged.sh.

43 39 OR 40 OR 41 OR 42

44 38 AND 43

Database: Ovid PsycINFO

1 exp Sports/ or exp Exercise/ or exp Physical Fitness/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diets/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Weight control/ or exp Weight loss/

9 ((Weight adj2 (program or change or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

10 8 OR 9

11 exp Feedback/

12 exp Health Education/

13 exp Teaching/

14 Goals/

15 Intention/

16 Mentoring/

17 Counseling/

18 Social Support/

19 OR/11-18

20 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

21 19 OR 20

22 (6 OR 7 OR 10) AND 21

23 exp Telemedicine/ or exp Computer-Assisted Instruction/ or exp Blogging/ or exp Cell Phone/ or exp Computer Graphics/ or Computers/ or exp Computers, Handheld/ or Educational Technology/ or Electronic Mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Games/ or Webcasts as Topic/ or Wireless Technology/

24 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or FB or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

25 23 OR 24

26 22 AND 25

27 Program Evaluation/

28 (evaluation or randomly or placebo* or trial* or group*).ab. or (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

29 (double-blind or random: assigned or control).tw.

30 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

31 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

32 OR/28-31

33 26 AND 32

34 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

35 ((college adj2 student*) or (university adj2 student*)).ti,ab.

36 34 OR 35

37 33 AND 36

Cochrane Database

#1 MeSH descriptor: [Physical Education and Training] explode all trees

#2 MeSH descriptor: [Sports] this term only

#3 MeSH descriptor: [Exercise] this term only

#4 MeSH descriptor: [Physical Fitness] this term only

#5 MeSH descriptor: [Exercise Therapy] this term only

#6 MeSH descriptor: [Motor Activity] this term only

#7 ((sedentary NEAR/2 behavior*) OR (physical NEAR/2 activi*) OR (physical NEAR/2 inactivi*) OR sport* OR exercis* OR (muscle NEAR/2 stretch*) OR (resistance NEAR/2 training) OR walk* OR bicycle* OR cycling OR swim* OR running OR jogging OR gymnastic* OR yoga OR dancing OR pilates OR gardening OR (physical NEAR/2 conditioning) OR circuit-based OR endurance OR (high-intensity NEAR/2 interval) OR HIIT OR plyometric* OR resistance OR running OR jogging OR swimming OR walking OR sports OR (stair NEAR/2 climbing) OR (cardiorespiratory NEAR/2 fitness) OR (motion NEAR/2 therapy) OR (physical NEAR/2 (education OR training OR fitness)) OR (motor NEAR/2 activity) OR (active NEAR/2 living)):ab,ti

#8 {OR #1-#7}

#9 MeSH descriptor: [Diet] this term only

#10 (nutrition OR diet* OR (intake NEAR/2 (calorie OR caloric OR restriction*)) OR fasting OR (mindful NEAR/2 eating) OR (healthy NEAR/2 diet*) OR (healthy NEAR/2 eating) OR (vending NEAR/2 machine*) OR (eating NEAR/2 behavior*) OR candy OR candies OR sweet* OR fruit* OR vegetable* OR vegetarian* OR vegan* OR “sweetened drink” OR “sugar sweetened beverage*” OR soda* OR carbonated OR low-fat OR gluten-free OR water OR food* OR pop OR dessert* OR cake* OR cookie* OR brownie* OR (baked NEAR/2 goods*) OR carbohydrate* OR sugar* OR “soft drink*” OR soda):ab,ti

#11 #9 OR #10

#12 #8 AND #11

#13 MeSH descriptor: [Body Weight Maintenance] this term only

#14 MeSH descriptor: [Obesity Management] this term only

#15 MeSH descriptor: [Weight Reduction Programs] explode all trees

#16 (((Weight NEAR/2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight)):ab,ti

