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Technologies, such as smartwatches or smartphones, may improve behavioural and health outcomes among those living with cardiovascular disease

Akinosun AS, Polson R, Diaz-Skeete Y, et al. Digital technology interventions for risk factor modification in patients with cardiovascular disease: Systematic review and meta-analysis JMIR Mhealth Uhealth. 2021;9(3): e21061.

Review question

Are digital strategies effective in changing behaviours and reducing risk factors in people living with cardiovascular disease (CVD)?


Lifestyle risk factors, such as diet, physical inactivity, smoking, and obesity account for approximately 50% of CVD cases. There are a growing number of digital strategies aiming to help people with and without chronic diseases improve their health and make behavioural changes. Although these strategies appear promising, summarized evidence on their effectiveness in changing behaviour and improving outcomes in individuals with CVD is lacking.

How the review was done

This is a systematic review and meta-analysis of 25 randomized controlled trials. The studies were published between 2002 and 2019 and included 5,799 participants.

Key features of the studies were:

  • Participants had a diagnosis of CVD and were on average 60 years of age.
  • Participants engaged in digital strategies—which combined the use of devices like cell/mobile phones, wearable technology, and laptops and desktops with technologies like the internet, apps, text messaging, and mobile sensors—alone or in addition to usual care. Examples of these strategies include phone or text-message support, telemonitoring, telerehabilitation, and online feedback and tracking.
  • Researchers measured changes to behavioural outcomes (such as physical activity, diet, medication adherence, smoking, and alcohol consumption) and clinical outcomes (such as cholesterol, body mass index, blood sugar, and blood pressure).
  • Results were compared to control groups who received usual care only.

What the researchers found

Compared to usual care, the review found that digital strategies may improve the following behavioural and health outcomes in people living with CVD: healthy eating, physical activity, medication adherence (in certain cases), sedentary behaviour, total cholesterol, LDL “bad” cholesterol, and lipoproteins (aka particles of fat + protein found in the blood). However, they do not seem to impact smoking, alcohol use, blood pressure, blood sugar, and body mass index.


Digital strategies may help improve some behavioural and health outcomes, potentially improving the lives of those living with CVD.


Control group
A group that receives either no treatment or a standard treatment.
Advanced statistical methods contrasting and combining results from different studies.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Coronary artery disease risk screening

    Health Link B.C.
    Men over 40 and women past menopause or over 50 should get screened for coronary artery disease (CAD) every 1 to 3 years. Your risk is higher if you have diabetes, high blood pressure, abdominal obesity, kidney disease, family history of CAD or if you smoke.
  • High cholesterol: Does reducing the amount of fat in your diet help?

    Informed Health Online
    Eat less saturated fats in your diet to help prevent heart disease. Eat less meat, butter, cheese and cream to improve your health long-term.
  • Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

    This patient decision aid helps people considering taking medicines called statins to lower their risk of heart attack and stroke by comparing the benefits, risks, and side effects of both options. It also includes alternative treatment options to taking statins such as trying to lower risk with lifestyle changes.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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