DE-PASS best evidence statement (BESt): determinants of adolescents’ device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis
Authors: Kolovelonis Athanasios , Syrmpas Ioannis , Marcuzzi Anna , Khudair Mohammed , Ng Kwok , Tempest Gavin Daniel , Peric Ratko , Bartoš František , Maier Maximilian , Brandes Mirko , Carlin Angela , Ciaccioni Simone , Cortis Cristina , Corvino Chiara , Di Credico Andrea , Drid Patrik , Gallè Francesca , Izzicupo Pascal , Jahre Henriette , Kongsvold Atle , Kouidi Evangelia , Mork Paul Jarle , Palumbo Federico , Rumbold Penny Louise Sheena , Sandu Petru , Stavnsbo Mette , Vilela Sofia , Woods Catherine , Wunsch Kathrin , Capranica Laura , MacDonncha Ciaran , Ling Fiona Chun Man ,   on behalf of DE-PASS
Published: June 2024

Abstract
Background
Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents’ device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings.

Methods
A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents’ device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked. PROSPERO ID: CRD42021282874.

Results
Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual–psychological, four individual–behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found.

Conclusions
Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents’ device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents’ PA/SB, including policy and environmental variables.