Effects of technology-enhanced physical activity on brain and mental health in youth: An umbrella review of meta-analyses

Table 1 Population, intervention, comparator, outcomes, and study design criteria

	Criteria	Description
Population	Does the review involve children or adolescents (≤ 18 years)	Included: Children and adolescents aged 0–18 years from both clinical and general populations. Excluded: Adults (> 18 years); animal or in vitro studies; populations not reporting age-specific outcomes for youth; individuals in institutionalized or inpatient settings (unless specifically specifically targeting mental or cognitive outcomes)
Intervention	Does the review involve technology-enhanced physical activity interventions	Included: Interventions that incorporate PA enhanced by technology (e.g., virtual reality-based exercise, mobile health applications, gamified programs, internet-based platforms, wearable-integrated training, or multicomponent digital PA modules). Excluded: Conventional PA interventions without a technological component; sedentary behavior interventions without PA emphasis
Comparator	Does the review include a control or comparator condition	Included: Wait-list, usual care, no intervention, or traditional non-digital PA programs. Excluded: Reviews without any comparator condition reported
Outcomes	Does the review report on brain or MH outcomes	Included: Cognitive function (e.g., memory, attention, executive function). Psychological wellbeing (e.g., anxiety, depression, emotional regulation, self-esteem). Excluded: Non-MH-related outcomes only (e.g., musculoskeletal fitness, nutrition-only outcomes, motor coordination in isolation)
Study design	Is the review secondary research	Included: Systematic reviews, meta-analyses, umbrella reviews, or overview of reviews. Excluded: Primary research (e.g., randomized controlled trials, observational studies). Non-systematic narrative reviews or protocols without results

MH: Mental health; PA: Physical activity.

Table 2 Summary of included studies by intervention type

Ref.	A Measurement Tool to Assess Systematic Reviews	Executive function	Cognitive function	Mental health	Quality of evidence (/4)
Virtual reality
Zhang et al[14]	Moderate	Sufficient evidence in favor	Some evidence in favor	Sufficient evidence in favor	3
Hao et al[15]	Moderate	Sufficient evidence in favor	Some evidence in favor	ND	3
App
Langarizadeh et al[16]	Moderate	ND	Some evidence in favor	Some evidence in favor	3
Exergame
Chen and Wilkosz[17]	High	ND	ND	Some evidence in favor	4
Liang et al[18]	Moderate	Some evidence in favor	Sufficient evidence in favor	Some evidence in favor	3
Internet
Lalanza et al[19]	High	Some evidence in favor	Some evidence in favor	Sufficient evidence in favor	4
Multicomponent
Henderson et al[20]	Moderate	ND	Some evidence in favor	Sufficient evidence in favor	3
Technology-enhanced physical activity
Li et al[21]	Moderate	Some evidence in favor	Sufficient evidence in favor	Some evidence in favor	3
Cognitive bias modification/attention bias modification
Cristea et al[22]	High	ND	Some evidence in favor	Some evidence in favor	4
Unguided/guided digital self-help
Bennett et al[23]	Moderate	ND	Some evidence in favor	Sufficient evidence in favor	3
School-based digital interventions
Hugh-Jones et al[24]	Moderate	Some evidence in favor	ND	Sufficient evidence in favor	3

App represents mobile health application–based intervention; exergame represents gamified or game-based physical activity interventions; internet represents internet-based physical activity modules (e.g., web platform, remote training); multicomponent represents multicomponent interventions combining digital technologies with physical activity. See online Supplementary Table 1 for details. Detailed intervention descriptions and participant characteristics are available in Supplementary Table 3. ND: Not determined.

Table 3 Effects of technology-enhanced physical activity intervention variables on executive function, cognitive function, and mental health

Intervention category	Executive function	Cognitive function	Mental health
Virtual reality	Overall: 1 review (n = 304)1,4	1 review (n = 304)3	1 review (n = 304)3
App	Overall2	2 reviews (n = 978)3	2 reviews (n = 978)5
Augmented reality	Overall2	5	1 review (n = 912)3,5
Heart rate variability	Overall1	ND	2 reviews (n = 795)3
Electroencephalogram	Overall1	ND	1 review (n = 215)3
Comprehensive program	Overall1	1 review (n = 404)3	2 reviews (n = 3299)4
Traditional + online	Overall1	2 reviews (n = 200)3	2 reviews (n = 711)5

¹Indicates positive overall evidence.

