Effectiveness of mHealth App-Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents:Systematic Review and Meta-analysis (Preprint)

Abstract

Background: The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health apps (mHealth apps) to increase PA and improve PF. However, the effectiveness of mHealth app-based interventions and potential moderators in this population are not yet fully understood.

Objectives: This study aims to review and analyze the effectiveness of mHealth app-based interventions in promoting PA and improving PF, and identify potential moderators of efficacy of mHealth app-based interventions in children and adolescents.

Methods: We searched for articles published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until October 25, 2022 to conduct this meta-analysis. Subgroup analysis was performed to identify potential influences that impact effect sizes.

Results: We included 15 randomized controlled trials with a total of 2476 participants. Our findings showed that mHealth app-based interventions significantly increased total PA (TPA) (standardized mean difference [SMD] 0.24, 95% confidence interval [CI] 0.01–0.48, P=0.04), reduced body mass index (BMI) (weighted mean difference [WMD] −0.39, 95% CI −0.67 to −0.10, P=0.0009), and improved muscle strength (WMD 2.86, 95% CI 1.57 to 4.16, P=0.0001) in children and adolescents. However, mHealth app-based interventions insignificantly affected SB (SMD −0.18, 95% CI −0.38 to 0.02, P=0.09), moderate-to-vigorous PA (MVPA) (WMD 0.11, 95% CI −0.69 to 0.90, P=0.79), waist circumference (WMD −0.16, 95% CI −2.66 to 2.99, P=0.91), and cardiorespiratory fitness (WMD −0.14, 95% CI −0.50 to 0.23, P=0.46). Subgroup analyses indicated that mHealth app interventions based on social cognitive theory (SCT) with 7 behavior change technique (BCT) clusters could produce higher effect sizes for TPA; mHealth app interventions based on age 13～18 years old, research apps, a combination of SCT and self-determination theory, 7 BCT clusters, and intervention duration of 20～24 weeks revealed higher effect sizes for SB; and mHealth app interventions based on age 3～6 years old, research apps, SCT, 7 BCT clusters, and intervention duration of 12 weeks revealed higher effect sizes for BMI.

Conclusions: Our meta-analysis suggests that mHealth app-based interventions may have beneficial effects on TPA, BMI, and muscle strength but not on SB, MVPA, waist circumference, and cardiorespiratory fitness in children and adolescents. Moderating effects, including theoretical paradigm and BCT clusters, were significantly related to higher effectiveness of mHealth app-based interventions on TPA. Similarly, moderating effects, including age, theoretical paradigm, BCT clusters, types of apps, and intervention duration, were significantly related to higher effectiveness of mHealth app-based interventions on SB and BMI but not on MVPA. However, the small sample size and high heterogeneity of the included literature still necessitate further studies to validate our findings.

Trial Registration: PROSPERO CRD42023426532