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@ARTICLE{McDermott:277910,
      author       = {K. T. McDermott and C. Noake and R. Wolff and L. Bauld and
                      C. Espina and J. Foucaud and K. Steindorf$^*$ and M. A.
                      Thorat and M. P. Weijenberg and J. Schüz and J. Kleijnen},
      title        = {{D}igital interventions to moderate physical inactivity
                      and/or nutrition in young people: a {C}ancer {P}revention
                      {E}urope overview of systematic reviews.},
      journal      = {Frontiers in digital health},
      volume       = {5},
      issn         = {2673-253X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2023-01569},
      pages        = {1185586},
      year         = {2023},
      abstract     = {Strategies to increase physical activity (PA) and improve
                      nutrition would contribute to substantial health benefits in
                      the population, including reducing the risk of several types
                      of cancers. The increasing accessibility of digital
                      technologies mean that these tools could potentially
                      facilitate the improvement of health behaviours among young
                      people.We conducted a review of systematic reviews to assess
                      the available evidence on digital interventions aimed at
                      increasing physical activity and good nutrition in
                      sub-populations of young people (school-aged children,
                      college/university students, young adults only (over 18
                      years) and both adolescent and young adults (<25
                      years)).Searches for systematic reviews were conducted
                      across relevant databases including KSR Evidence
                      (www.ksrevidence.com), Cochrane Database of Systematic
                      Reviews (CDSR) and Database of Abstracts of Reviews of
                      Effects (DARE; CRD). Records were independently screened by
                      title and abstract by two reviewers and those deemed
                      eligible were obtained for full text screening. Risk of bias
                      (RoB) was assessed with the Risk of Bias Assessment Tool for
                      Systematic Reviews (ROBIS) tool. We employed a narrative
                      analysis and developed evidence gap maps.Twenty-four reviews
                      were included with at least one for each sub-population and
                      employing a range of digital interventions. The quality of
                      evidence was limited with only one of the 24 of reviews
                      overall judged as low RoB. Definitions of 'digital
                      intervention' greatly varied across systematic reviews with
                      some reported interventions fitting into more than one
                      category (i.e., an internet intervention could also be a
                      mobile phone or computer intervention), however definitions
                      as reported in the relevant reviews were used. No reviews
                      reported cancer incidence or related outcomes. Available
                      evidence was limited both by sub-population and type of
                      intervention, but evidence was most pronounced in
                      school-aged children. In school-aged children eHealth
                      interventions, defined as school-based programmes delivered
                      by the internet, computers, tablets, mobile technology, or
                      tele-health methods, improved outcomes.
                      Accelerometer-measured (Standardised Mean Difference [SMD]
                      0.33, $95\%$ Confidence Interval [CI]: 0.05 to 0.61) and
                      self-reported (SMD: 0.14, $95\%$ CI: 0.05 to 0.23) PA
                      increased, as did fruit and vegetable intake (SMD: 0.11,
                      $95\%$ CI: 0.03 to 0.19) (review rated as low RoB, minimal
                      to considerable heterogeneity across results). No difference
                      was reported for consumption of fat post-intervention (SMD:
                      -0.06, $95\%$ CI: -0.15 to 0.03) or sugar sweetened
                      beverages(SSB) and snack consumption combined
                      post-intervention (SMD: -0.02, $95\%$ CI:-0.10 to 0.06),or
                      at the follow up (studies reported 2 weeks to 36 months
                      follow-up) after the intervention (SMD:-0.06, $95\%$ CI:
                      -0.15 to 0.03) (review rated low ROB, minimal to substantial
                      heterogeneity across results). Smartphone based
                      interventions utilising Short Messaging Service (SMS), app
                      or combined approaches also improved PA measured using
                      objective and subjective methods (SMD: 0.44, $95\%$ CI: 0.11
                      to 0.77) when compared to controls, with increases in total
                      PA [weighted mean difference (WMD) 32.35 min per day, $95\%$
                      CI: 10.36 to 54.33] and in daily steps (WMD: 1,185, $95\%$
                      CI: 303 to 2,068) (review rated as high RoB, moderate to
                      substantial heterogeneity across results). For all results,
                      interpretation has limitations in terms of RoB and presence
                      of unexplained heterogeneity.This review of reviews has
                      identified limited evidence that suggests some potential for
                      digital interventions to increase PA and, to lesser extent,
                      improve nutrition in school-aged children. However, effects
                      can be small and based on less robust evidence. The body of
                      evidence is characterised by a considerable level of
                      heterogeneity, unclear/overlapping populations and
                      intervention definitions, and a low methodological quality
                      of systematic reviews. The heterogeneity across studies is
                      further complicated when the age (older vs. more recent),
                      interactivity (feedback/survey vs. no/less
                      feedback/surveys), and accessibility (type of device) of the
                      digital intervention is considered. This underscores the
                      difficulty in synthesising evidence in a field with rapidly
                      evolving technology and the resulting challenges in
                      recommending the use of digital technology in public health.
                      There is an urgent need for further research using
                      contemporary technology and appropriate methods.},
      subtyp        = {Review Article},
      keywords     = {cancer (Other) / diet (Other) / digital health (Other) /
                      evidence appraisal (Other) / evidence synthesis (Other) /
                      physical activity (Other) / public health (Other) /
                      systematic reviews (Other)},
      cin          = {C110},
      ddc          = {610},
      cid          = {I:(DE-He78)C110-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37534029},
      pmc          = {pmc:PMC10393256},
      doi          = {10.3389/fdgth.2023.1185586},
      url          = {https://inrepo02.dkfz.de/record/277910},
}