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A systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activity
Open accessAbstract
BACKGROUND: Progress in mobile health (mHealth) technology has enabled the design of just-in-time adaptive interventions (JITAIs). We define JITAIs as having three features: behavioural support that directly corresponds to a need in real-time; content or timing of support is adapted or tailored according to input collected by the system since support was initiated; support is system-triggered. We conducted a systematic review of JITAIs for physical activity to identify their features, feasibility, acceptability and effectiveness. METHODS: We searched Scopus, Medline, Embase, PsycINFO, Web of Science, DBLP, ACM Digital Library, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the ISRCTN register using terms related to physical activity, mHealth interventions and JITAIs. We included primary studies of any design reporting data about JITAIs, irrespective of population, age and setting. Outcomes included physical activity, engagement, uptake, feasibility and acceptability. Paper screening and data extraction were independently validated. Synthesis was narrative. We used the mHealth Evidence Reporting and Assessment checklist to assess quality of intervention descriptions. RESULTS: We screened 2200 titles, 840 abstracts, 169 full-text papers, and included 19 papers reporting 14 unique JITAIs, including six randomised studies. Five JITAIs targeted both physical activity and sedentary behaviour, five sedentary behaviour only, and four physical activity only. JITAIs prompted breaks following sedentary periods and/or suggested physical activities during opportunistic moments, typically over three to four weeks. Feasibility challenges related to the technology, sensor reliability and timeliness of just-in-time messages. Overall, participants found JITAIs acceptable. We found mixed evidence for intervention effects on behaviour, but no study was sufficiently powered to detect any effects. Common behaviour change techniques were goal setting (behaviour), prompts/cues, feedback on behaviour and action planning. Five studies reported a theory-base. We found lack of evidence about cost-effectiveness, uptake, reach, impact on health inequalities, and sustained engagement. CONCLUSIONS: Research into JITAIs to increase physical activity and reduce sedentary behaviour is in its early stages. Consistent use and a shared definition of the term 'JITAI' will aid evidence synthesis. We recommend robust evaluation of theory and evidence-based JITAIs in representative populations. Decision makers and health professionals need to be cautious in signposting patients to JITAIs until such evidence is available, although they are unlikely to cause health-related harm. REFERENCE: PROSPERO 2017 CRD42017070849.
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“Beyond connectivity and feasibility, the advantages of AI chatbot programs lie essentially in the computational power to develop and deliver personalized interventions [22-24].”
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“Furthermore, rapid progress in mobile health technologies and functions has enabled the design of just-in-time adaptive interventions (JITAIs) [24].”
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“Similar to Hardeman and colleagues’ recent review of JITAIs to promote physical activity [10], as research into JITAIs is in its early stages (both in terms of the quality of current implementations and the strength of available evidence), it is premature to comment on the effectiveness of JITAIs for reducing harmful…”
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“Made possible by N-of-1 methodologies [54], this goal has been recently pursued by using control systems engineering approaches [55] and just-in-time adaptive interventions [56], among others.”
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“[83] reported that goal setting, action planning, discrepancy between current behavior and goal, feedback on behavior, prompts and cues, social reward, and instruction on how to perform a behavior were present in effective just-in-time adaptive interventions targeting physical activity.”
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“JITAIs have been shown to diminish sedentary behaviours and increase physical activity in individuals with obesity [51, 52], and a trial is underway to test a JITAI aimed at preventing lapses in healthy eating behaviour [53].”
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“Furthermore, there is empirical evidence that just-in-time interventions [19,20], individualized or tailored interventions [21], and interventions that incorporate multiple BCTs [22] show large potential in this respect.”
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“Research on JITAIs has, to date, been limited to young or middle-aged populations and community settings such as the workplace, universities, and secondary care [16]; none has targeted older adults in a free-living setting.”
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“As such, JITAIs are effective for weight management in non-pregnant women [58] and show promise in pregnant women with type 1 diabetes [30].”
