## 4 Discussion  
This study found that participation in an ICT-based health promotion service for 24 weeks significantly improved physical fitness in adolescents, such as the 20 m shuttle run, grip strength, long jump, and sit-ups. Notably, MPA, VPA, and MVPA physical activity significantly increased after 24 weeks. Furthermore, there were body composition, physical fitness, and physical activity differences among adolescents living in urban or rural areas. The rapidly developing ICT-enabled healthcare is a promising healthcare delivery system with unprecedented usage [19]. In chronic diseases, various self-management devices allow patients to monitor their health status in real-time outside specialized clinics [20]. Moreover, digital health interventions are essential in the global fight against infectious diseases caused by COVID-19 [21]. For example, 313 children and their parents participated in a 6-month mobile health technology program designed to help parents achieve a healthy weight and body fat for their children and improve their eating habits and physical activity. There were significant intervention effects on mean composite scores comprised of diet and physical activity variables, and these effects were more pronounced in children with a high-fat mass index [22]. Similarly, a 12-month randomized controlled trial study of digital health interventions found significant and sustained improvements in physical capacities and body composition. This adolescent-appealing mobile health intervention offered a compelling approach for obese adolescents with limited access to health services [23]. Homecare users (receiving a tablet with a fitness app and an activity tracker [treatment group]) strongly agreed that after four months, they increased their regular physical activity by 28 percentage points (\(p<0.001\); 95% CI: 0.20, 0.36) and reported exercising at least once a week by 45 percentage points (\(p<0.001\); 95% CI: 0.32, 0.57) [24]. In this study, elementary and middle school students participated in a 24-week ICT-based health promotion service, achieving significant increases in physical fitness, such as the 20 m shuttle run, grip strength, long jump, and sit-ups. The increase in height is characteristic of growing adolescents, and the unchanged weight is a positive effect of increased physical activity. MPA, VPA, and MVPA elevated significantly after 24 weeks for male and female adolescents (Figure 3). Previous studies evaluating ICT programs have reported higher participant utilization and retention rates with improvements in body composition and other health-related clinical indicators [25]. Moreover, the proportion of patients achieving 12.5 METs or more was significantly higher in the group receiving information via ICT than in the control group [26]. This improved effectiveness is due to the \"push\" approach, where automatic and specific materials (such as web hyperlinks and personalized feedback) are delivered directly to the participant through personal emails or short message services. This approach makes ICT-based interventions more accessible to participants' existing lifestyles, as they only need to check their email or message services on their cell phones [27]. This study was also designed to collect feedback from adolescents based on ICT to improve their health. These technologies eliminate space and time constraints and can provide and share information with anyone.