#17 {OR #13-#16}

#18 MeSH descriptor: [Feedback] explode all trees

#19 MeSH descriptor: [Health Education] this term only

#20 MeSH descriptor: [Teaching] explode all trees

#21 MeSH descriptor: [Reminder Systems] explode all trees

#22 MeSH descriptor: [Goals] explode all trees

#23 MeSH descriptor: [Intention] explode all trees

#24 MeSH descriptor: [Mentoring] explode all trees

#25 MeSH descriptor: [Counseling] explode all trees

#26 MeSH descriptor: [Social Support] explode all trees

#27 (self-monitor* OR (goal* NEAR/2 setting) OR intention* OR track* OR behavior OR behaviour OR coach* OR mentor* OR counsel* OR (social NEAR/2 support*) OR feedback OR educat* OR (teach* NEAR/2 skill*) OR monitor* OR (health NEAR/2 educat*) OR reminder):ab,ti

#28 {OR #18-#27}

#29 #11 OR #12 OR #17

#30 #28 AND #29

#31 MeSH descriptor: [Telemedicine] explode all trees

#32 MeSH descriptor: [Computer-Assisted Instruction] explode all trees

#33 MeSH descriptor: [Blogging] explode all trees

#34 MeSH descriptor: [Cell Phone] explode all trees

#35 MeSH descriptor: [Computer Graphics] explode all trees

#36 MeSH descriptor: [Computers] explode all trees

#37 MeSH descriptor: [Computers, Handheld] explode all trees

#38 MeSH descriptor: [Educational Technology] explode all trees

#39 MeSH descriptor: [Internet] explode all trees

#40 MeSH descriptor: [Multimedia] explode all trees

#41 MeSH descriptor: [Technology] explode all trees

#42 MeSH descriptor: [Text Messaging] explode all trees

#43 MeSH descriptor: [User-Computer Interface] explode all trees

#44 MeSH descriptor: [Videoconferencing] explode all trees

#45 MeSH descriptor: [Video Games] explode all trees

#46 MeSH descriptor: [Webcasts as Topic] explode all trees

#47 MeSH descriptor: [Wireless Technology] explode all trees

#48 ((instant NEAR/2 messag*) OR IM OR (Interactive NEAR/2 voice NEAR/2 response) OR IVR OR (personal NEAR/2 digital NEAR/2 assistant) OR PDA OR (social NEAR/2 network*) OR (text NEAR/2 messag*) OR SMS OR (world NEAR/2 wide NEAR/2 web) OR website* OR (apple NEAR/2 watch) OR automated OR blog* OR Bluetooth OR chat OR (chat NEAR/2 room) OR (communication NEAR/2 network) OR (computer NEAR/2 assisted) OR (computer NEAR/2 interface) OR computer* OR computer-based OR computerized OR laptop* OR (digital NEAR/2 assistant*) OR ecoach* OR (educational NEAR/2 technolog*) OR edutainment OR e-health OR ehealth OR (electronic NEAR/2 feedback) OR (electronic NEAR/2 health) OR e-mail OR (electronic NEAR/2 mail) OR Facebook OR FB OR fitbit* OR (fitness NEAR/2 tracker*) OR graphic* OR (handheld NEAR/2 computer*) OR (health NEAR/2 information*) OR technolog* OR hypermedia OR individualized OR Instagram OR interactive OR (internet NEAR/2 based) OR internet OR iOTA OR mhealth OR m-health OR (mobile NEAR/2 app*) OR (mobile NEAR/2 technolog*) OR (mobile NEAR/2 health) OR mobile OR (mobile NEAR/2 phone*) OR android* OR smartphone* OR (smart NEAR/2 phone*) OR (cell* NEAR/2 phone*) OR (mobile NEAR/2 device*) OR iphone OR multimedia OR (new NEAR/2 technolog*) OR online OR on-line OR (personal NEAR/2 electronic NEAR/2 device*) OR podcast* OR programmed OR prompt* OR (remote NEAR/2 consultation*) OR remote OR (short NEAR/2 message NEAR/2 service*) OR (social NEAR/2 media) OR software OR tablet* OR tailored OR telecare OR telehealth OR telemonitoring OR twitter OR tweet OR (video NEAR/2 conferenc*) OR (video NEAR/2 game*) OR (virtual NEAR/2 reality) OR web-based OR webcast* OR wireless* OR apps OR iOs OR (digital NEAR/2 health)):ab,ti