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MethodIn Vitro Killing of Schistosomula of Schistosoma Mansoni by BCG and C. Parvum-Activated Macrophages
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“…personalized, for example, just-in-time adaptive interventions, where participants are prompted with messages suited to them, based on data (e.g., Hardeman et al., 2019), expectations of enactment are likely to be higher, and monitoring whether participants enact the BCTs tailored precisely to…”
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“More specifically, JITAIs adapt the provision of intervention content (eg, the type, timing, and intensity) by measuring the health condition or patient behavior with mobile technology such as smartphones, sensors, and software analytics to deliver intervention content at the time and in the context that the person ne…”
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“Furthermore, sedentary behavior–triggered EMA can be modified as a methodological system in a JITAI [37].”
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“…approaches, which can be categorized as part of a suite of innovative behavioral approaches such as just-in-time adaptive interventions (18– 20), adds a unique workflow and evidence for achieving more ecologically valid approaches to overcome barriers and accentuate facilitators of…”
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“The just-in-time adaptive intervention (JITAI) is an adaptive intervention design concept, aiming to provide the right type /amount of support at the right time based on an individual’s changing internal and external states [2, 3].”
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“To date, published studies on the effects of just-in-time interventions are limited to physical activity and sedentary behavior, with mixed evidence for intervention effects [13].”
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“Recently, just-in-time adaptive intervention (JITAI) has gained attention and been considered to be an effective strategy in the field of mobile healthcare intervention [6].”
Lee, V. V., Vijayakumar, S., Ng, W. Y., Lau, N. Y., Leong, Q. Y., Ooi, D. S. Q., Su, L. L., Lee, Y. S., Chan, S., Blasiak, A., et al. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00924-6 · Cited by 30
“Nevertheless, a recent systematic review reported that many JITAIs for physical activity lack evaluation of JITAI usage and adoption among representative real-world and clinical populations 29 .”
The Digital Transformation in Health: How AI Can Improve the Performance of Health Systems
Periáñez, Á., del Río, A. F., Nazarov, I., Jané, E., Hassan, M., Rastogi, A., & Tang, D. (2024) · Health Systems & Reform · doi:10.1080/23288604.2024.2387138 · Cited by 44
“14,38 These systems dynamically adapt, allowing rapid innovation cycles to support the deployment of agile and responsive public health and health care systems.”
Yang, C., Huh, J., Mason, T. B., Belcher, B. R., Kanning, M. K., & Dunton, G. F. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-00951-6 · Cited by 29
Implementing the Soil Enrichment Protocol at Scale: Opportunities for an Agricultural Carbon Market
Hammond, A. A. J., Motew, M. M., Brummitt, C. D., DuBuisson, M. L., Pinjuv, G., Harburg, D. V., Campbell, E. E., & Kumar, A. A. (2021) · Frontiers in Climate · doi:10.3389/fclim.2021.686440 · Cited by 28
“As a project developer, Indigo is now undertaking the first implementation of the new baseline approach in the SEP that generates what we term a Just-inTime Adaptive Baseline (JITAB)—inspired by the Just-In-Time Adaptive Intervention approach in behavioral science (NahumShani et al., 2018; Hardeman et al., 2019).”
Ng, A., Wei, B., Jain, J., Ward, E. A., Tandon, S. D., Moskowitz, J. T., Krogh‐Jespersen, S., Wakschlag, L. S., & Alshurafa, N. I. (2022) · JMIR mhealth and uhealth · doi:10.2196/33850 · Cited by 29
“Such homework can take the form of technologically supported just-in-time (JIT) interventions [21], which in the case of maternal stress can enhance effectiveness of stress-reducing techniques.”
BackgroundRohaj, A., & Bulaj, G. W. (2023) · Healthcare · doi:10.3390/healthcare11101469 · Cited by 27
Schroeder, J., Suh, J., Wilks, C. R., Czerwinski, M. P., Munson, S. A., Fogarty, J. A., & Althoff, T. (2020) · International Conference on Pervasive Computing Technologies for Healthcare · doi:10.1145/3421937.3421975 · Cited by 27
Enhancing digital health services: A machine learning approach to personalized exercise goal setting
Fang, J., Lee, V. C. S., Ji, H., & Wang, H. (2024) · Digital Health · doi:10.1177/20552076241233247 · Cited by 39
“6 Building upon the accurate cognitive health assessment provided by IoT devices, machine learning technologies in the digital health service provide personalized exercise guidance tailored to the physical needs of users, 7 and offer achievement rewards by incorporating external incentives (e.g.…”
BackgroundOikonomidi, T., Ravaud, P., LeBeau, J., & Tran, V.-T. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2022.12.006 · Cited by 26
Yfantidou, S., Sermpezis, P., & Vakali, A. I. (2023) · ACM Transactions on Computing for Healthcare · doi:10.1145/3592621 · Cited by 36
“Such reminders fall under the umbrella of Just-in-Time Adaptive Interventions (JITAIs), a ield that has gathered scientiic attention [70] and should be the focus of future work in the ield of ST.”
