Effectiveness of Digital Commitment Devices in Improving Lifestyle and Cardiometabolic Outcomes in Adults with Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis.

Abstract

Aim: Lifestyle modification is crucial for cardiovascular disease prevention but remains challenging due to complex behavioural factors such as the intention-behaviour gap. Digital commitment devices (DCD) could narrow this gap by leveraging behavioural economics, but its effectiveness remains unclear. Therefore, this review aims to evaluate the effects of DCDs on lifestyle and cardiometabolic outcomes in adults with elevated cardiometabolic risk.

Methods: A systematic search of 12 electronic databases was conducted from database inception to August 2025. Study selection and methodological quality appraisal using the Cochrane Risk of Bias 2.0 tool were performed independently by two reviewers. Where appropriate, effect sizes were pooled using random effects meta-analyses. The certainty of evidence for meta-analysed outcomes was assessed using the GRADE approach.

Results: A total of 7,378 articles were retrieved, of which 29 randomised controlled trials involving 7,534 participants were included. DCDs were found to significantly increase daily step count (WMD=664.87, 95% CI: 463.22 to 866.51, T=6.88, p<0.00001; I2=0%) and weight loss (WMD=-1.90kg, 95% CI: -2.59 to -1.21, p<0.0001; I2=70%), improve self-reported emotional (WMD=-1.34, 95% CI: -2.59 to -0.09, p=0.04; I2=0%) and uncontrolled eating (WMD=-1.74, 95% CI: -3.05 to -0.43, p=0.02; I2=0%) behaviours, body fat percentage, diet and medication adherence.

Conclusion: DCDs could improve lifestyle and cardiometabolic outcomes by improving physical activity and weight management, thus enhancing cardiometabolic disease prevention. Future research should prioritise long-term trials with extended follow-up periods beyond 12 months to observe physiological improvements and assess maintenance of effects.