. 2023 Jul 6;25:e46439. doi: 10.2196/46439

Table 2.

Grading of Recommendations Assessment, Development, and Evaluation summary of findings.

Outcome; time point	Number of participants (studies)	Relative effect (95% CI)	Anticipated absolute effects				Certainty		What happens
			Without digital health interventions, %	With digital health interventions (95% CI)	Difference
Objectively measured physical activity; end of intervention: mean 20.7 (SD 16.6) weeks	6207 (51 RCTs^a)	N/A^b	N/A	N/A	SMD^c 0.29 SD higher (0.21 higher to 0.37 higher)	⊕⊕⊕○ Moderate^d,^e		Digital health interventions that promote physical activity likely slightly increase objectively measured physical activity. This may correspond to an average increase of 970.8 daily steps (95% CI 657.1 1284.5 steps; I²=54.0%; 30 RCTs; 3904 participants). However, there was no effect on objectively measured moderate to vigorous physical activity (SMD 0.03, 95% CI −0.31 to 0.37; I²=89.8%; 18 RCTs; 1921 participants).
Objectively measured physical function; end of intervention: mean 17.5 (SD 18.0) weeks	6056 (47 RCTs)	N/A	N/A	N/A	SMD 0.36 SD higher (0.12 higher to 0.59 higher)	⊕○○○ Very low^f,g^,^h,i		Digital health interventions promoting physical activity may slightly increase objectively measured physical function, but the evidence is very uncertain. However, at the end of the intervention (mean 16.8 weeks), the effect may correspond to an average increase of 19.8 m (95% CI 9.5-30.0 m; I²=75.9%; 34 RCTs; 4725 participants) on the 6-minute walk test.
Subjectively measured physical activity; end of intervention: mean 27.3 (SD 21.4)	10,906 (58 RCTs)	N/A	N/A	N/A	SMD 0.29 SD higher (0.19 higher to 0.39 higher)	⊕○○○ Very low^d,f^,^g,i,j		Digital health interventions promoting physical activity may slightly increase subjectively measured physical activity, but the evidence is very uncertain.
Subjectively measured physical function; end of intervention: mean 18.5 (SD 10.5) weeks	4065 (26 RCTs)	N/A	N/A	N/A	SMD 0.21 SD higher (0.13 higher to 0.29 higher)	⊕⊕⊕○ Moderate^d,e,g		Digital health interventions that promote physical activity likely slightly increase subjectively measured physical function.
Depression assessed with subjective measures; end of intervention: mean 20 (SD 15.4) weeks	4604 (40 RCTs)	N/A	N/A	N/A	SMD 0.25 SD lower (0.35 lower to 0.16 lower)	⊕⊕⊕○ Moderate^d,e^,^g		Digital health interventions that promote physical activity likely slightly reduce depression.
Anxiety assessed with subjective measures; end of intervention: mean 16 (SD 11.1) weeks	2934 (25 RCTs)	N/A	N/A	N/A	SMD 0.17 SD lower (0.26 lower to 0.09 lower)	⊕⊕○○ Low^d,g,i,j,k		Digital health interventions that promote physical activity may slightly reduce anxiety.
Health-related quality of life assessed with subjective measures; end of intervention: mean 24.3 (SD 24.3) weeks	10,645 (74 RCTs)	N/A	N/A	N/A	SMD 0.18 SD higher (0.07 higher to 0.29 higher)	⊕⊕○○ Low^i,j,k		Digital health interventions that promote physical activity may slightly increase health-related quality of life.
Nonserious adverse events; end of intervention: mean 21.5 weeks	6813 (45 RCTs)	1.31 (1.11-1.55)^l	8.5%	11.1% (9.4%-13.2%)	2.6% more (0.9 more to 4.7 more)	⊕⊕⊕○ Moderate^d,e		Digital health interventions that promote physical activity likely slightly increase nonserious adverse events.
Serious adverse events; end of intervention: mean 26.2 weeks	10,508 (61 RCTs)	0.89 (0.76-1.04)^l	8.3%	7.4% (6.3%-8.7%)	0.9% fewer (2 fewer to 0.3 more)	⊕⊕⊕○ Moderate^d,e		Digital health interventions that promote physical activity likely result in little to no difference in serious adverse events.

^aRCT: randomized controlled trial.

^bN/A: not applicable.

^cSMD: standardized mean difference.

^dSome conditions are not represented, or the results only included a few studies within each condition.

^eModerate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

^fVery low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

^gStudies with low risk of bias reported lower effect on the outcome.

^hThe 95% CI ranges from no effect to high effect.

ⁱA possible presence of a small study bias from visual inspection of the funnel plot and Egger test.

^jResults are inconsistent and measured using the I² statistics.

^kLow certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

^lThe risk in the intervention group (and its 95% CI) was based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).