Effects of Commercially Available Wearable Devices on Physical Activity Promotion and Health in Children and Adolescents: Systematic Review

Abstract

Children and adolescents do not participate in enough physical activity (PA) to meet the recommended levels, which stops them from benefiting from regular PA’s positive effects on their health. In recent years, technology-based initiatives have provided children and adolescents with a compelling and viable way to encourage PA. Based on the results of previous research, we have conducted this review to gain a better understanding of if and how specific commercially available wearable devices impact physical activity promotion and health in children and adolescents. We have conducted this review, that was based on a theoretical framework of the self-determination theory (SDT), and focused on the impact that wearable devices have on physical activity promotion and health. The electronic databases of Google Scholar, Web of Science, and PubMed were searched between 2010 and 2023 for all available literature. Eleven studies overall satisfied the requirements for inclusion criteria. The sample sizes for the studies ranged from 32 to 502, and they included both boys and girls between the ages of 4 and 14. Wearable technology was used for no less than one week and no more than four months. The current review revealed that commercial wearable activity tracker-based programs among children and adolescents had a positive influence on daily levels of MVPA and step totals, as well as sedentary behavior.

1. Introduction

As these are the years in which good lifestyle habits can be created and established, childhood and adolescence are seen as delicate times in life [1]. The two most important lifestyle choices for school-aged children during the awake hours are physical activity (PA) and sedentary behavior (SB). Regular PA during childhood and adolescence has numerous positive health effects [2,3,4]. The physical, social, and mental health of adolescents has been shown to improve with increased PA levels [3,5]. According to WHO guidelines, children and adolescents should engage in at least 60 minutes per day of MVPA (moderate-to-vigorous physical activity). For children to achieve the aforementioned criteria, a range of PA activities should be taken part in (standard school PE, organized sport practice, engaged play, active modes of transportation, etc.) [6]. To determine when and for how long a child or an adolescent is active and inactive throughout the course of a typical day, it is optimal to monitor their PA while they are living their normal lives [7]. In recent decades, studies on motivation in physical education have increasingly been presented in terms of physical activity levels and health [8,9]. Self-determination theory (SDT) is a comprehensive theory on motivation and social development and has gained significance in the field of physical education research during recent years. It has been employed to help researchers understand the motivating effects of digital technology on young people’s physical activity habits. It is a theoretical framework that has been frequently used in the study of youth physical activity [10,11,12]. According to SDT, in order to ensure that children and adolescents are psychologically satisfied with their innate needs for autonomy, competence, and relatedness in physical education, it is essential to be supportive and build strong relationships with the children. Commercial wearable fitness trackers and their accompanying applications have been shown to increase physical activity levels in children and adolescents and have an effect on the motivational concepts of healthy lifestyle motivation, challenge, connection, and enjoyment [13]. One of the most popular fitness trends in recent years has been wearable activity devices, and various age groups have reported considerable acceptance [14]. Wearable activity trackers are technological devices that use sensors to measure movement and collect biometric data [15]. Obviously, researchers and professionals are interested in the prospects that consumer wearable technology offers to promote PA [16,17]. The real-time feedback and competitive Fitbit features have also been praised by children and adolescents, who find them to be motivating [18]. This suggests that encouraging self-monitoring and goal-setting behaviors can lead to an increase in physical activity levels [15,19]. Using self-monitoring to encourage the adoption of particular healthy habits, such as PA, is an efficient technique for behavior change [20].

The first wearable health gadget that was commercially available and had the potential for wide accessibility was the Fitbit, which arrived in 2007. Nowadays, there are numerous types of health wearables available, each with slightly different functional characteristics. However, the majority of them include data on burned calories, heart rate, steps walked, and floors climbed [21], and allow consumers to monitor their data [22,23]. The great expansion of the use of wearables in different areas of life in children and adolescents has been observed in recent years. These wearable devices have become increasingly popular among young individuals for various purposes. Nevertheless, we are still investigating their efficacy in improving PA, health, and preventing obesity and other non-communicable diseases in children and adolescents. It is important to look into how effective wearable technology is as a physical activity intervention. Additionally, we are unsure whether a certain item is superior to others. Therefore, the purpose of this review was to determine the effects of commercially available wearable devices on physical activity promotion and health in children and adolescents.

