Detailed Search Results
| Author/Association: | Au WW, Recchia F, Fong DY, Wong SHS, Chan DKC, Capio CM, Yu CCW, Wong SWS, Sit CHP, Ip P, Chen Y-J, Thompson WR, Siu PM |
| Title: | Effect of wearable activity trackers on physical activity in children and adolescents: a systematic review and meta-analysis [with consumer summary] |
| Source: | The Lancet Digital Health 2024 Sep;6(9):e625-e639 |
| Method: | systematic review |
| Method Score: | This is a systematic review. Systematic reviews are not rated. |
| Consumer Summary: | RESEARCH IN CONTEXT: EVIDENCE BEFORE THIS STUDY: The potential of technology-based interventions, particularly the use of wearable activity trackers, to promote healthy physical activity behaviours has been highlighted. We searched PubMed, from database inception to Feb 3, 2023, without language restrictions, for studies on the use of wearable activity trackers to motivate physical activity behaviour using the search strategy: ("wearable activity"(Title/Abstract) OR "wearable device"(Title/Abstract) OR "wearable technology"(Title/Abstract) OR "activity track"(Title/ Abstract) OR "fitness tracker"(Title/Abstract) OR "commercial wearable"(Title/Abstract) OR "fitbit"(Title/Abstract) OR "pedometer"(Title/Abstract) OR "accelerometer"(Title/ Abstract) OR "smart band"(Title/Abstract) OR "wristband"(Title/Abstract) OR "wearable electronic device"(Title/Abstract)) AND ("physical activ"(Title/Abstract) OR "MVPA"(Title/Abstract) OR "step"(Title/Abstract) OR "daily step count"(Title/Abstract) OR "steps per day"(Title/Abstract) OR "activity count"(Title/Abstract) OR "energy expenditure"(Title/Abstract) OR "fitness"(Title/Abstract)). From this search, we found that most studies focused on the effects of wearable trackers on increasing physical activity in adults, and that systematic reviews showed inconclusive findings in children and adolescents. We identified only two meta-analytical studies that quantitatively synthesised available evidence on the effects of wearable activity trackers in children and adolescents, but one of them only focused on adiposity-related outcomes. Another meta-analysis investigated the effect of trackers on objectively measured physical activity and sedentary time in the healthy young population (mean age 5 to 18 years), where they found a moderate effect of wearable trackers on increasing daily total steps and a small effect on increasing moderate-to-vigorous physical activity, but an unfavourable effect on reducing sedentary behaviour. However, this meta-analysis had several limitations, including inclusion of a large proportion of non-randomised or non-controlled trials with high risk of bias, exclusion of clinical populations, limited rigorousness of data analysis method that might no account for between-individual variability, and the inclusion of control groups that might mask true intervention effects. To this end, we aimed to complete a meta-analysis that examined the effects of wearable activity trackers on physical activity in young participants (mean age <= 19 years) from both healthy and clinical populations, and synthesise data using rigorous data analyses from only studies with randomised controlled designs. ADDED VALUE OF THIS STUDY: To our knowledge, this is the first systematic review and meta-analysis that examined the effects of wearable activity trackers on physical activity in both healthy children and adolescents, as well as young people with suboptimal health. By synthesising data derived from randomised controlled trials and using stringent data analysis procedures, we found that wearable trackers seemed to have a positive effect on increasing daily steps in children and adolescents of various health statuses, but not on moderate-to-vigorous physical activity. Comprehensive sensitivity analyses that tested for robustness of findings confirmed the null effect found on moderate-to-vigorous physical activity, but also highlighted the importance of more rigorously designed trials that minimise missing data to confirm the positive effects on increasing step counts. IMPLICATIONS OF ALL THE AVAILABLE EVIDENCE: Higher daily step count is associated with improved physical and mental health in young cohorts, and reduces risks of developing various non-communicable diseases and all-cause mortality, highlighting the potential of wearable activity trackers in improving the health of children and adolescents. More high-quality evidence is needed to confirm findings on steps and explore possible long-term effects, and future studies should also explore whether there might be differences in the effect of activity trackers on children and adolescents of different age, sex, or health statuses to facilitate more personalised and effective application of wearable activity trackers on physical activity promotion. |
| Abstract: | BACKGROUND: Physical inactivity in children and adolescents has become a pressing public health concern. Wearable activity trackers can allow self-monitoring of physical activity behaviour and promote autonomous motivation for exercise. However, the effects of wearable trackers on physical activity in young populations remain uncertain. METHODS: In this systematic review and meta-analysis, we searched PubMed, Embase, SPORTDiscus, and Web of Science for publications from database inception up to Aug 30, 2023, without restrictions on language. Studies were eligible if they were randomised controlled trials or clustered randomised controlled trials that examined the use of wearable activity trackers to promote physical activity, reduce sedentary behaviours, or promote overall health in participants with a mean age of 19 years or younger, with no restrictions on health condition or study settings. Studies were excluded if children or adolescents were not the primary intervention cohort, or wearable activity trackers were not worn on users' bodies to objectively track users' physical activity levels. Two independent reviewers (WWA and FR) assessed eligibility of studies and contacted authors of studies if more information was needed to assess eligibility. We also searched reference lists from relevant systematic reviews and meta-analyses. Systematic review software Covidence was used for study screening and data extraction. Study characteristics including study setting, participant characteristics, intervention characteristics, comparator, and outcome measurements were extracted from eligible studies. The two primary outcomes were objectively measured daily steps and moderate-to-vigorous physical activity. We used a random-effects model with Hartung-Knapp adjustments to calculate standardised mean differences. Between-study heterogeneity was examined using Higgins I2 and Cochran Q statistic. Publication bias was assessed using Egger's regression test. This systematic review was registered with PROSPERO, CRD42023397248. FINDINGS: We identified 9619 studies from our database research and 174 studies from searching relevant systematic reviews and meta-analyses, of which 105 were subjected to full text screening. We included 21 eligible studies, involving 3676 children and adolescents (1618 (44%) were female and 2058 (56%) were male, mean age was 13.7 years (SD 2.7)) in our systematic review and meta-analysis. Ten studies were included in the estimation of the effect of wearable activity trackers on objectively measured daily steps and 11 were included for objectively measured moderate-to-vigorous physical activity. Compared with controls, we found a significant increase in objectively measured daily steps (standardised mean difference 0.37 (95% CI 0.09 to 0.65; p = 0.013); Q 47.60 (p < 0.0001); I2 72.7% (95% CI 53.4 to 84.0)), but not for moderate-to-vigorous physical activity (-0.08 (-0.18 to 0.02; p = 0.11); Q 10.26 (p = 0.74); I2 0.0% (0.0 to 53.6)). INTERPRETATION: Wearable activity trackers might increase daily steps in young cohorts of various health statuses, but not moderate-to-vigorous physical activity, highlighting the potential of wearable trackers for motivating physical activity in children and adolescents. More rigorously designed trials that minimise missing data are warranted to validate our positive findings on steps and to explore possible long-term effects. FUNDING: The Hong Kong University Grants Committee and Seed Fund for Basic Research of the University of Hong Kong. Full text (sometimes free) may be available at these link(s):  help |
