Table 1.
Summary of the characteristics and outcomes of the studies included in the systematic review. The studies are ordered by intervention duration.
| Study, year, and country | Design and population | Study groups | Intervention | Primary outcomes and findings | PAa outcomes and findings | ||||||
| Intervention duration: 24 months | |||||||||||
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Jakicic et al [33], 2016, United States | Two-arm RCTb; sample size: 470; median age 30.9 years; 71.1% female participants; median BMI 31.2 kg/m2 |
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Digital tool: FIT Core; BodyMedia; a 24-month intervention where all participants initially increased PA, followed a low-calorie diet, and attended group counseling. At 6 months, telephone counseling, text message prompts, and website access were introduced. The standard group used a website for self-monitoring, while the enhanced group used a wearable device with a web interface. Moderate to vigorous PA progressed from 100 to 300 min per week over 4-week intervals. | Significant decreases in BWc BMI, BF%d, and FMe in both groups; no significant between-group differences for BMI, BF%, and FM, while postintervention BW was significantly lower in the standard group. | Significant improvements in LPAf and MVPAg in both groups; no significant between-group differences | |||||
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Svetkey et al [34], 2015, United States | Three-arm RCT; sample size: 365; mean age 29.4 years; 69.6% female participants; mean BMI 35.2 kg/m2 |
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Digital tool: Investigator-designed app; a 24-month intervention delivered via a smartphone app based on social cognitive theory and transtheoretical model, incorporating goal setting, behavioral self-management, and motivational enhancement, with a PA target of achieving ≥180 min per week of moderate PA. | Significant differences in BW between the study groups, with greater reductions in the personal coaching group at 6 and 12 months, but not at 24 months. | —i | |||||
| Intervention duration: 12 months | |||||||||||
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Héroux et al [35], 2017, Canada | Single-arm intervention trial; sample size: 28; mean age 49.6 years; 100% female participants; mean BMI 32.2 kg/m2 |
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Digital tool: The online Precision Nutrition Coaching Program; a 12-month online program focused on daily physical exercise, dietary habits, and health behavior lessons, with coaching delivered via computer, tablet, and mobile device. The exercise program included detailed daily workouts (aerobic interval training, weight training, or walking) with progressive intensity over time. | Significant decreases in BW, WCj, and FM (but not in BMI). | — | |||||
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Lynch et al [36], 2017, United States | Single-arm intervention trial; sample size: 46; mean age 39 years; 65.2% female participants; mean BMI 31.8 kg/m2 |
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Digital tool: Lean Eating by Precision Nutrition Coaching; a 12-month weight loss intervention with daily components of physical exercise, nutrition, behavioral modification strategies, and health lessons via an online platform, along with online coaching. The PA component included at least 150 min of physical exercise per week, with a minimum of 2 strength training sessions per week. | Significant decreases in BW, BMI, and BF% (but not in WHRk). | — | |||||
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Watson et al [37], 2015, United Kingdom | Two-arm RCT; sample size: 65; mean age 52.2 years; 55.4% female participants; mean BMI 32.6 kg/m2 |
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Digital tool: Imperative Health; a 12-month web-based weight loss intervention incorporating PA and dietary components, along with goal setting and tailored feedback and support provided by physiologists via telephone and email. The PA program included a weekly schedule for planning activities at light to vigorous intensity levels. | Significant decreases in BW in the intervention group, with significant between-group differences at 3 and 6 months, but not at 12 months. Significant between-group differences in BMI and WC at 3 and 6 (but not at 12) months. | Significant between-group differences in daily PA at 3 months, but not at 6 and 12 months. | |||||
| Intervention duration: 6 months | |||||||||||
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Alcántara-Aragón et al [38], 2018, Spain | Two-arm RCT; sample size: 183; mean age 44.5 years; 83.6% female participants; mean BMI 34.75 kg/m2 |