2. Materials and Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement standards were followed for conducting this study [24].

2.1. Search Strategy

The electronic databases of Google Scholar, Web of Science, and PubMed were searched for all available literature between 2010 and 2023. The following search terms were identified: “healthy children” or “healthy adolescents” and “wearable devices” or “portable sensors” or “pedometers” or “accelerometers” and “physical activity” or “physical exercise” and “physical education” or “school”.

2.2. Eligibility Criteria

The included studies were based around wearable technology and physical activity outcomes in preschool and school settings and were written in English, published in a peer-reviewed journal, and assessed physical activity promotion in children and adolescents in all school environments (playtime, physical education programs, and school sports). Review articles, such as qualitative reviews, systematic reviews, and meta-analyses, were not taken into account, nor were theses, dissertations, congress abstracts, or proceedings. The research design, goal, subjects, methods, and conclusions of all the studies that were part of the systematic review served as the framework for the data collected.

2.3. Data Collection

The complete examination revealed 474 publications, as can be seen in Figure 1. Twenty-nine studies passed an initial screening and were accepted for examination; those that failed to fulfill the inclusion criteria (such as the intervention approach or conflicting data on research methods) were eliminated. Finally, 11 studies were included in the qualitative analysis. These studies ranged in publication date from 2017 (the earliest) to 2020 (the most recent). The publications that were included in this collection gathered data on sample size, age, wearable technology, measurements, key findings, and conclusions.

2.4. Data Extraction

The titles and abstracts were examined separately by two researchers (G.D. and R.H.). Potentially pertinent papers were found, and full texts of those articles were then obtained for independent evaluation in accordance with the inclusion criteria. Any discrepancies were settled by consensus or, if required, discussion with a third reviewer (S.S.). Both reviewers (G.D. and R.H.) independently extracted data from each paper that was included. Any inconsistencies of results were discussed and compared.

3. Results

3.1. Description of the Studies

All of the details regarding the papers that made up the review are shown in

Table 1. Characteristics of the studies included in the review.

