Behaviour change techniques in eHealth interventions for older, frail, or sarcopenic adults: A systematic review and meta-analysis

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Abstract

BACKGROUND: Behaviour change techniques (BCTs) are key components of eHealth physical activity interventions. They may be especially important for older adults and individuals with frailty or sarcopenia, who often face additional barriers to sustaining physical activity. This review aimed to identify BCTs used in eHealth physical activity trials and examine which techniques are associated with greater effectiveness. METHODS: Six databases (MEDLINE, Embase, CINAHL, CENTRAL, PsycINFO, and Scopus) were searched for randomized controlled trials (RCTs) published up to 2024. Eligible studies evaluated eHealth physical activity interventions delivered to older adults (mean age ≥60 years) or adults with frailty or sarcopenia. Trials delivered exclusively through virtual reality, wearable devices, or telephone-based modalities were excluded. Random-effects meta-analysis estimated pooled effects on physical activity, with subgroup analyses examining differences according to BCTs reported and behavioural theory. Completion, adherence, and adverse events were summarized descriptively. RESULTS: Eighty-seven studies met inclusion criteria, and 53 contributed to the meta-analysis. eHealth interventions produced a small positive effect on physical activity (standardized mean difference = 0.22, 95% confidence interval: 0.13 to 0.31). Completion was generally high and adherence moderate, with few reported adverse events. The most frequently used BCTs were feedback on behaviour, goal setting, social support, self-monitoring, and prompts/cues. Among these BCTs, all were non-significant, with social support (unspecified) having a p=0.05. CONCLUSIONS: eHealth interventions yield modest improvements in physical activity among older adults, although evidence specific to frailty and sarcopenia remains limited. Further research is needed to better understand the role of social support and other BCTs in eHealth physical activity interventions among older adults. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42025641608.

Abstract as published, via PubMed.