Apps and wearables are quietly shaping healthier habits in young people

Parents frequently express apprehension regarding the duration of mobile phone, tablet, and game console usage among their children. It is common to associate screens with nearly all childhood and adolescent health issues, such as insufficient sleep or problematic levels of sedentary behavior. However, an increasing amount of evidence is leading researchers to determine that the same devices that reportedly cause problems may also be part of an effective solution.

A large, global review of digital health initiatives has now indicated that "apps, wearables, and interactive online tools nudge young people to do better," (i.e., to be more active, sit less, eat healthier, manage body weight) and to provide data (i.e., tracking behavior). The review included studies of more than 133,000 children and teens across 440 separate studies and offers clarity of how technology may harness support in healthy daily living.

Researchers reviewed and synthesized dozens of high-level reviews to know how digital technologies influence young people's physical activity, screen time, sleep, diet, and weight, specifically young people-0-18. The umbrella review approach synthesizes large numbers of systematic reviews and meta-analyses, where more reliable evidence commonly converges.

The overarching goal was direct: Does the technology work, i.e., do digital health technology behaviors ultimately help kids move more, sit less, eat better, and manage their weight? Overall, researchers found small but consistent benefits, with evidence of a "small" effect size (specifically for physical activity, diet improvement, reduced body weight, and improved body fat). The evidence was unclear; based on the current measurements for sedentary behavior, the results varied based on the nature of the measurement.

In total, there were 25 reviews that met strict inclusion criteria. The research involved the tracking of thousands of youth from early childhood to adolescence, including both youth living with chronic health conditions and those identified as having excess weight. The types of digital health programs studied were varied. Some employed mobile applications or wearable devices, others used active video games, text messages, websites, or integrated several of these together.

Overall, the children and teens utilizing various digital health interventions, regardless of mode of delivery, reported higher levels of increased physical activity. The increases to moderate to vigorous intensity physical activity ranged from minimal increases to roughly 10 - 20 or more minutes per day on average, resulting in other studies' baseline on the agenda.

There were often increases in the overall quantity of physical activity across the physical activity measures in almost all the studies included in the review, though, of course, the increases do not occur overnight. The surrounding changing patterns of physical activity may contribute to healthier patterns of behavior, which may lead to healthier adults.

Improvement in quality of life associated with dietary behaviors was also evident as children using the digital health interventions consumed more fruit and vegetables and reported lower consumption of high-fat options, as measured through dietary recalls around the variety of intervention approaches. While some data did not show marked levels of dietary intervention changes throughout the study. For example, eating more fruits and vegetables during childhood is often associated with healthier adult patterns.

In the measures of overall diet patterns in health correlated with weight measures, body proportion measures, body weight, body fat, and while modest evidence showed that BMI averaged a decline of approximately to approximately 0.22 kg/m2, body weight averaged a decline low to an average of 1 kg. Waist circumference also carried a mixed result, although no evidence of change or lack thereof, hence the result weighed in favor of the digital health interventions using an integrated approach.

Sedentary behavior did not negate the benefits of the overall results of the integrated digital health intervention. Researchers' analyses of standardized effect sizes across the specified studies yielded inconsistent results. In contrast, when raw minutes were analyzed, there was a clear pattern demonstrating that several of the digital programs were able to reduce children's screen time and other sedentary behaviors by 20 to 25 minutes per day.

The only clear exception to this was in sleep, where programs intended to increase sleep duration showed no convincing effects.

Not all approaches to digital health were equally effective. For example, mobile applications made the most difference in terms of diet and weight. This is likely because they allow for tracking, reminders, and personalized feedback. Wearable devices, such as activity trackers and smart watches, were associated with the most reductions in sedentary time, possibly as they provide real-time prompts and visible cues towards progress.

The length of the programs mattered too: shorter programs lasting less than 8 weeks were most effective for improving physical activity, while longer programs of 12 weeks or more were best for weight management.

Age did not change the results in any significant way. Younger children and older adolescents responded similarly, but perhaps there are developmental differences in how much each group requires support.

The quality of reviews averaged below acceptable, often rated low/critical due to nonreporting; still, the consistency of findings provides reasonable confidence that digital health tools provide small, but real, health benefits.

The lead author, Dr. Ben Singh from UniSA, said the findings show a significant opportunity: "Digital health tools such as wearables, fitness apps, and online programs could help to turn this situation around by engaging kids to become more active and eat well. Because children and teenagers have grown up with technology, they are naturally likely to engage with apps."

Dr. Singh and his colleagues believe these digital health tools could be incorporated into schools, health visits, and community health initiatives, as features such as tailored messaging, rewards, or machine learning could enhance engagement and the natural adoption of healthy behaviors.

The clear need for this work is underscored by international health statistics: The World Health Organization indicates that 80% of adolescents are not physically active enough and that 390 million children are overweight globally. In Australia, 1 in 5 kids would be classified in this context.

The review provides strong evidence that digital health interventions are similar in effect – and at times more effective – than traditional health programs. It also appears that strategies that incorporate digital tools along with extra support by teachers, parents, or health coaches had a stronger effect.

This all together means that technology is accessible, and fueled by human encouragement, families and schools can create an environment that feels tangible for children and young adolescents, developing healthier routines.

Research findings are available online in the Journal of Medical Internet Research.

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