Reference	Sample/Age (Years)	Devices	Findings	Conclusion
Kerner and Goodyear (2017) [31]	n = 84 (44 girls, 40 boys) Age 13–14 years	Wrist-worn Fitbit Charge	Motivation for PA and psychological need satisfaction while wearing the Fitbit for 8 weeks.	Need satisfaction ↑ Self-determined forms of motivation ↑ Motivation for PA ↓
Evans et al. (2017) [25]	n = 32 Age 10.0 years	Wrist-worn Fitbit Charge	Differences between 3 groups over 4 (phase 1) and 6 weeks (phase 2) in MVPA or steps from initial to final measurement.	Adherence for the wrist- worn Fitbit ↑ Average daily steps →↑ Level of usual MVPA →
Gaudet et al. (2017) [33]	n = 46 Age 13–14 years	Wrist-worn Fitbit Charge	Changes in MVPA as a result of wearing PA tracker for 7 weeks.	Daily average of MVPA in adopters subgroup ↑ Daily average of MVPA in preadopters subgroup → MVPA at different stages of behavior change →
Müller et al. (2018) [34]	n = 59 (34 girls and 25 boys) Age 4–9 (7.1 ± 1.7) years	Wearable bracelet Garmin vivofit Jr.	Assessment of general feasibility and PA levels among children.	Daily PA and steps + 60 min of MVPA per day on a weekly average +
Ridgers et al. (2018) [28]	n = 60 Ag 13–14 years	Wrist-worn Fitbit Flex	Examination of the usability and acceptability of a PA tracker among adolescents for 6 weeks.	Awareness of PA levels + Tracking daily PA + Using technology in health promotion program + Opportunity to promote PA to adolescents +
Byun et al. (2018) [26]	n = 93 girls Age 4–5 years	Fitbit Flex	Sedentary behavior (SED), PA, demographic and anthropometric characteristics, parental perspective of child’s PA, and intervention acceptability were measured for control and intervention group, for a 1-week period.	Acceptability from teachers and parents + Level of SED ↓ Level of total MVPA + Level of children’s PA in school + Number of in-school PA opportunities + Promoting PA to prevent obesity in children +
Stradze et al. (2019) [35]	n = 502 (235 girls and 267 boys) Age 8–14	Wrist bracelet tracker Xiaomi Mi Band 3	Assessment of results for motor activity of schoolchildren of both sexes by using wearable PA trackers for 30 calendar days.	Duration of PA + Improvement of the tolerance to physical and mental stress + Strengthening the cardiovascular and respiratory system + Individualization of PE classes +
Kerner et al. (2019) [32]	n = 62 (24 girls and 38 boys) Age 13–14 years	Fitbit Charge	The impact of wearing a Fitbit for 5 weeks on the body satisfaction, physical activity motivation, and objective physical activity of adolescents.	Autonomous motivation for PA ↓ Amotivation and controlled motivation for PA ↑ Changes in MVPA ↓
Voskuil et al. (2020) [27]	n = 33 inactive girls Age 14.62 ± 0.60 years	Fitbit Flex 2TM wrist-worn band; Fitbit survey	Average daily steps, miles, and minutes of MVPA among inactive adolescent girls for 1 week.	Awareness of PA + Setting goals for PA + Motivation to do more than 10000 steps +
Koorts et al. (2020) [29]	n = 275 Age 13 years	Wrist-worn Fitbit Flex	The increase of MVPA during 12-week RAW-PA study among inactive adolescents.	RAW-PA acceptability ↑ Effects on PA motivation and awareness ↑ Engagement in and adherence to PA ↓
Drehlich et al. (2020) [30]	n = 124 Age 13–14 years	Wrist-worn Fitbit Flex	Adolescents’ acceptance of PA trackers (Fitbit Flex) and social media (Facebook) combined with a PA over 12-week intervention.	Impact of wearable activity trackers on PA ↑ Recognized the potential usefulness of the WD + Motivation among adolescents for PA ↑

↑—increase/improvement; ↓—decrease/decline; →—no significant changes; +—feasible, useful, effective; PA—physical activity; MVPA—moderate to vigorous physical activity; BCT—behavior change techniques; SED—sedentary behavior; RAW-PA—Raising Awareness of Physical Activity; WD—wearable devices.

. Boys and girls in the age range of 4 to 14 years made up the sample sizes for the studies, which ranged from 32 to 502. The overall number of participants was 1370. Wearable technology was used for a minimum of one week and a maximum of six months. The sample was selected from studies conducted in seven different countries, including three in the United States [25,26,27], three in Australia [28,29,30], two in the United Kingdom [31,32], and one each in Canada [33], Germany [34], and Russia [35]. In terms of the wearable technology used in the studies, the wrist-worn Fitbit Flex accounted for 45.45% (n = 5) of the investigations, the wrist-worn Fitbit Charge accounted for 36.36% (n = 4), as well as the wearable bracelet Garmin vivofit Jr. (n = 1) and the wrist bracelet tracker Xiaomi Mi Band 3 (n = 1). Of all the study participants, 100% (n = 1370) wore the device on their wrist or arm.

To assess motivation for PA, the authors used self-monitoring and goal setting for PA in 27.27% of the investigations (n = 3), The Behavioural Regulations in Exercise Questionnaire II was in 18.18% of studies (n = 2), The Behavior Change Technique Questionnaire (n = 1), and the child-oriented questionnaire (n = 1), questionnaire for teachers and children’s parents (n = 1), Fitbit survey (n = 1), web-based survey (n = 1), and a combination of WD and social media (Facebook) (n = 1) were also used.

