Background Midlife women with menopausal symptoms are less likely to meet the recommended level of physical activity (PA). Promoting PA among women in midlife could reduce their risk of cardiovascular diseases and perhaps improve menopausal symptoms. Mobile PA interventions in the form of smartphone apps and wearable activity trackers can potentially encourage users to increase PA levels and address time and resource barriers to PA. However, evidence on the acceptability and effectiveness of these interventions among midlife women is unclear. Objective This systematic review evaluated the effectiveness, acceptability, and active behavior change techniques (BCTs) of mobile PA technologies among midlife menopausal women. Methods A mixed methods systematic review of qualitative and quantitative studies was conducted. MEDLINE (Ovid), Embase, Scopus, CINAHL, Web of Science, SPORTDiscus, CENTRAL, PsycINFO, and the ProQuest Sports Medicine and Education Index were systematically searched. Studies were selected and screened according to predetermined eligibility criteria. In total, 2 reviewers independently assessed the risk of bias using the Mixed Methods Appraisal Tool and completed BCT mapping of the included interventions using the BCT Taxonomy v1. Results A total of 12 studies were included in this review. Overall risk of bias was “Moderate to high” in 58% (7/12) of the included studies and “low” in 42% (5/12) of the studies. Of the 12 studies, 7 (58%) assessed changes in PA levels. The pooled effect size of 2 randomized controlled trials resulted in a small to moderate increase in moderate to vigorous PA of approximately 61.36 weekly minutes among midlife women, at least in the short term (95% CI 17.70-105.01; P=.006). Although a meta-analysis was not feasible because of heterogeneity, positive improvements were also found in a range of menopause-related outcomes such as weight reduction, anxiety management, sleep quality, and menopause-related quality of life. Midlife women perceived mobile PA interventions to be acceptable and potentially helpful in increasing PA and daily steps. The average number of BCTs per mobile PA intervention was 8.8 (range 4-13) according to the BCT Taxonomy v1. “Self-monitoring of behaviour,” “Biofeedback,” and “Goal setting (behaviour)” were the most frequently described BCTs across the included interventions. Conclusions This review demonstrated that mobile PA interventions in the form of smartphone apps and wearable trackers are potentially effective for small to moderate increases in moderate to vigorous PA among midlife women with menopausal symptoms. Although menopause is a natural condition affecting half the population worldwide, there is a substantial lack of evidence to support the acceptability and effectiveness of mobile PA interventions on menopause-related outcomes, which needs further investigation. Trial Registration PROSPERO CRD42021273062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273062

BACKGROUND Midlife women with menopausal symptoms are less likely to meet the recommended level of physical activity (PA). Promoting PA among women in midlife could reduce their risk of cardiovascular diseases and perhaps improve menopausal symptoms. Mobile PA interventions, in the form of smartphone apps and wearable activity trackers, can potentially encourage users to increase PA levels and address time and resource barriers to PA. However, evidence about the acceptability and effectiveness of these interventions among midlife women population is unclear. OBJECTIVE This systematic review evaluates the acceptability, effectiveness, and active Behaviour Change Techniques (BCTs) of mobile PA technologies among midlife menopausal women. METHODS A mixed-methods systematic review of qualitative and quantitative studies was conducted. MEDLINE(Ovid), EMBASE, Scopus, CINAHL, Web of Science, SPORT Discus, CENTRAL, PsycINFO and ProQuest Sports Medicine and Education Index were systematically searched. Studies were selected and screened against pre-determined eligibility criteria. Two reviewers independently assessed risk of bias using the Mixed-Methods Appraisal Tool (MMAT) and completed BCT mapping of included interventions using BCT Taxonomy V1. RESULTS Twelve studies were included in this review. Overall risk of bias was ‘Moderate to high risk’ in eight, and ‘low risk’ in four of the included studies. The average number of BCTs per mobile PA intervention was 8.8 (range 4-13) according to the BCTTv1 Taxonomy. ‘Self-monitoring of behaviour’, “Biofeedback’, and ‘Goal setting (behaviour)’ were the most frequently described BCTs across the included interventions. Of the 12 included studies, 7 studies assessed changes in physical activity levels. The pooled effect size of two RCTs resulted in a small to moderate increase in Moderate-vigorous physical activity (MVPA) of approximately 61.36 weekly minutes among midlife women at least in the short term. While meta-analysis was not feasible due to heterogeneity, positive improvements were also found in a range of menopause-related outcomes such as weight reduction, anxiety management, sleep quality and menopause-related quality of life. Midlife women perceived mobile PA interventions to be acceptable and potentially helpful in increasing PA and daily steps. CONCLUSIONS This review has demonstrated that mobile PA interventions in the form of smartphone apps and wearable trackers are potentially effective in small-to-moderate increase of MVPA among midlife women with menopausal symptoms. Although menopause is a natural condition affecting half of the population worldwide, there is substantial lack of evidence to support the acceptability and effectiveness of mobile PA interventions on menopause-related outcomes which need further investigation. CLINICALTRIAL PROSPERO 2021 CRD42021273062 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273062