#49 {OR #31-#48}

#50 #30 AND #49

#51 MeSH descriptor: [Program Evaluation] explode all trees

#52 (effectiveness or intervention or (program* NEAR/2 evaluat*)):ab,ti

#53 ((pre NEAR/5 post) OR (pretest NEAR/5 posttest)):ab,ti

#54 ((control* or before or (before and after stud*) or follow up assessment)):ab,ti

#55 {OR #51-#54}

#56 #50 AND #55

#57 MeSH descriptor: [Adult] explode all trees

#58 MeSH descriptor: [Young Adult] explode all trees

#59 ((college NEAR/2 student*) OR (university NEAR/2 student)):ab,ti

#60 (geriatric* OR senior* OR adult* OR m?n OR wom?n or participant*):ab,ti

#61 {OR #57-#60}

Abbreviations: exp, explode; mp, multi-purpose; ti; title; ab, abstract; adj, adjacency; pt, publication type; kw, keyword heading; sh, MESH subject headings; *, unlimited suffix variations

Beleigoli AM, Andrade AQ, Cancado AG, Paulo MNI, Diniz MFH, et al. Web-based digital health interventions for weight loss and lifestyle habit changes in overweight and obese adults: systematic review and meta-analysis. Journal of Medical Internet Research 2019;21(1):e298.

Michie S, Yardley L, West R, Patrick K, Greaves F. Developing and evaluating digital interventions to promote behavior change in health and health care: recommendations resulting from an international workshop. J Med Internet Res 2018;19 (6):e232.

Pew Research Center. Internet/Broadband Fact Sheet, 2021a. Date Accessed 7/2/2021. Available at: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/.

Pew Research Center. Mobile Fact Sheet, 2021b. Date Accessed 12/1/2021. Available at https://www.pewresearch.org/internet/fact-sheet/mobile/.

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion from the CPSTF, as noted below.

• Interventions that use technology may offer an easier way to reach more people.
• Digital health interventions may be more accessible than in-person classes or programs, especially for people who live in rural areas or have transportation challenges.
• The digital divide needs to be considered when using technology other than telephones to implement programs. Key issues include participants’ access to affordable internet networks or mobile devices and digital readiness.
• Implementers may want to consider the built environment around participants. It is important for participants to have access to healthier foods and safe places where they can be physically active.
• Studies in this review included primarily White and Black or African American participants, with smaller representations of Hispanic or Latino or Asian participants. Implementers may want to tailor interventions based on the dietary preferences of their population.
• Studies that engaged participants with professionally trained health coaches or counselors reported more favorable results for fruit and vegetable intake and time spent in physical activity when compared with the overall body of evidence.
• CPSTF suggests implementers incorporate behavior change theories into program designs.
• Intervention intensity may vary. Populations may respond differently to varying levels of intensity. For example, younger adults may be more comfortable tracking their daily behaviors on mobile devices than older adults would be.
• Data security and privacy issues need to be considered when individuals enter personal information electronically.
• Digital health is rapidly evolving. Newer digital health interventions, such as those that incorporate social media platforms, were not represented in this body of evidence.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of adults who do no physical activity in their free time — PA-01
• Increase the proportion of adults who do enough aerobic physical activity for substantial health benefits — PA-02
• Increase the proportion of adults who do enough muscle-strengthening activity — PA-04
• Increase fruit consumption by people aged 2 years and over — NWS-06
• Increase vegetable consumption by people aged 2 years and older — NWS-07
• Increase consumption of dark green vegetables, red and orange vegetables, and beans and peas by people aged 2 years and over — NWS-08
• Increase whole grain consumption by people aged 2 years and over — NWS-09
• Reduce consumption of saturated fat by people aged 2 years and over — NWS-11