BackgroundSocial Comparison and Mental Health
Arigo, D., Bercovitz, I., Lapitan, E., & Gular, S. (2024) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-024-00313-0 · Cited by 32
“To our knowledge, social comparison is rarely included as a treatment component in JITAIs for promoting physical health [71] and has not yet been tested in JITAIs for mental health outcomes.”
Suh, J., Howe, E. S., Lewis, R., Hernandez, J., Saha, K., Althoff, T., & Czerwinski, M. P. (2024) · JMIR Mental Health · doi:10.2196/48974 · Cited by 26
“Despite JITAI systems’ potential to provide precision support [27], few studies demonstrate the value of just-in-time (JIT) support in improving user engagement [43,44].”
BackgroundJust-in-Time Adaptive Interventions: Where Are We Now and What Is Next?
Nahum-Shani, I. B., & Murphy, S. A. (2025) · Annual Review of Psychology · doi:10.1146/annurev-psych-121024-044244 · Cited by 35
Reinforcement Learning in Modern Biostatistics: Constructing Optimal Adaptive Interventions
Deliu, N., Williams, J. J., & Chakraborty, B. (2024) · International Statistical Review · doi:10.1111/insr.12583 · Cited by 32
“This distinctive characteristic contributes to its increasing popularity in a variety of behavioral domains, ranging from physical activity [47, 36] and weight management [97] to addictive disorders [42, 39] and smoking cessation [90].”
BackgroundKudinova, A. Y., Brick, L. A. D., Armey, M. F., & Nugent, N. R. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13869 · Cited by 30
Herold, F., Zou, L., Theobald, P., Manser, P., Falck, R. S., Yu, Q., Liu-Ambrose, T. Y. L., Hillman, C. H., Kramer, A. F., Erickson, K. I., et al. (2025) · European Journal of Applied Physiology · doi:10.1007/s00421-025-05858-3 · Cited by 40
“…evidence holds great potential to inform and optimize intervention approaches aimed at promoting PA (e.g. “just-in-time adaptive PA interventions” (Hardeman et al. 2019; Müller et al. 2017; Wunsch et al. 2022)) to break up prolonged sitting with acute bouts of PA (Chueh et al. 2022; Li et al.…”
Cognitive and Affective Mediators of Alcohol-Facilitated Intimate-Partner Aggression
Eckhardt, C. I., Parrott, D. J., Swartout, K. M., Leone, R. M., Purvis, D. M., Massa, A. A., & Sprunger, J. G. (2021) · Clinical Psychological Science · doi:10.1177/2167702620966293 · Cited by 24
Digital encounters: Human interactions in mHealth behavior change interventions
Müssener, U. (2021) · Digital Health · doi:10.1177/20552076211029776 · Cited by 24
“41 The design of just-in-time adaptive interventions 34 in combination with personal preferences and contextual factors allow chatbots to customize the timing, amount, content, and frequency of the intervention by adapting each individual’s internal and external changes over time.”
BackgroundVětrovský, T., Král, N., Pfeiferová, M., Kühnová, J., Novák, J., Wahlich, C., Jaklova, A., Jurková, K., Janek, M., Omcirk, D., et al. (2023) · BMC Public Health · doi:10.1186/s12889-023-15513-1 · Cited by 25
Nicholas, J., Ntoumanis, N., Smith, B. J., Quested, E., Stamatakis, E., & Thøgersen‐Ntoumani, C. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01391-3 · Cited by 26
Budnick, C. J., Stults‐Kolehmainen, M., Dadina, C., Bartholomew, J. B., Boullosa, D. A., Ash, G., Sinha, R., Blacutt, M. E., Haughton, A. D., & Lu, T. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1094288 · Cited by 25
“Conduct just-in-time adaptive interventions (JITAI) (91) to maximize opportunities when people experience “CRAVE moments” (moments when the desire to move is high), and perhaps intervene to promote desires when they are low.”