3.2. Characteristics of the Devices

Fitbit Flex, Fitbit Charge, Garmin Vivofit Jr., and Xiaomi Mi Band are wireless, water-resistant, and waterproof devices that can be worn as a tiny bracelet to easily measure daily activity, exercise, and sleep. They make advanced health and fitness monitoring easier with programmed all-day activity, exercise, and sleep tracking to demonstrate how the entire day adds up, keeping individuals motivated and accountable to reach their goals. Users may measure their daily physical activity, including steps taken, floors climbed, calories burnt, and the number of hours they slept, with the help of these wristband devices that collect step counts and heart rate data. Only the Garmin Vivofit Jr. is made specifically for children and tracks the suggested 60 minutes of activity each day as well as steps, sleep, and other activities.

3.3. Physical Activity in Children Using Wrist-Worn Fitbit Flex

In this systematic review, the Fitbit Flex wearable device was used in five studies (45.45%) by Ridgers et al. [28], Byun et al. [26], Voskuil et al. [27], Koorts et al. [29], and Drehlich et al. [30]. The study conducted by Ridgers et al. [28] investigated the use of a wearable device for activity tracking among adolescents. Adolescents claimed that the Fitbit Flex was simple to use and a helpful tool for keeping track of everyday activities. By utilizing a monitoring system and teacher’s behavior, Byun et al. [26] concluded that the intervention improved the physical activity (PA) of preschoolers and contributed to the prevention of childhood obesity. The research by Voskuil et al. [27] assessed whether inactive adolescent girls found the Fitbit Flex 2TM activity tracker and application to be acceptable and usable. A more sophisticated tracker with a screen display and improved reliability for gathering PA data is advised to increase usability in future studies, even though we judged the acceptance of the Fitbit Flex 2TM and application to be satisfactory. The authors in [29] evaluated the Raising Awareness of Physical Activity (RAW-PA) research, a wearable technology intervention aimed at increasing physical activity among adolescents. The aim of the study by Drehlich et al. [30] was to determine, using the technology acceptance model, whether adolescents will accept the use of wearable activity trackers together with social media as part of a physical activity intervention.

3.4. Physical Activity in Children Using Wrist-Worn Fitbit Charge

The wrist-worn Fitbit Charge wearable device is used in four studies (36.36%) by Kerner et al. [31], Evans et al. [25], Kerner et al. [32], and Gaudet et al. [33]. The authors [31] examined how wearable devices for a healthy lifestyle affected adolescents’ (10- to 14-year-olds’) motivation for physical activity. Data show that the Fitbit served as a source of internal pressure (guilt) as well as external pressure (goal achievement). Evans et al. [25] evaluated the preliminary effectiveness, viability, and acceptability of using wearable PA monitors to increase PA in schoolchildren. The findings indicate that wearable physical activity monitors may not improve physical activity when used in combination with goal setting and incentives. Accelerometers were given to students in the study by Kerner et al. [32] to assess the level of physical activity before and after using the Fitbit Charge HR. MVPA modifications were assessed pre and post Fitbit. Even with motivation increasing and autonomous motivation decreasing, MVPA also significantly decreased by almost 9 minutes each day. In the third study by Gaudet et al. [33], the main goal was to examine whether young adolescents would engage in more physical activity as a result of a modest physical activity tracker-based intervention. The findings imply that using a physical activity tracker may encourage early adolescents who are ready to be active to engage in better physical-activity-related behavior.

3.5. Physical Activity in Children Using the Wearable Bracelet Garmin Vivofit Jr.

In addition to wearable devices, wearing the Garmin Vivofit Jr. wristband motivated children to increase their PA. Even among kindergarten and elementary school children, wearable wristbands appear to be practical tools for PA assessment [34].

3.6. Physical Activity in Children Using the Wrist Bracelet Tracker Xiaomi Mi Band 3

The researchers [35] were able to draw the following conclusions from the study regarding the efficacy of using a fitness tracker to accomplish related tasks, such as the implementation of current and practical controls over the amount and intensity of children’s physical activity, taking into account all types of classes.

