Efficacy of digital coaching-based diet and exercise interventions on metabolic syndrome: A comprehensive...

Digital coaching provides personalized lifestyle guidance via intelligent platforms such as mobile applications and wearable devices. In the context of metabolic syndrome (MetS), such digital coaching is commonly applied to lifestyle interventions targeting diet and exercise. Although numerous trials have investigated these interventions, evidence regarding their impact on clinical and behavioral outcomes remains fragmented.

To evaluate the efficacy of digital coaching interventions on metabolic and behavioral outcomes in adults with MetS, and to examine whether effects vary by intervention characteristics (type, duration, and delivery mode).

We systematically searched PubMed, Cochrane Library, Embase, Web of Science, and CINAHL up to 13 December 2025, for randomized controlled trials comparing digital coaching-based diet and exercise interventions to routine care. Clinical and behavioral indicators related to MetS were extracted and analyzed using standardized mean differences (SMD) with 95% confidence intervals (CI).

Analysis of 21 randomized controlled trials (n = 2618 participants) demonstrated that digital coaching-based diet and exercise interventions led to significant improvements in the following primary outcomes (core components of MetS): waist circumference (SMD: -0.28, 95% CI -0.46 to -0.10, p = 0.002), systolic blood pressure (SMD: -0.23, 95% CI -0.33 to -0.13, p < 0.001), diastolic blood pressure (SMD: -0.25, 95% CI -0.43 to -0.08, p = 0.004), fasting blood glucose (SMD: -0.23, 95% CI -0.35 to -0.11, p < 0.001), high-density lipoprotein cholesterol (SMD: 0.19, 95% CI 0.09 to 0.29, p < 0.001), and triglycerides (SMD: -0.20, 95% CI -0.28 to -0.11, p < 0.001). Significant improvements were also seen in secondary outcomes: weight, body mass index, total cholesterol, metabolic syndrome Z score, and physical activity (all p < 0.05). However, no significant effects were observed for low-density lipoprotein cholesterol or energy intake. Modes of digital coaching and intervention duration did not significantly affect outcomes.

Digital coaching-based diet and exercise interventions are effective in improving cardiometabolic risk factors in adults with MetS. These findings support the integration of digital coaching as a scalable and accessible approach to lifestyle management in both clinical and community settings. Future studies should optimize digital coaching components and test long-term safety and effectiveness in adults with MetS.