Effectiveness of mHealth interventions targeting physical activity, sedentary behaviour, sleep or nutrition on emotional, behavioural and eating disorders in adolescents: A systematic review and meta-analysis

Hannes Baumann^1*Ben Singh²Staiano E Amanda³Claire Gough⁴Mavra Ahmed⁵Janis Fiedler⁶Kathrin Wunsch⁶Alyssa Button⁷Zenong Yin⁸Maria Vasiloglou⁹Bridve Sivakumar¹⁰Joan Martine Dallinga¹¹Jasmine Petersen⁴Christopher Huong⁸Stephanie Schoeppe¹²Katie Spring³Chelsea L Kracht¹³Carol Maher²Corneel Vandelanotte¹²

• ¹German Sport University Cologne, Cologne, Germany
• ²University of South Australia, Adelaide, Australia
• ³Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States
• ⁴Flinders University, Adelaide, South Australia, Australia
• ⁵University of Toronto, Toronto, Ontario, Canada
• ⁶Karlsruhe Institute of Technology (KIT), Karlsruhe, Baden-Württemberg, Germany
• ⁷Virginia Commonwealth University, Richmond, Virginia, United States
• ⁸University of Texas at San Antonio, San Antonio, Texas, United States
• ⁹Nestle Institute of Health Sciences (NIHS), Lausanne, Vaud, Switzerland
• ¹⁰Ontario Tech University, Oshawa, Ontario, Canada
• ¹¹The Hague University of Applied Sciences, The Hague, Netherlands
• ¹²Central Queensland University, Rockhampton, Queensland, Australia
• ¹³University of Kansas Medical Center, Kansas City, Kansas, United States

Introduction: Mental disorders affect one in seven adolescents and account for 15 % of their global disease burden. Improving physical activity (PA), diet and sleep, while limiting sedentary behaviour, eases symptoms, yet population‑scale delivery requires mobile‑health (mHealth) solutions. Evidence for their efficacy in adolescents with emotional, behavioural or eating disorders is still uncertain. We therefore conducted a systematic review and meta‑analysis of mHealth behaviour‑change interventions targeting PA, sedentary behaviour (SB), nutrition or sleep.Methods: Following PRISMA (PROSPERO CRD42024591285) we searched eight databases up to 20 September 2024 for randomised controlled trials (RCTs) of 11–21‑year‑olds with a diagnosed or self‑reported emotional, behavioural or eating disorder. Interventions had to deliver ≥ 75 % of content digitally and address at least one of the four behaviours. Pairs of reviewers screened records, applied ROB 2.0 and GRADE, and pooled standardised mean differences (SMD) with random‑effects models.Results: Nine RCTs (3 703 participants) were eligible. Compared with controls, mHealth interventions produced small but significant reductions in anxiety (6 studies, SMD = –0.19, 95 % CI –0.37 to –0.01; I² = 71 %) and eating‑disorder symptoms (3 studies, SMD = –0.23, –0.44 to –0.02; I² = 38 %). Effects on depressive symptoms (7 studies, SMD = –0.12, –0.28 to 0.04; I² = 59 %) and behavioural disorders (2 studies, SMD = –0.07, –0.36 to 0.22; I² = 95 %) were not significant. Sleep‑focused or multicomponent (PA + SB + diet + sleep) programmes appeared to drive the anxiety effect, while diet‑centred or diet + PA interventions underpinned the eating‑disorder effect. Certainty of evidence ranged from very low to moderate; six trials showed some concern and three high risk of bias. Interventions with more sessions, greater intensity, longer duration and limited face‑to‑face contact tended to yield larger effects but lower scalability.Discussion: mHealth behaviour‑change interventions can modestly reduce anxiety and eating‑disorder symptoms in adolescents, whereas benefits for depression and behavioural problems remain inconclusive. Larger, high‑quality RCTs with longer follow‑up are needed to confirm effectiveness and to define an optimal balance between programme intensity and reach, ideally by integrating digital tools with routine clinical care.