²Unclear/mixed evidence.

³Indicates some effect.

⁴Indicates strong effect.

⁵Indicates neutral effect.

Intervention types refer to technology-enhanced physical activity modalities. App represents mobile health application–based intervention. Sample sizes (n) derived from meta-analytic or systematic review synthesis. ND: Not determined.

Table 4 Summary of included systematic reviews and meta-analyses

Ref.	Year	Country	Number of studies	Sample size	Intervention	Outcome measure	Limitations
HughJones et al[24]	2020	United Kingdom	20	20 studies (RCT and non-RCT)	School-based prevention interventions for anxiety (cognitive behavioral therapy, mindfulness, skills training etc.)	Anxiety symptoms reduction (various scales used)	Heterogeneity in setting and delivery
Bennett et al[23]	2019	Multi-country (Mainly United Kingdom, Netherlands, Germany)	NR	N = 3396 (self-help); n = 1100 (face-to-face); n = 2366 (control)	Unguided and guided self-help (bibliotherapy, computerised, online materials)	Depression, anxiety, disruptive behaviour symptoms, treatment acceptability	Lacked EF/CF outcomes
Cristea et al[22]	2015	Multi-country (Mainly Romania, Italy, Netherlands, United States)	NR	23 RCTs, n = 28 per condition	CBM, including attention bias modification and interpretation bias modification (CBM-I)	MH symptoms (anxiety, depression), cognitive bias change, treatment acceptability	Short duration; mostly single-session
Chen and Wilkosz[17]	2014	United States	14	14 studies included; n ranged from 21 to 473 per study	Technology-based interventions (internet-based programs, active video games) focused on diet and PA	BMI, body fat percentage, PA level, dietary behavior, psychosocial outcomes	Mixed tech modalities; small sample
Hao et al[15]	2024	Multi-country (Mainly United States, Australia, Taiwan, United Kingdom, Belgium)	18	18 studies included; n ranged from 8 to 51 per study	Home-based VR rehabilitation (Nintendo Wii, Kinect, customized VR systems, VR-integrated constraint-induced therapy)	Motor function (upper extremity, gross motor), strength, balance, bone density, cognition, daily activity performance, Participation	Cerebral palsy only; small samples
Henderson et al[20]	2025	Multi-country (Mainly Canada, United States, Australia, Europe)	NR	73 RCTs included; Total n = 6305; 53% female	Behavioural and psychological interventions including PA, nutrition, psychological therapy, technology-based, multicomponent interventions	BMI, BMI z-score, weight, health-related quality of life, anxiety, depression, cardiometabolic outcomes (blood pressure, lipids, insulin resistance), adverse events	No subgroup; varied designs
Lalanza et al[19]	2023	Multi-country (Mainly Spain, United States, Netherlands, Australia)	143	143 studies included; n varies across studies	HRV biofeedback with different protocols: Optimal RF, individual RF, preset-pace RF	Cardiovascular health, MH (anxiety, stress reduction), performance outcomes, HRV parameters	Varied tech tools; lacked follow-up
Langarizadeh et al[16]	2021	Multi-country (Mainly United States, Canada, Australia, Italy, Sweden)	9	9 studies included; n = 19 to 361 per study; Total n = 978	Mobile app-based interventions for weight management (diet, PA, behavior change)	Body weight, BMI, waist circumference, fat mass, PA level (step count)	No EF/CF analysis
Li et al[21]	2021	China	NR	50 students in a middle school	Exercise intervention based on medical imaging monitoring; different intensities (low, medium, high) aerobic exercise intervention	Inhibitory control function (stroop task response time and accuracy), cardiopulmonary function, vital capacity, step test index	No control group; varying protocols

BMI: Body mass index; CBM: Cognitive bias modification; CF: Cognitive function; EF: Executive function; HRV: Heart rate variability; MH: Mental health; NR: Not reported; PA: Physical activity; RCTs: Randomized controlled trials; RF: Radio frequency; VR: Virtual reality.