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Meta-Analysis
. 2022 May 11;10(5):e35920.
doi: 10.2196/35920.

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

Hannes Baumann #  1   2   3 , Janis Fiedler  4 , Kathrin Wunsch #  4 , Alexander Woll #  4 , Bettina Wollesen #  1
Affiliations
Meta-Analysis

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

Hannes Baumann et al. JMIR Mhealth Uhealth. .

Abstract

Background: Children and adolescents increasingly do not meet physical activity (PA) recommendations. Hence, insufficient PA (IPA) and sedentary behavior (SB) among children and adolescents are relevant behavior change domains for using individualized mobile health (mHealth) interventions.

Objective: This review and meta-analysis investigated the effectiveness of mHealth interventions on IPA and SB, with a special focus on the age and level of individualization.

Methods: PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library were searched for randomized controlled trials published between January 2000 and March 2021. mHealth interventions for primary prevention in children and adolescents addressing behavior change related to IPA and SB were included. Included studies were compared for content characteristics and methodological quality and summarized narratively. In addition, a meta-analysis with a subsequent exploratory meta-regression examining the moderating effects of age and individualization on overall effectiveness was performed.

Results: On the basis of the inclusion criteria, 1.3% (11/828) of the preliminary identified studies were included in the qualitative synthesis, and 1.2% (10/828) were included in the meta-analysis. Trials included a total of 1515 participants (mean age (11.69, SD 0.788 years; 65% male and 35% female) self-reported (3/11, 27%) or device-measured (8/11, 73%) health data on the duration of SB and IPA for an average of 9.3 (SD 5.6) weeks. Studies with high levels of individualization significantly decreased insufficient PA levels (Cohen d=0.33; 95% CI 0.08-0.58; Z=2.55; P=.01), whereas those with low levels of individualization (Cohen d=-0.06; 95% CI -0.32 to 0.20; Z=0.48; P=.63) or targeting SB (Cohen d=-0.11; 95% CI -0.01 to 0.23; Z=1.73; P=.08) indicated no overall significant effect. The heterogeneity of the studies was moderate to low, and significant subgroup differences were found between trials with high and low levels of individualization (χ21=4.0; P=.04; I2=75.2%). Age as a moderator variable showed a small effect; however, the results were not significant, which might have been because of being underpowered.

Conclusions: Evidence suggests that mHealth interventions for children and adolescents can foster moderate reductions in IPA but not SB. Moreover, individualized mHealth interventions to reduce IPA seem to be more effective for adolescents than for children. Although, to date, only a few mHealth studies have addressed inactive and sedentary young people, and their quality of evidence is moderate, these findings indicate the relevance of individualization on the one hand and the difficulties in reducing SB using mHealth interventions on the other.

Trial registration: PROSPERO CRD42020209417; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209417.

Keywords: health app; health behavior change; individualization; mobile phone; personalized medicine; physical activity; sedentary behavior; tailored interventions.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flowchart and study selection process (adapted from Page et al [45]). IPA: insufficient physical activity; SB: sedentary behavior.
Figure 2
Figure 2
Forest plot for effect size comparison of high-individualized versus low-individualized mobile health interventions on decreasing IPA [42,58-63,66]. IPA: insufficient physical activity.
Figure 3
Figure 3
Forest plot for effect size comparison of high-individualized versus low-individualized mobile health interventions on decreasing SB [42,58-64,66]. RCT: randomized controlled trial; SB: sedentary behavior.
Figure 4
Figure 4
Funnel plot of comparison: insufficient physical activity outcomes. SMD: standardized mean difference.
Figure 5
Figure 5
Funnel plot of comparison: sedentary behavior outcomes. SMD: standardized mean difference.
Figure 6
Figure 6
Grouped bubble plot of weighted standardized mean differences of individual trials and mean age of participants. Group differentiation based on the primary outcome (IPA and SB). High-individualized trials included only.
See this image and copyright information in PMC

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