3.7. Motivation for Physical Activity

Self-monitoring and goal setting for PA were used in three studies (27.27%) by Evans et al. [25], Ridgers et al. [28], and Stradze et al. [35]. Teenagers frequently stated that they liked exploiting features that allowed them to track and receive feedback on their sleep, steps, distance traveled, and calories burned. The Behavioural Regulations in Exercise Questionnaire II was used in two studies (18.18%) by Kerner et al. [31] and Kerner et al. [32]. To evaluate motivation for physical activity, the questionnaire was modified to change the word “exercise” to “physical activity”. It has 19 elements in total, which correspond to five distinct subscales, including amotivation, external regulation, introjected regulation, identified regulation, and intrinsic regulation. The Behavior Change Technique Questionnaire was used by researchers [33] to demonstrate how self-monitoring may result in a beneficial change in behavior associated with physical exercise when combined with at least one additional self-regulation ability. Müller et al. [34] used a child-oriented questionnaire in which children had to answer five questions regarding the wearable device. Byun et al. [26] monitored real-time PA with a self-reported questionnaire for teachers and children’s parents. The parents or teachers of each child filled out a self-reported questionnaire on a five-point Likert scale to share their opinions on the child’s PA level in relation to other kids, PA quantity, and PA satisfaction. A Fitbit survey was used by Voskuil et al. [27] to examine if the participants liked using this wearable device. A web-based survey at baseline and postintervention was used in study by Koorts et al. [29] to perceive the impact of RAW-PA on children and adolescents. The combination of WD and social media (Facebook) within a PA intervention was used by Drehlich et al. [30] in order to promote a healthy lifestyle among children and adolescents.

4. Discussion

Due to the increased interest of children and adolescents in modern technologies and wearable devices, the purpose of this review was to examine whether commercially available wearable devices have an impact on physical activity and health in children and adolescents. In 11 studies, the authors used four different commercially available wrist-wearable activity devices. In general, wearable technology may be used as a motivating tool to enhance PA behaviors and evaluate PA programs, in accordance with previous research [30,32]. Only two studies were not able to identify an increase in PA in children and adolescents [31,32]. Different questionnaires that were modified for children, their parents, and teachers were used to assess PA motivation [25,26,27,28,29,30,31,32,33,34,35]. The findings indicate that technology promoting a healthy lifestyle may cause negative motivation and autonomous motivation for PA and a decrease in changes in MVPA after wearing the Fitbit. These motivational results have been attributed to aspects of the Fitbit that interfere with pupils’ basic psychological needs [31]. The decrease in autonomous motivation may have contributed to the decrease in MVPA, according to self-determination theory [36]. In a large number of the included studies, an increased motivation for physical activity has been observed after using pedometers or accelerometers. The analysis of the obtained results shows an increase in daily steps, the daily average of MVPA, daily PA, RAW-PA acceptability, usefulness, ease of use, and motivation among adolescents [26,27,28,29,30,34,35]. In one of the studies [25], the average daily step count and degree of usual MVPA did not show any changes. In the second study [33], the daily average of MVPA in the adopters group demonstrated improvement, but there were no changes in the preadopters group. The inactive teen girls became more conscious of their physical activity thanks to activity monitors and apps, which also assisted them in setting objectives and motivated them to walk further [27]. Adolescents demonstrated good acceptance of the Raising Awareness of Physical Activity (RAW-PA) program, which aims to increase their physical activity [29].

