Digital Health Interventions to Promote Physical Activity Among Adolescents: Systematic Review.
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BACKGROUND: Insufficient physical activity among adolescents is a major global public health concern. Digital health interventions (DHIs) have gained increasing attention as a promising approach to promoting physical activity in adolescents. However, existing systematic reviews predominantly focus on single-intervention formats or specific study designs, while reviews that integrate multiple DHIs and diverse study designs remain scarce. OBJECTIVE: This systematic review aims to synthesize evidence from diverse DHIs and multiple study designs to assess their effectiveness in promoting physical activity among adolescents. METHODS: The review protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD420251117923). This systematic review searched literature published between January 1, 2014, and June 30, 2025, across Web of Science, PubMed, EBSCO, Scopus, Embase, the Cochrane Library, ProQuest, and Google Scholar. The final search was completed on August 3, 2025. Using the PICOS (population, intervention, comparator, outcomes, and study design) framework, the review included adolescents aged 10-19 years and focused on evidence-based research promoting physical activity through DHIs. The review was limited to peer-reviewed English-language literature and excluded studies solely focused on measurement tools, those not evaluating intervention effectiveness, or those not involving adolescents. Two reviewers independently screened studies and extracted data. Research quality was assessed using the Joanna Briggs Institute tool. Findings were synthesized through narrative synthesis and qualitative content analysis. RESULTS: A total of 24 studies were included, involving approximately 12,183 adolescents. Study designs comprised 10 randomized controlled trials, 4 quasi-experimental studies, 3 quantitative research studies, 3 cross-sectional studies, and 4 mixed methods studies. Overall, 7 (29%) studies were of high quality, 16 (67%) were of moderate quality, and 1 (4%) was of low quality. Study populations included general adolescents as well as subgroups with specific health risks: insufficient physical activity (1/24, 4%), obesity or overweight (4/24, 17%), attention-deficit/hyperactivity disorder (1/24, 4%), cancer survivors (1/24, 4%), and at-risk youth (1/24, 4%). DHIs were categorized into 3 types: single-driver interventions (14/24, 58%), multimodal integrated interventions (7/24, 29%), and interaction-enhanced interventions (3/24, 13%). Most studies reported positive outcomes, including direct effectiveness (15/24, 63%), indirect effectiveness (8/24, 33%), and unclear effectiveness (1/24, 4%). CONCLUSIONS: This systematic review synthesizes evidence from diverse research designs and multiple types of DHIs, offering a more comprehensive perspective than previous reviews focused on single designs or technological formats. The results indicate that DHIs generally enhance adolescent physical activity levels, although their effectiveness varies considerably across intervention types and study designs. The review fills key research gaps and highlights the critical role of intervention adaptability and implementation context. It also addresses practical concerns, including adolescents with special health conditions, digital health inequalities, and technology dependency. Despite limitations related to methodological quality and insufficient follow-up, this review provides important evidence to inform practical application, policy development, and the equitable promotion of DHIs to enhance adolescent physical activity. Against the backdrop of rising global adolescent physical inactivity and widening health disparities, it also outlines directions for future high-quality research. TRIAL REGISTRATION: PROSPERO CRD420251117923; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251117923.