Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 11, 2025
Date Accepted: Jan 21, 2026
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Digital tools’ effectiveness on physical activity practice in healthy children and adolescents: an umbrella review within the DigitAl Lifelong pREvention (DARE) project
ABSTRACT
Background:
Children and adolescents do not meet the current guidelines for physical activity (PA). Interventions aimed at increasing their PA have been worldwide implemented through the use of different digital tools, but a clearer view of their effectiveness is needed.
Objective:
The present review is aimed to summarize the evidence on the characteristics and effectiveness of digital approaches used to increase PA in healthy schoolchildren aged 6-17.
Methods:
A systematic review of reviews and meta-analyses (MAs) that collected randomized controlled trials (RCTs), hereafter referred to as an umbrella review, was performed. The PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) checklist was followed. Papers published between 2018 and 2023 were searched in the SCOPUS and PubMed/MEDLINE databases, using a combination of terms addressing the type of digital tool (such as apps, wearables, social media, messaging, exergames, or web coaching), the main outcomes related to PA, and the effectiveness outcomes. Eligibility criteria included reviews and MAs targeted to healthy people (including overweight and obese people) aged 6-17 years, that used digital approaches to increase PA in comparison with any other intervention or no intervention. The methodological quality of included reviews and MAs was assessed using the AMSTAR 2 tool. Results of the study characteristics and on the efficacy outcomes are summarized and presented as frequencies, and the chi-square test was used to reveal significant differences between the studies in relation to their efficacy.
Results:
A total of 41 reviews/MAs and 61 RCTs were considered for detailed analysis. The overall quality of included reviews and MAs was moderate to poor. Main PA outcomes were moderate-to-vigorous PA (MVPA) (59.0%) and steps (34.4%); around half of the RCTs assessed also sedentary behaviors (SB) such as sitting and screening time. A total of 63.9% of the interventions were effective or partially effective on one or more PA/SB outcomes. With regard to PA outcomes such as MVPA, higher effectiveness rates were found for studies using wearables as digital device and component for intervention delivery (100%) or using web-based tools as digital component (61.5%). Step counts increased more in interventions using computer, tablet or iPod (100%) as digital device for intervention delivery, and text messaging, wearable or web-based tools as digital components (100%). For SB outcomes, higher efficacy rates were found in interventions using a wearable (100%), a web-based tool (70.0%) or a mix of digital tools (60.0%). In general, studies conducted on American and Asian populations showed higher efficacy rates, than those targeted to populations from Europe or Australia/New Zealand.
Conclusions:
A large heterogeneity is present among the analyzed reviews and RCTs. Authors recommend higher methodological rigor for future systematic reviews and interventions aiming at increasing PA in children and adolescents through digital tools. Clinical Trial: PROSPERO, registration number CRD42024510602, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024510602
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