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Digital tool: PREDIRCAM2 web platform; a 6-month tailored physical exercise and dietary plans based on international PA guidelines and the Mediterranean diet. The telematic group received online support and virtual contact, while the nontelematic group followed traditional methods. | Significant decreases in BW, WC, and WHR in the telematic intervention group; no significant between-group differences. | — | |||||
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Allen et al [39], 2013, United States | Four-arm RCT; sample size: 68; mean age 44.9 years; 77.9% female participants; mean BMI 34.3 kg/m2 |
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Digital tool: Lose It!; a 6-month intervention (PA and diet) using an eclectic approach combining social cognitive theory, behavioral self-management, and motivational interviewing techniques to achieve 5% BW loss and a minimum of 150 minutes of moderate-intensity PA per week. Intensive groups attended frequent in-person sessions, while less intensive and smartphone-based groups had fewer sessions. | Significant decreases in BW, BMI, and WC in all groups; no significant between-group differences. | No significant between-group difference in MVPA. | |||||
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Apiñaniz et al [40], 2019, Spain | Two-arm RCT; sample size: 110; mean age 38.5 years; 71.8% female participants; mean BMI 32.7 kg/m2 |
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Digital tool: AKTIDIET; a 6-month intervention consisting of health advice (PA and dietary) based on international guidelines for both groups. In the intervention group, this advice was reinforced through an app consisting of aerobic and muscle training programs and food intake tracking. | Significant decreases in BW in both groups; no significant between-group differences. | — | |||||
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Batsis et al [41], 2021, United States | Single-arm intervention trial; sample size: 53; mean age 72.9 years; 69.8% female participants; mean BMI 36.5 kg/m2 |
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Digital tool: Video conferencing; a 6-month weight management program combining synchronous videoconference-based physical exercise and nutrition sessions, remote Fitbit monitoring, and periodic face-to-face interactions. Participants attended 75-minute, twice-weekly group exercise sessions led by a trained physical therapist. | Significant decreases in BW, BMI, and WC; no change in WHR. | Significant improvements in 30-second sit-to-stand and 6-minute walk test; no changes in gait speed or grip strength. | |||||
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Block et al [42], 2015, United States | Two-arm RCT; sample size: 339; mean age 55.0 years; 31.3% female participants; mean BMI 31.2 kg/m2 |
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Digital tool: Alive-PD; a 6-month program with weekly goal setting (PA and dietary) delivered via web, email, interactive voice response calls, and a supportive mobile app. The PA target included 150-300 minutes of aerobic activity and resistance training weekly, based on baseline levels and progress. | Significant decreases in BW, BMI, and WC in both groups, with significantly greater reductions in the intervention group. | — | |||||
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Duncan et al [18], 2020, Australia | Three-arm RCT; sample size: 116; mean age 44.5 years; 70.7% female participants; mean BMI 31.7 kg/m2 |
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Digital tool: Balanced app; a 6-month multicomponent (PA and dietary) mHealth intervention delivered via a smartphone app, providing educational materials, goal setting, self-monitoring, and feedback; the enhanced group received additional sleep-related support. PA action planning focused on MVPA, resistance training, and step count increases. | No significant between-group difference in BW, while postintervention WC was significantly lower in the traditional group. | No significant between-group differences in MVPA and LPA. | |||||
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Hartman et al [43], 2016, United States | Two-arm RCT; sample size: 55; mean age 59.5 years; 100% female participants; mean BMI 31.9 kg/m2 |
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Digital tool: Fitbit and a website; a 6-month weight loss intervention focused on developing and practicing self-monitoring and self-regulatory skills, with a goal of losing 10% of BW by engaging in at least 150 minutes per week of MVPA and restricting calorie intake. | Significant decreases in BW in the intervention group, with a significant between-group difference (no BW change in the usual care group). | Significant improvement in daily MVPA in the intervention group, with no significant between-group differences. | |||||
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Haufe et al [44], 2021, Germany | Two-arm RCT; sample size: 314; mean age 48.1 years; 14% female participants; mean BMI 33.3 kg/m2 |
