Effects of Smartphone-Based Interventions on Physical Activity in Children and Adolescents: Systematic Review and Meta-analysis

Abstract

Background About 70% of children and adolescents worldwide do not meet the recommended level of physical activity (PA), which is closely associated with physical, psychological, and cognitive well-being. Nowadays, the use of technologies to change PA is of interest due to the need for novel, more effective intervention approaches. The previous meta-analyses have examined smartphone-based interventions and their impact on PA in adults, but evidence in children and adolescents still needs further research. Objective This systematic review and meta-analysis aimed to determine the effectiveness of smartphone-based interventions for improving PA in children and adolescents. Methods Five electronic databases (PubMed, Web of Science, OVID, Scopus, and the China National Knowledge Infrastructure) were searched up to June 29, 2020. Randomized controlled trials with a control group that examine the effect of smartphone interventions on PA among children and adolescents were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect on PA using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (eg, types of intervention, intervention duration, age, measurement, study quality). Results A total of 9 studies were included in this review, including 4 mobile app interventions, 3 SMS text messaging interventions, and 2 app + SMS text messaging interventions. In general, the risk of bias of included studies was low. Compared with the control group, the use of smartphone intervention significantly improved PA (standardized mean difference [SMD] 0.44, 95% CI 0.11-0.77, P=.009), especially for total PA (TPA; weighted mean difference [WMD] 32.35, 95% CI 10.36-54.33, P=.004) and daily steps (WMD 1185, 95% CI 303-2068, P=.008), but not for moderate-to-vigorous PA (WMD 3.91, 95% CI –1.99 to 9.81, P=.19). High statistical heterogeneity was detected (I2=73.9%, P<.001) for PA. Meta-regression showed that duration (β=–.08, 95% CI –0.15 to –0.01, n=16) was a potential factor for high heterogeneity. The results of subgroup analyses indicated that app intervention (SMD 0.76, 95% CI 0.23-1.30, P=.005), children (SMD 0.64, 95% CI 0.10-1.18, P=.02), “≤8 weeks” (SMD 0.76, 95% CI 0.23-1.30, P=.005), objective measurement (SMD 0.50, 95% CI 0.09-0.91, P=.02), and low risk of bias (SMD 0.96, 95% CI 0.38-1.54, P=.001) can significantly improve PA. Conclusions The evidence of meta-analysis shows that smartphone-based intervention may be a promising strategy to increase TPA and steps in children and adolescents. Currently, app intervention may be a more effective strategy among smartphone intervention technologies. To extend the promise of smartphone intervention, the future needs to design comparative trials among different smartphone technologies. Trial Registration PROSPERO CRD42019148261; https://tinyurl.com/y5modsrd

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“…If the daily step count is decreased by 4000 steps or more, healthcare professionals should directly contact such individuals and check their health status. There are different types of intervention methods to promote physical activity (e.g., in-person, telephone, emails, text messaging, mobile applications, and social media), and among them, the smartphone-based intervention effectively improves total physical activity and daily steps in children and adolescents [39]. In addition, wearable activity trackers are recognized as useful and acceptable healthcare devices in individuals aged >50 years and with chronic disease [40].…”

mHealth Interventions to Reduce Physical Inactivity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Böhm et al [ 28 ] furthermore criticize the quality of mHealth interventions for children and adolescents in this respect and suggest that more age-appropriate solutions are needed. The results of other reviews indicate that smartphone-based mHealth interventions (especially apps) are a versatile strategy for increasing PA and steps in children and adolescents [ 29 ]. For example, Laranjo et al [ 30 ] found an average increase of 1850 steps per day after an mHealth intervention.…”

The Acceptability, Feasibility, and Effectiveness of Wearable Activity Trackers for Increasing Physical Activity in Children and Adolescents: A Systematic Review

“…A previous systematic review found that smartphone-based interventions were more effective at increasing child PA than adolescent PA [73]. It was suggested that younger participants would have required parental assistance to use the technology, which may have encouraged parental involvement and the monitoring of their child's PA behaviours [73]. One study included in this review found no difference in daily steps, MVPA, or calorie expenditure between adolescents provided with a wearable alone and adolescents and their parent receiving a wearable [66].…”

“…Thus, caution should be taken when generalising results to all age groups (5 to 19-year-olds). A previous systematic review found that smartphone-based interventions were more effective at increasing child PA than adolescent PA [73]. It was suggested that younger participants would have required parental assistance to use the technology, which may have encouraged parental involvement and the monitoring of their child's PA behaviours [73].…”