Keywords

1 Introduction

Globally, it is widely accepted that the physical health of the young generation is continuously declining, which remains unnoticed in many countries (Fan 2021). The twenties of the twenty-first century are marked by digital transformation. Digital technologies are being actively introduced into all spheres of life and are becoming an indispensable component of business plans. Medicine is not left out. A study from Deloitte showed that 92% of medical institutions consider increased customer satisfaction and engagement as the main result that can be achieved due to digital transformation (Deloitte Center for Health Solutions 2021). In recent years, there have been innovations in physical health tools and health applications designed to manage and promote physical health and fitness among the general population (Sawyer et al. 2023).

Several wearable devices on the market are suitable for monitoring a person’s physical health. The growth of technological innovation is rapidly redefining the right to the highest attainable standard of physical health. In a growing number of countries, this has strengthened the ability of governments to protect and fulfill this fundamental human right by ensuring accessibility, acceptability, and good quality of medical facilities, goods, and services. The 2030 Agenda for Sustainable Development emphasizes that spreading information and communication technologies and global connectivity have enormous potential to accelerate human progress, bridge the digital divide and develop (United Nations General Assembly resolution 2015).

Digitalization research is still in its early stages but is expanding. The widespread use of digital technologies in the healthcare sector includes the search for medical knowledge resources, monitoring the quality of patient care, and improving clinical support (Paul et al. 2023).The availability of digital devices with integrated sensors has caused a growing interest in their use in health care systems and sports science (Antunes et al. 2018; Botilias et al. 2020). In addition, digital devices have become a promising tool for improving the regular collection of health data, disease monitoring, and support for public health surveillance (Ravalli et al. 2022).

Digital technologies allow patients and doctors to both inform and control the treatment process. However, this technology complements physical consultation and in no way replaces physical consultation (Haleem et al. 2021). Multicomponent health promotion programs with digital components are increasingly being implemented in the workplace to assess and promote employees’ health and reduce the risk of chronic diseases (Thai et al. 2023). Regular physical activity (PA) and good physical health reduce the risk of developing diseases such as heart disease, stroke, and some cancers. Also, it helps to cope with life problems, protecting against fatigue, injury, and illness (National Center for Chronic Disease Prevention and Health Promotion 2023; Booth et al. 2012). Since the positive impact of regular PA on a person’s physical health is well known and is an essential prerequisite for healthy aging, digital technologies are also increasingly being used to encourage unstructured and structured forms of PA (Herold et al. 2022). The World Health Organization (WHO) is drafting the ‘Global action plan on physical activity (GAPPA) to be implemented from 2018 to 2030 (WHO 2018).

Mobile and wireless technologies, such as mobile phones and wearable devices, have the potential to reach millions of people and can help promote and increase PA and reduce sedentary behaviors. WHO is working with scientific partners and industry to find out what works and scale the reach and impact of applications and programs aimed at helping people of all ages to be more active (World Health Organization 2023). In 2017 the World Confederation for Physical Therapy (WCPT) launched a collaboration to develop initiatives for the global practice and regulations of digital physical therapy practice through a Joint WCPT/INPTRA digital physical therapy Practice Task Force (Task Force). The variety of technologies encompassing digital and physical therapy may include telemonitoring, tele-education, telemedicine, teleassistance, and mobile health, and each field has its subset of technologies and specificities (World confederation for physiotherapy 2017–2019).

2 Focusing on LMICs

Health issues in low- and middle-income countries (LMICs) have been the focus of many digital initiatives to ensure the sustainability of these services. Policymakers should take into account the issues of utility, usability, integration, and infrastructure in order to improve digital health functions (Duggal et al. 2023). Digital technologies can increase the availability of technologically advanced treatment for individuals living in countries where such treatment may be unavailable (Pagliari 2021), e.g., LMICs. Due to recent regulatory changes, the LMICs are just starting to discuss digital practice. Healthcare challenges in LMICs have been the focus of many digital initiatives that have aimed to ensure consistent implementation of these services (Duggal et al. 2023). Digital health can support health care in LMICs by overcoming distance problems, poor infrastructure, and the need to provide community practitioners with specialist support (Hui et al. 2022).