BackgroundGroarke, J. M., Richmond, J. P., McSharry, J., Groarke, A., Harney, O., Kelly, M. G., & Walsh, J. C. (2020) · JMIR mhealth and uhealth · doi:10.2196/18288 · Cited by 23
“A recent review found that these interventions are acceptable to participants and are often used in combination with the same BCTs as in this study (ie, goal setting, prompts, feedback, and action planning) [52].”
Delobelle, J., Lebuf, E., Dyck, D. V., Compernolle, S., Janek, M., Backere, F. D., & Větrovský, T. (2024) · Digital Health · doi:10.1177/20552076241262710 · Cited by 24
“13,14 Speci fi cally, these interventions adapt in real time to an individual ’ s changing internal (e.g. when an individual is most likely to be receptive and needs it most) and external (e.g. social and environmental context) states.”
BackgroundHealy, S., Patterson, F., Biddle, S., Dumuid, D., Glorieux, I., Olds, T., Woods, C. B., Bauman, A. E., Gába, A., Herring, M. P., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108500 · Cited by 23
“56 The model may also be used as a framework to help elucidate specific temporal elements obscured within the barrier of the ‘lack of time’ for exercise.”
Stults‐Kolehmainen, M., Gilson, T. A., SantaBarbara, N. J., McKee, P. C., Sinha, R., Bartholomew, J. B., Boullosa, D. A., Budnick, C. J., Bueno, F. A., Haughton, A. D., et al. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1033619 · Cited by 28
“These might be conducted as part of justin-time adaptive interventions (JITAI) (87), which attempt to gauge and take advantage of motivation states (i.”
BackgroundHasselman, F. (2023) · Development and Psychopathology · doi:10.1017/s0954579423001281 · Cited by 29
“…will have profound consequences for the design of diagnostic tools and intervention methods as well as the evaluation of the current empirical record (see e.g., Hardeman et al., 2019; Lichtwarck-Aschoff et al., 2012; Nahum-Shani et al., 2017; Olthof et al., 2019; Schiepek, Aichhorn, et al., 2016).”
MethodAdvances and challenges in sensor-based research in mobility, health, and place
Kim, E., Conrow, L., Röcke, C., Chaix, B., Weibel, R., & Perchoux, C. (2023) · Health & Place · doi:10.1016/j.healthplace.2023.102972 · Cited by 21
Domin, A., Uslu, A. S., Schulz, A., Ouzzahra, Y., & Vögele, C. (2022) · JMIR Formative Research · doi:10.2196/35118 · Cited by 24
“Another study reported that the JITAI condition demonstrated a significant improvement in health over the wait-list control condition [13,14].”
BackgroundSporrel, K., Wang, S., Ettema, D., Nibbeling, N., Kröse, B., Deutekom, M. D. L. F., Boer, R. D., & Simons, M. (2022) · JMIR Formative Research · doi:10.2196/35268 · Cited by 19
Cox, D. J., & Jennings, A. M. (2023) · Behavior Analysis in Practice · doi:10.1007/s40617-023-00864-3 · Cited by 21
“…interventions (JITAIs) have been used to increase physical activity, improve dietary patterns and food consumption, and to improve health-related decision making in everyday environments (e.g., Hardeman et al., 2019; Rabbi et al., 2015; Van Dantzig et al., 2013; Van Dantzig et al., 2018).”
