A digital-health multidomain lifestyle management framework and its associations with cardiometabolic health: a real-world observational study.

Abstract

It remains unclear whether digital health-based multidomain management is associated with long-term cardiometabolic health control in real-world scenarios. We conducted a retrospective analysis of a real-world health management program involving 40,216 adults from 2018 to 2024 across 30 provinces in China. The program combined digital health platforms (including mobile health apps and smartwatches) with offline wellness centers to provide personalized lifestyle management. Participants' demographics, physiological (blood pressure, blood glucose, body composition, heart rate, grip strength, and cholesterol), psychological, and lifestyles (sleep and physical activity) data were longitudinally collected. Program engagement was measured by mobile health app usage frequency, device wear time, and wellness center participation. The population-level trajectory of cardiometabolic health changes was fitted over a 12-month follow-up using the linear mixed-effects models. Associations between participants' engagement and cardiometabolic health (blood pressure, blood glucose, and body fat percentage) improvement were further examined. The median (IQR) age of 40,216 participants was 71 (64-75). During the 5-year management period, participants contributed a total of 9,749,898 physical activity, 8,623,004 heart rate, 8,323,161 sleep, 2,925,903 body composition, 2,619,725 blood pressure, and 291,240 blood glucose data. Over the 5 years, participants used mobile health app to upload their health data for an average of 5.7 days per week, and wore smartwatches 5.8 days per week, with 95.5% wearing them for ≥ 8 h per valid day. Older age, female sex, and higher education level were associated with higher weekly frequency of mobile health app usage. Among participants with elevated blood pressure, elevated blood glucose, or obesity, those with high engagement were associated with greater reductions in systolic blood pressure (- 3.85 [-5.2 to -2.49] mmHg), blood glucose (- 1.20 [ -2.06 to -0.34] mmol/L), and body fat percentage (- 1.24% [-1.59% to -0.88%]). Explorative mediation analyses suggested that reductions in body fat percentage partially mediated these associations. Findings of this study suggest that a digital health-based multidomain program may support daily cardiometabolic health monitoring and management. Such frameworks can be feasible and scalable to help facilitate proactive prevention strategies.