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

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends community-based digital health interventions to increase healthy eating and physical activity among adults interested in improving these behaviors.

Systematic review evidence shows these interventions increase or maintain the amount of time adults spend in physical activity, with the greatest improvements seen among those who were less active before the intervention. Participants also eat more fruits and vegetables and fewer unhealthy foods, consume fewer calories overall, and improve weight-related and clinical outcomes.

The CPSTF has related findings for the following:

The full CPSTF Finding and Rationale Statement and supporting documents for Nutrition and Physical Activity: Community-based Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions aim to increase healthy eating and physical activity using websites, mobile apps, text messages, emails, or one-on-one telephone calls. Interventions include one or more of the following:

Coaching or counseling with trained professionals
Self-monitoring to record healthy eating, physical activity, or weight
Goal setting

Interventions also may include one or more of the following:

Social support from peers through social media, internet forums, or discussion groups
Educational tools and resources (e.g., newsletter, handbook)
Motivational strategies that include incentives, rewards, prompts, and gaming techniques
Computer-generated feedback that provides tailored information

About The Systematic Review

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

Study Characteristics

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).

Summary of Results

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).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

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 sex, income level, race, or ethnicity.

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?

Implementation Considerations and Resources

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.

Crosswalks

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