Exploratory comparative review of wearable-based versus app-based behavioral monitoring tools: evidence synthesis and...

Digital health interventions using wearable devices and mobile health (mHealth) applications are increasingly used to promote health-related behaviors. However, direct comparative evidence between these modalities remains scarce.

To conduct an exploratory comparative (scoping-style) systematic review synthesizing direct evidence comparing wearable-based versus app-only behavioral monitoring tools, with emphasis on hypothesis generation rather than comparative effectiveness.

A systematic search was conducted following PRISMA 2020 guidelines. Two studies met inclusion criteria: one population-based observational cohort and one secondary analysis of a randomized controlled trial. Risk of bias was assessed using ROBINS-I and RoB 2.0, and certainty of evidence using GRADE.

Evidence was limited and heterogeneous, precluding meta-analysis. Wearables demonstrated higher adherence and sustained data transmission (low certainty), while app-only interventions showed similar or slightly greater improvements in specific behaviors such as walking practice (very low to low certainty). No robust evidence supported equivalence or superiority of either modality for overall health or metabolic outcomes.

Direct comparative evidence between wearable-based and app-based monitoring tools is extremely limited. Findings should be interpreted as hypothesis-generating rather than confirmatory. Future adequately powered head-to-head trials are required.