Numerous behavior-change techniques (BCTs) that have been previously proved to promote adult physical activity (PA) are included in wearable activity trackers. The results have shown that wearable devices are capable of capturing and processing parameters of physical activity such as sleep duration and quality or heart rate. The device automatically calculates parameters such as the length of time spent in the aerobic and anaerobic zones, as well as the duration of physical work at the maximum oxygen consumption level, based on the collected data. Tracking these parameters is important for the good health of young individuals. The use of wearable devices can improve the strength of the cardiovascular and respiratory systems [35]. The findings demonstrate that increasing PA can reverse the child obesity pandemic since children in the intervention group had considerably lower levels of SED and higher levels of total PA than children in the control group [26]. These technologies have shown good results in health promotion programs [28]. Since there are more factors that can be investigated with an accelerometer than a pedometer, they are used more commonly by researchers and in clinical settings. Unlike pedometers, which only track the distance walked by the number of steps, accelerometers allow us to assess the frequency, duration, and intensity of PA [37]. In terms of activity count (number of steps) and energy expenditure in various demographics (healthy and chronically sick populations), both devices demonstrated good validity [38,39]. Vigorous (or greater) physical activity is a stronger predictor of vascular function [40], cardiorespiratory fitness [41,42,43,44], or body fat [45,46,47].

There are certain limitations that need to be acknowledged in this systematic review. Firstly, the majority of the articles analyzed only used pedometers and accelerometers to evaluate children’s levels of physical exercise in preschool and school environments. Lastly, only one study considered the impact of WDs on reducing obesity. Although the inclusion of varied demographics, sample sizes, types of interventions, and study designs helped in the generalizability of results, it also produced a considerable amount of variability. While a higher number of studies examined feasibility and usefulness, only a small number actually included interventions that required wearing wearable devices for an extended length of time. Finally, user-based activity monitors have occasionally been employed to both objectively quantify PA and to keep participants motivated throughout interventions. This could bias results by increasing participants’ accurate PA levels in the control group or at baseline evaluations. In the future, research on trends in PA time in schools and preschools could use a comparable procedure that involves assessing PA subjectively initially, then monitoring PA objectively. For the purpose of developing procedures and public health recommendations, more research is required to examine these problems among children and adolescents.

5. Conclusions

Wearable technology usage had a favorable effect on children’s and adolescents’ levels of physical activity as measured by objective methods and had an impact on sedentary behavior. According to the current review, consumer-wearable activity-tracker-based programs among children and adolescents had a positive influence on daily total steps and objectively measured daily levels of MVPA. This review found that the results in two studies [31,32] did not show an increase in PA motivation. On the contrary, a significant number of the studies included revealed some indication that wearables can improve steps and MVPA and decrease sedentary behavior. There is evidence that some children and adolescents find wearables acceptable; however, their use may be impacted by technological issues, gadget designs, and the novelty effect. Opinions on whether wearables increased PA were divided. The use of wearable features to motivate children and adolescents, increase long-term use, reduce unpleasant feelings, and remove barriers to wearing wearables generally as well as PA involvement should be the subject of future research. This study emphasized the significance of perceived utility, usability, risk, and compatibility for understanding how adolescents interact with such devices. We conclude that accelerometers and pedometers should be used whenever resources allow and it is logistically feasible because they have improved measurement properties for evaluating common movement-related outcomes (for example, MVPA and TPA) for school-based activities for preschool and school-aged children. The results for the Fitbit Zip and Fitbit Flex were based on a relatively large sample of research and were highly encouraging. The best movement-related measuring properties can be found in pedometers (e.g., MVPA and VPA). In light of the imperative need to create novel PA-promoting interventions to stop the epidemic of childhood obesity, more research addressing the insightful findings of this research is required to confirm the preliminary findings of the current intervention’s efficacy. It is important to define the limitations of our review’s findings. A relatively small number of studies met our inclusion standards. It was challenging to come to any firm conclusions in light of this. Additionally, the great diversity of the wearable devices utilized in the included studies in this review cannot be ignored. Further studies are required to find out more about possible additions to physical activity trackers that could increase the levels of physical activity among adolescents at all phases of behavior change and to determine the wearable technology indicators of physical activity that are most useful for treating and preventing childhood and adolescent obesity and other non-communicable diseases. The biggest strength of this review is that it shows the possibility of continually and objectively tracking physical activity throughout school and preschool settings and adolescent interventions.