Lentferink, A., Noordzij, M. L., Burgler, A., Klaassen, R., Derks, Y. P. M. J., Oldenhuis, H. K. E., Velthuijsen, H., & van Gemert‐Pijnen, J. E. W. C. (2021) · Behaviour and Information Technology · doi:10.1080/0144929x.2021.1876764 · Cited by 21
“The sending of JIT-messages can be highly impactful (Hardeman et al. 2019) but it is only effective when someone is also receptive to the JIT-message (Nahum-”
BackgroundBrons, A., Wang, S., Visser, B., Kröse, B., Bakkes, S. C. J., & Veltkamp, R. C. (2024) · Journal of Medical Internet Research · doi:10.2196/47774 · Cited by 22
Oh, Y. J., Liang, K.-H., Kim, D. D., Zhang, X., Yu, Z., Fukuoka, Y., & Zhang, J. (2025) · Digital Health · doi:10.1177/20552076251324445 · Cited by 19
“55,58 As for linguistic characteristics of user ’ s responses to Exerbot, participants in the relational chatbot condition demonstrated a greater use of total word counts as well as linguistic markers such as fi rst-person pronouns, prepositions, auxiliary verbs, adverbs, and question marks, which…”
Haag, D., Kumar, D., Gruber, S., Hofer, D. P., Sareban, M., Treff, G., Niebauer, J., Bull, C. N., Schmidt, A., & Smeddinck, J. D. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713307 · Cited by 37
“The contextual variables representing these contexts were selected based on tailoring variables typically used according to JITAI literature [21, 27], existing work on momentary determinants of PA [26], and the aktivplan application [90], in which this exploratory work is grounded for motivation…”
Castro, R., Alves, M. R., de Oliveira, C. C. M., Romero, C., Perazzo, H., Simjanoski, M., Kapciznki, F., Balanzá‐Martínez, V., & Boni, R. B. D. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.735624 · Cited by 21
“Overall, the sample size of the included RCTs ranged between 6 (37) and 69,219 (38) participants.”
BackgroundXu, Z., & Smit, E. S. (2023) · Digital Health · doi:10.1177/20552076231183543 · Cited by 18
“Several systematic reviews have reviewed fundamental components of JITAIs and provided useful guidance on designing and testing JITAIs as well as addressing challenges.(5,33) To our knowledge, only one prior meta-analysis assessed the effectiveness of JITAIs, and it only included studies published by February 2018.”
BackgroundAllender, S. E., Hayward, J., Gupta, S., Sanigorski, A. J., Rana, S., Seward, H. G., Jacobs, S., & Venkatesh, S. (2020) · npj Digital Medicine · doi:10.1038/s41746-019-0205-y · Cited by 18
“5 A second machine learning technique, reinforcement learning, has been used in “ just-in-time ” adaptive intervention (JITAI) optimisation 6 starting with individual user/patient data to select from a set of possible interventions.”
MethodAbusamaan, M. S., Ballreich, J., Dobs, A., Kane, B., Maruthur, N., McGready, J., Riekert, K., Wanigatunga, A. A., Alderfer, M., Alver, D., et al. (2024) · Trials · doi:10.1186/s13063-024-08177-8 · Cited by 16
“Studies on JITAIs have demonstrated their effectiveness in promoting behavior change for various goals, including weight loss and physical activity, and across various patient demographics [26–36].”
BackgroundSimpson, A., Beauchamp, M. R., Dimmock, J. A., Willis, C., & Jackson, B. (2025) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2025.102918 · Cited by 23
Metadata
- Authors
- Hardeman, W., Houghton, J., Lane, K., Jones, A., & Naughton, F.
- Affiliations
- University of East Anglia (GB)
- Corresponding author
- Hardeman, Wendy
- Venue
- International Journal of Behavioral Nutrition and Physical Activity
- Published
- 2019-04-03
- Volume
- 16
- Issue
- 1
- Pages
- 31-31
- ISSN
- 1479-5868 (ISSN-L)
- PMC
- PMC6448257
- OpenAlex
- W2924472360
- Cited by
- 396
- References
- 48
- Citations by year
- 2026: 70 · 2025: 79 · 2024: 72 · 2023: 61 · 2022: 41 · 2021: 45 · 2020: 22 · 2019: 4
- FWCI
- 5.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- Wellcome Trust
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research
- British Heart Foundation
- Centre for Diet and Activity Research
- Medical Research Council (MR/K023187/1)
- Economic and Social Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- just-in-time adaptive interventions, physical activity promotion, mobile health, sedentary behavior, behaviour change techniques, intervention feasibility and acceptability, sensor reliability, theory-based intervention, health disparities, cost-effectiveness, sustained engagement, goal setting, action planning
- MeSH terms
- Behavior Therapy, Cost-Benefit Analysis, Health Promotion, Humans, Exercise, Sedentary Behavior
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