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Digital tool: Custom-designed smartphone app; a 6-month telemonitoring-supported lifestyle intervention focused on regular physical exercise, including individual exercise recommendations provided during face-to-face meetings and via a smartphone app, aiming for at least 150 minutes of PA per week. | Significant decrease in WC in the intervention group, with a significant between-group difference (less but significant decrease in WC in the control group). | Significant increase in exercise capacity in both groups, with a significantly greater increase in the intervention group. | |||||
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Hutchesson et al [20], 2018, Australia | Two-arm RCT; sample size 57; mean age 27.1 years; 100% female participants; mean BMI 29.4 kg/m2 |
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Digital tool: Be Positive Be Health e; a 6-month weight loss program delivered via eHealth technologies (website, app, email, text messages, and social media), incorporating goal setting and grounded in social cognitive theory and control theory, aligned with international PA and dietary guidelines. | Significant decreases in BW, BMI, FM, and BF% in the intervention group, with no significant between-group differences except for FM. Significant decreases in WC in both groups. | No significant changes in MVPA, MPAl, and VPAm in any study group. | |||||
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Lim et al [45], 2022, Singapore | Two-arm RCT; sample size: 148; mean age 53.1 years; 39.9% female participants; mean BMI 29.8 kg/m2 |
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Digital tool: nBuddy Diabetes app; a 6-month in-app dietitian coaching incorporating behavioral strategies (goal setting, stimulus control, problem-solving, self-monitoring, cognitive restructuring, and motivational interviewing), with a PA goal of 150 minutes per week of moderate-intensity physical exercise. | Significant decreases in BW and BMI in both groups, with significantly greater reductions in the intervention group. | Significant improvement in general PA in the intervention group; no significant between-group difference. | |||||
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Rogers et al [46], 2016, United States | Three-arm RCT; sample size: 39; mean age 39.9 years; 79.5% female participants; mean BMI 39.5 kg/m2 |
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Digital tool: BodyMedia Fit and LINK; a 6-month mHealth intervention program incorporating PA and dietary components, alongside self-monitoring and feedback. The PA component involved unsupervised, home-based physical exercise at moderate intensity, with a gradual increase in session duration. | Significant decreases in BW, BMI, WC, BF%, and FM in all groups; no significant between-group differences. | — | |||||
| Intervention duration: 12-16 weeks | |||||||||||
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Hurst et al [47], 2021, United States | Single-arm intervention trial; sample size: 30; mean age 38.1 years; 43% female participants; median BMI 32.7 kg/m2 |
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Digital tool: Telehealth coaching; 16-week telehealth intervention delivered in primary care clinics, using wearable devices, automated text messaging, and trained health coaching (including real-time feedback) to support physical exercise and nutrition goals, including achieving at least 150 minutes of PA per week. | Significant decreases in BW and BMI. | Significant improvement in MVPA. | |||||
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Stephens et al [48], 2017, United States | Two-arm RCT; sample size: 62; median age 20.0 years; 71% female participants; median BMI 28.5 kg/m2 |
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Digital tool: Lose it!; a 3-month intervention using a behavior-based smartphone app (primarily grounded in self-efficacy theory) for weight loss, combined with counseling sessions and text messages from a health coach, with goals of losing 1-2 pounds per week and engaging in at least 150 minutes of moderate-intensity PA weekly. | Significant decreases in BW, BMI, and WC in the intervention group (but not in the control group), with significant between-group differences. | Significant improvement in PA score in the intervention group, with no significant between-group difference. | |||||
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Wong et al [49], 2021, Hong Kong | Two-arm RCT; sample size: 77; mean age 58.9 years; 55.8% female participants; mean BMI 27.02 kg/m2 |