Remote treatment can reduce the need for physical examination and strengthen the human resources of healthcare. Digital medicine can help healthcare systems overcome barriers such as the shortage of healthcare providers in LMICs due to “brain drain” (Human Rights Council Fifty-third session 2023). The COVID-19 pandemic has accelerated the introduction of innovations in the field of digital healthcare due to the availability of various technologies and the urgent need for medical care for treatment and prevention (Abdolkhani et al. 2022). COVID-19 is the first global pandemic of the digital age, and there are numerous examples of how digital health solutions have helped a lot during the pandemic (Aisyah et al. 2022). Perhaps the most notable acceleration in both the United States and other parts of the world has been due to the rapid adoption of telemedicine. In many ways, the response to COVID-19 has led to years of progress in just a few months (Lee et al. 2022).

In just a few weeks in March and April 2020, telemedicine applications and services, health sensors, 3D-printed protective equipment, and laboratory tests at home became part of everyday life (Meskó 2022). For example, in Catalonia, Spain, telemedicine replaced personal visits to primary health care doctors in less than a month. Compared to the beginning of March 2020, telemedicine visits increased by 5.5 times just four weeks later, and personal visits decreased by seven times (Pol et al. 2020).

The COVID-19 crisis considered the possibility of developing telemedicine in several countries. Australia, England, and the USA face several challenges. However, a few years ago, they incorporated digital practice into the healthcare system, and recently their associations have developed recommendations for helping specialists during the COVID-19 outbreak (Dantas et al. 2020).

3 Armenia as a Case Study

Physical inactivity accounts for over three million deaths yearly, mostly from non-communicable diseases in low-income and middle-income countries (Pratt et al. 2012). An essential component for improving physical health and reducing premature mortality by one-third is an increase in the level of PA. To achieve this goal, research is needed in LMICs to support evidence-based policy development, identify barriers, and motivate people to PA (Liu 2022).Our recent research conducted in Armenia, one of the LMICs, showed the effects of PA on some parameters of physical health. According to the results of studies, the indicators of body composition and stress resistance are on the border between the norm and violation, and the relationship of body composition with stress resistance, endothelial function, and well-being in the population varies depending on the degree of physical activity and gender (Muradyan et al. 2021; Macheiner et al. 2022).

Based on the literature data on practice, we initially hypothesized that regular PA classes would improve stress resistance and wellness indicators. For this purpose, we selected participants according to the method. The change was detected by a comparative analysis of the study’s results before and after the inclusion of clients in the PA program. The study showed significant changes in stress and wellness indicators in the group of supporters of PA two to four times a week. This proves that the regularity of fitness programs is an essential criterion for improving indicators, reducing what leads to stress, and increasing the indicators of health (Muradyan et al. 2022).

We also conducted research before the COVID-19 pandemic (from May 2018 to September 2019) and during the pandemic (November 2020 to December 2021). We evaluated the correlation and infrastructure of some physical health indicators before and during the COVID-19 pandemic in the Armenian population. In conclusion, during COVID-19 pandemic significantly decreased stress resistance, endothelium function, and wellness indicators (Muradyan 2022).

Our current study showed that a high level of PA improves the indicator of body composition and increases stress resistance. We have also identified that the probability of getting infected with COVID-19 was higher among people with low levels of PA. Thus, our research indicates the need to develop and implement health programs, including PA. The application and subsequent analysis of the effectiveness of these programs can be monitored with the help of digital technologies not yet widely used in Armenia.

