Effects of digital multimodal interventions on objectively measured physical activity in older adults: a systematic review and meta-analysis.

BACKGROUND

With the acceleration of global population aging, low physical activity levels have become a primary threat to the health of older adults. Consequently, digital health interventions (DHIs) based on objective monitoring tools (e.g., accelerometers, wearable devices) are progressively emerging as a novel means to promote active health in older adults.

OBJECTIVE

This study aims to quantitatively evaluate the actual effects of DHIs based on objective monitoring data on the physical activity levels of older adults through a systematic review and meta-analysis.

METHODS

PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL were searched up to April 12, 2026. Randomized controlled trials (RCTs) that utilized objective instruments, such as accelerometers or smart sensors, to record DHIs promoting physical activity in older adults were included. A random-effects model was used for the meta-analysis, with mean differences (MD) applied to evaluate effect sizes. The quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Sensitivity and subgroup analyses were performed to explore sources of heterogeneity, and a trim-and-fill method was implemented for stress testing. The certainty of the evidence was evaluated using the GRADE system.

RESULTS

Ultimately, 21 RCTs involving 2,962 participants were included. Meta-analysis results demonstrated that DHIs significantly increased daily steps in older adults [MD = 381.58, 95% CI (237.58, 525.58), p < 0.00001], and Egger's test detected no significant publication bias (p = 0.062). In contrast, while the original pooled effect for moderate-to-vigorous physical activity (MVPA) duration was significant [MD = 34.78, p < 0.00001], si gnificant publication bias was present (p = 0.033). After adjusting and filling 6 studies using the trim-and-fill method, the effect size decreased to 19.70 and lost statistical significance (p = 0.059). Exploratory subgroup analysis indicated that wearable devices and remote human feedback exhibited a trend toward better effect sizes for daily steps, and the interventions tended to yield superior MVPA improvements in populations with specific health risks compared to generally healthy older adults; however, these findings possess only hypothesis-generating value. The GRADE evaluation revealed that the certainty of evidence was at a "Low" level for weekly MVPA duration and at a "Very Low" level for daily steps.

CONCLUSION

Limited low-certainty evidence suggests that DHIs may have potential promotive benefits in increasing the total amount of daily activity in older adults, but their robustness in driving MVPA remains insufficient. Digital interventions exhibit relatively better behavioral promotive benefits when targeting populations with specific health risks, but they should not be considered a standalone means to improve exercise intensity in clinical promotion. Future research and development should explore transitioning from simple data recording to intelligent closed-loop systems that incorporate intensity regulation and multidimensional feedback, thereby enhancing the robustness of intervention effects.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261366882, CRD420261366882.