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Digital tool: MetS app; a 3-month lifestyle intervention delivered via a mobile app to support participants’ individual physical exercise routines through goal setting, logging exercise type and duration, and self-monitoring. The PA goal was at least 30 minutes per day, 5 days per week. | Significant decreases in BW and BMI (but not in WC or WHR) in the app group, with significant between-group differences for BW and BMI (no change in the booklet group). | Significant improvements in exercise score and exercise self-efficacy in the app group, with significant between-group differences. | |||||
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Zhang et al [50], 2023, China | Three-arm RCT; sample size: 750; mean age 70.1 years; 53.9% female participants; mean BMI 27.7 kg/m2 |
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Digital tool: mHealth app; a 3-month remote weight management intervention focused on PA (with or without dietary components) including health assessments and guidance from exercise instructors and nutritional professionals. The PA program included 20 minutes of resistance or aerobic exercise or walking 6000 steps daily. | Significant decreases in BW, BMI, WC, and WHR in the remote PA and diet group, with significant between-group differences at day 90, but not at day 45. | No significant changes in total PA and PA levels in any study group. | |||||
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Anderson et al [51], 2018, United Kingdom | Two-arm RCT; sample size: 78; mean age 47.1 years; 88% female participants; mean BMI 32.7 kg/m2 |
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Digital tool: LivingWELL; a 12-week intervention consisting of 1 face-to-face session, 4 phone consultations, and web-based support to achieve 5% BW reduction. It included a personalized diet and physical exercise plan with behavioral techniques such as motivational interviewing and action planning. | Decreases in BW, BMI, and WC in the intervention group, but not in the control group. | Increases in daily MPA and daily steps (but not daily VPA) in the intervention group. | |||||
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Bughin et al [52], 2021, France | Two-arm RCT; sample size: 50; mean age 52.2 years; 54% female participants; mean BMI 36.5 kg/m2 |
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Digital tool: Telemouv app; a 12-week multicomponent intervention (PA, diet, and education) available on smartphones and a website. The PA program included endurance exercises (targeting 150 minutes of PA per week), muscle strengthening (with gradual increases in volume), and balance exercises. | Significant decreases in BF% and FM in both groups, with no significant changes in BW, BMI, or WHR. No significant between-group differences for any outcomes. | No significant within- or between-group change or difference in the 6-minute walk test. | |||||
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Hebden et al [53], 2014, Australia | Two-arm RCT; sample size: 51; mean age 22.8 years; 81% female participants; mean BMI 27.3 kg/m2 |
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Digital tool: ePASS; a 12-week mHealth program targeting key lifestyle behaviors associated with weight gain, delivered via smartphone apps, internet forums, text messages, and emails. The PA program included 30 minutes of moderate-intensity PA per day for general health and 60 minutes per day for weight management. | Significant decreases in BW and BMI in both groups; no significant between-group differences. | Significant increase in daily LPA (but not MVPA) in the intervention group. | |||||
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Hong et al [54], 2022, Korea | Two-arm RCT; sample size: 31; mean age 79.9 years; 100% female participants; mean BF% 41.6 |
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Digital tool: Smartphone telepresence platform; a 12-week smartphone mirroring-based telepresence physical exercise program conducted at home with 3 sessions per week, primarily focused on resistance training (with gradual intensity increases), all based on international guidelines; while the control group performed the same program in person. | Significant decreases in BF% in both groups and in BW in the control group; no significant between-group differences. | Significant left-hand grip strength improvement in the intervention group and right-hand in the controls; no significant between-group differences. | |||||
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Hurkmans et al [16], 2018, Belgium | Four-arm RCT; sample size: 81; mean age 45.0 years; 71.6% female participants; mean BMI 32.0 kg/m2 |
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Digital tool: Mobile Weight Loss App; 12-week weight loss programs using face-to-face, mobile, and combined approaches, offering physical exercise and dietary guidance aligned with standard guidelines, along with personalized exercise plans provided by a coach. | Significant decreases in BMI in the face-to-face, app, and combined groups; no significant difference between the 3 interventions. | Significant improvements in MVPA; no significant between-group differences. | |||||