4 Challenges and Opportunities in PA-Related Research in LMICs

There are many social barriers to encouraging PA in LMICs, including a lack of resources and amenities, which should be the attention of researchers. The most significant barriers are cost and reimbursement, legal liability, and ethical issues such as confidentiality, infrastructure, equipment, Internet, age and level of education of patients, computer literacy, bandwidth range, and internet speed (Pratt et al. 2012; Liu 2022; Kaboré et al. 2022). For example, for pregnant women in South Africa, the lack of prenatal PA can be associated with insufficient relevant information, work commitment, discomfort, lack of time, tiredness and low energy, inadequate or conflicting information about prenatal physical activity, and lack of financial resources (Okafor and Goon 2022). Thus, more profound research and support for introducing digital technologies such as wearables, websites, and mobile applications can help people in LMICs benefit from PA. Moreover, increased access to information technology, even among the most vulnerable people, has led to digital interventions being promoted as a tool to reduce inequalities in health promotion.

Research using mobile devices is gaining popularity. A meta-analysis of electronic databases (PubMed, PsychINFO, SCOPUS) that provided raw data and aimed to influence PA through the distribution or collection of intervention materials using a mobile device suggests that this platform is an effective means of influencing PA behavior, and harnessing the potential of smartphone technology could provide researchers with an effective tool to increase PA (Fanning et al. 2012). Using a systematic search strategy to identify relevant studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library published between January 1990 and March 2020 suggests that the opposite is true in the context of PA, that is, the people who will benefit most from these interventions are left behind. The authors recommend that in the future when developing digital interventions to improve the PA, more efforts will be made to meet the needs of people with low socioeconomic status (SES) (Western et al. 2021). The review that maps and describes the impact of digital workplace wellness measures in LMICs revealed that digital workplace wellness measures are feasible, cost-effective, and acceptable. However, no long-term and consistent effects were found in this review, and further studies are needed to obtain additional evidence (Thai et al. 2023).

A review of Ovid MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Scopus, and Cochrane Library for peer-reviewed articles, emphasized the advantages of wearable devices for physical activity and also urged people with chronic diseases to maximize the effectiveness of wearable devices. The authors suggest that wearable devices may develop some special functions in combination with the treatment of chronic diseases. It is necessary to formulate targeted strategies of PA per the specific characteristics of the disease (Yu et al. 2023). A systematic search in PubMed of studies evaluating the impact of the Internet, personal sensors, mobile phone or autonomous computer software on a diet, PA, obesity, tobacco or alcohol use has shown that interventions using the Internet and mobile devices improve important lifestyle habits up to 1 year and supports the effectiveness of Internet and mobile interventions for improving lifestyle and reducing risk factors for non-communicable diseases (NCDs) (Afshin et al. 2016). A systematic review of mobile health and PA was conducted in October 2017 using CINAHL, ERIC, EMBASE, MEDLINE, and PsycINFO databases, and identified two mechanisms by which mobile health use promotes PA: increased motivation and changes in self-awareness and strategizing (Carter et al. 2018). The study was conducted on 46 LMICs; people with chronic diseases and multimorbidity are significantly less physically active (especially the elderly), and it is essential to study the effectiveness and efficacy of PA in treating chronic diseases in LMICs (Vancampfort et al. 2017). Thus, one of the main factors in improving the population’s physical health is PA.

5 Conclusion

Considering that digital technology opens up a wide range of opportunities for motivating PA and a healthy lifestyle, implementing programs, and improving health indicators, it is essential to emphasize the use of digital technology in healthcare institutions at LMICs. The digitization of physical health data can become the basis of helpful information for implementing and prioritizing GAPA actions in LMICs. The digitized data will be helpful to policymakers and stakeholders involved in promoting PA and physical health at the individual, local, national, regional, and global levels, with a particular focus on LMICs. In addition, digitizing physical health data will be an essential basis for a research program on the economic aspects of PA in LMICs. This will be a valuable guide for researchers to plan research in economics and physical health using a reliable methodology focused on the LMICs research needs. In addition, the information obtained from digitalization will help funding agencies allocate and monitor resources efficiently.