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Johnson et al [55], 2019, United States | Three-arm RCT; sample size: 30; mean age 43.2 years; mean BMI 36.1 kg/m2 |
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Digital tool: Withings app and Healow app; 12-week telemedicine-based health coaching, including physical exercise routines, goal setting, and PA progression, with feedback provided by a registered dietitian and exercise physiologist. PA program followed international guidelines recommending at least 150 minutes of PA per week (30 minutes of MVPA, 5 days per week). | Significant differences in BW reduction between the study groups, with greater reduction in the videoconferencing group; no significant between-group differences in BMI. Decrease in BW and BMI in all groups. | Improvement in daily steps in all groups, with a significantly greater improvement in the videoconferencing group. | |||||
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Pressler et al [56], 2010, Germany | Two-arm RCT; sample size: 105; median age 48 years; 11.8% female participants; mean BMI 29.0 kg/m2 |
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Digital tool: Interactive internet platform; a 12-week intervention with structured or nonstructured internet-delivered physical exercise programs performed individually, alongside education sessions. The exercise program included 3 moderate endurance sessions and 1 strength training session per week. | Significant decreases in WC in both groups and in BMI and BF% in the control group; no significant between-group differences in any of these outcomes. | No significant changes in daily step counts in any study group. | |||||
| Intervention duration: 8-10 weeks | |||||||||||
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Ballin et al [57], 2020, Sweden | Two-arm RCT; sample size: 77; mean age 71.0 years; 50% female participants; mean BMI 29.2 kg/m2 |
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Digital tool: Healthy Ageing Initiative; a 10-week intervention consisting of a web-based progressive interval training program (10 weekly videos, 3 sessions per week), while the supervised exercise group participated in in-person sessions. | Significant decreases in BF% and FM in both groups, and in BMI only in the supervised exercise group; no significant between-group differences, except for FM (with a greater reduction in the supervised exercise group). | — | |||||
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Hyun [58], 2021, Korea | Two-arm RCT; sample size: 16; mean age 38.4 years; 100% female participants; mean BMI 25.6 kg/m2 |
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Digital tool: Real-time video web program; a 8-week real-time video web program based on international PA and exercise guidelines, including bidirectional communication along with instructor feedback. Training sessions lasted 30 minutes (for moderate intensity group) or 50 minutes (for high intensity group), held 3 times weekly, with exercise intensity increasing biweekly for the high intensity group. | Significant decreases in BW, WC, FM, BMI, and BF% in both groups, with significant between-group differences for BMI, WC, and FM (greater reductions in the high intensity group), but not for BW or BF%. | Significant left-hand grip strength improvement in the high intensity group and right-hand in both groups; significant between-group differences. | |||||
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Seo et al [59], 2023, Korea | Three-arm RCT; sample size: 75; mean age 48.3 years; 100% female participants; mean BMI 25.5 kg/m2 |
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Digital tool: VRFit app; an 8-week virtual reality physical exercise program using an Internet of Things sensor attached to an indoor bicycle, connected to a smartphone, and paired with a head-mounted display for immersive virtual reality exercise. Exercise sessions were conducted 3-5 times weekly, following international guidelines. | Significant decreases in BMI in the virtual reality group, with significant between-group differences (no BMI change in the 2 other groups). | Significant improvement in exercise fun in the virtual reality group, along with significant between-group differences. | |||||
aPA: physical activity.
bRCT: randomized controlled trial.
cBW: body weight.
dBF%: body fat percentage.
eFM: fat mass.
fLPA: light physical activity.
gMVPA: moderate to vigorous physical activity.
hmHealth: mobile health.
iNot available.
jWC: waist circumference.
kWHR: waist-to-hip ratio.
lMPA: moderate physical activity.
mVPA: vigorous physical activity.