Cited by 396Mobile Health and mHealth ApplicationsPhysical Activity and HealthDigital Mental Health Interventions

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A systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activity

Open access

Hardeman, Wendy, Houghton, Julie, Lane, Kathleen, Jones, Andy, Naughton, Felix·2019·International Journal of Behavioral Nutrition and Physical Activity

DOI 10.1186/s12966-019-0792-7PMC PMC6448257

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Abstract

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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Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
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“Finally, we extracted data about the following outcomes: feasibility, acceptability, engagement [17], effectiveness and health-economic outcomes.”
Method
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“On this basis, we excluded some studies [22, 23, 40] which others described as JITAIs.”
BackgroundResult
A meta-analysis of computer-tailored interventions for health behavior change
Krebs, P., Prochaska, J. O., & Rossi, J. S. (2010) · Preventive Medicine · doi:10.1016/j.ypmed.2010.06.004 · Cited by 854 · cited 1×
“We adopt the Naughton [9] definition and define behavioural JITAIs as having three key features: 1) The intervention aims to provide behavioural support that directly corresponds to a need in real time when the user is at risk of engaging in a negative health behaviour or has an opportunity to engage in a positive beh…”
Method
Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist
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Show all 48 references

Research works printed but not linked: 2

Nahum-Shani S, Smith S, Tewari A, Witkiewitz K, Collins LM, Spring B, et al. Just-in-time adaptive interventions (JITAIs): An organizing framework for ongoing health behavior support. (Technical Report No. 14–126). University Park, PA: The Methodology Center, Penn State; 2014.
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“33 Finally, just- in-time adaptive interventions (JITAIs) have been applied in various fields including addictions treatment, 34,35 physical activity, 36 obesity 37 and depression.”
One SMS a day keeps the stress away? A just‐in‐time planning intervention to reduce occupational stress among apprentices
Schenkel, K., Haug, S., Castro, R. P., Lüscher, J., Scholz, U., Schaub, M. P., & Radtke, T. (2022) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12340 · Cited by 8
“So far, the effectiveness of JITPIs has not been addressed for occupational stress, but conceptually JITPIs can also be applied to occupational stress reduction, since the mechanisms behind are independently of the target behavior (Hardeman et al., 2019).”
BackgroundMethodInfluential
How to establish a digital therapeutic alliance between chatbots and users: The role of relational cues
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“…et al., 2020)，并给予用户个性化的反馈(Laranjo et al., 2018; Zhang et al., 2020)，比基于传统编程的虚拟化身更高效、灵活且人性化，无疑是更活跃的社会行动者(Alkhaldi et al., 2016; Ames et al., 2019; Hardeman et al., 2019; Tremain et al., 2020)。自 1966 年世界上第一个真正意义上的聊天机器人 ELIZA 诞生以来(Weizenbaum, c h i n a X i v : 202210 .”
Ratings and experiences in using a mobile application to increase physical activity among university students: implications for future design
Figueroa, C. A., Pathak, L. E., Khan, I., Williams, J. J., Lyles, C. R., & Aguilera, A. (2023) · Universal Access in the Information Society · doi:10.1007/s10209-022-00962-z · Cited by 11
“, activity suggestion or motivational message) [41, 43].”
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A Pilot Study and Ecological Model of Smoking Cues to Inform Mobile Health Strategies for Quitting Among Low-Income Smokers
Zhou, S., Levinson, A. H., Zhang, X., Portz, J. D., Moore, S. L., Gore, M. O., Ford, K. L., Li, Q., & Bull, S. S. (2020) · Health Promotion Practice · doi:10.1177/1524839920942214 · Cited by 11
“Systematic reviews suggest server-triggered interventions are often used to promote physical activities (Hardeman et al., 2019), whereas user-triggered interventions are frequently used to address mental health issues (Wang & Miller, 2019).”
Background
Modeling longitudinal variation in affective response to exercise across a 16-week randomized control trial (RCT).
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“Enhanced just-in-time interventions enabled by the app’s real-time data capabilities through ecological momentary assessment could revolutionize preventive health measures [104,105].”
Just-in-Time Adaptive Interventions for Adolescent and Young Adult Substance Use: A Systematic Review
Koike, C., Nestor, B. A., Gelmez, P. S., Fladger, A., Shrier, L. A., & Kossowsky, J. (2025) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2025.07.027 · Cited by 9
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“Interventions which are optimized based on context to target behavior change, or Just in Time Adaptive Interventions (JITAI), have been explored in existing works on mobile health [15, 22, 25].”
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Sequencing conversational turns in peer interactions: An integrated approach for evidence-based conversational agent for just-in-time nicotine cravings intervention
Singh, T., Truong, M., Roberts, K. E., & Myneni, S. (2024) · Digital Health · doi:10.1177/20552076241228430 · Cited by 9
“12 Anastasiadou et al. 44 used the RASA framework to build a chatbot prototype that helps to improve individuals ’ engagement in diabetes self-management.”
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Why Machines Matter for Survey and Social Science Researchers
Buskirk, T. D., & Kirchner, A. (2020) · doi:10.1002/9781118976357.ch1 · Cited by 8
Editorial: Motivation states and hedonic motivation for physical activity, exercise, and sport vs. sedentary behaviors
Stults‐Kolehmainen, M., Dunton, G. F., Boullosa, D. A., Ash, G. I., & Filgueiras, A. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1282118 · Cited by 8
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Gandrup, J., Selby, D., & Dixon, W. G. (2024) · JMIR Formative Research · doi:10.2196/50679 · Cited by 7
“Just-in-time adaptive interventions are an emerging area of research that, until now, has primarily been deployed in mental health and behavior-change treatments [6,7].”
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Functions of Smartphone Apps and Wearable Devices Promoting Physical Activity: Six-Month Longitudinal Study on Japanese-Speaking Adults
Konishi, N., Oba, T., Takano, K., Katahira, K., & Kimura, K. (2024) · JMIR mhealth and uhealth · doi:10.2196/59708 · Cited by 9
“…highlighted the importance of behavioral goals and self-monitoring [24]; SMS text messaging, personalization, goal setting and planning, and graded tasks [25]; goal setting, prompts/cues, feedback on behavior, and action planning [26]; and personalized goal setting with motivational feedback [27].”
A call to integrate menstrual cycle influences into just-in-time adaptive interventions for suicide prevention
Tauseef, H. A., Coppersmith, D. D. L., Reid-Russell, A., Nagpal, A., Ross, J. M., Nock, M. K., & Eisenlohr-Moul, T. A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1434499 · Cited by 8
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“Compared to psychotherapy which addresses related problems like depression and anxiety, digital smartphone interventions offer ﬂ exible and cost-effective intervention approaches that can easily be used by many people (Hardeman et al., 2019; Nahum-Shani et al., 2015).”
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Newhouse, N., Bartlett, Y. K., Simao, S. C., Miles, L. M., Cholerton, R., Kenning, C., Locock, L., Williams, V., French, D., Rea, R. D., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/70203 · Cited by 7
“…content (eg, including evidence-based BCTs designed to support motivation and action control and increase confidence), its just-in-time relevance [54-56], and the way in which it was delivered (eg, regularly, in short messages, and over the course of a year) could have acted together in these…”
Human Digital Twins for pervasive healthcare: A scoping review
Park, J., Park, E., Lee, D., Kang, S., Lee, T., Hong, H., Lee, S.-J., Kim, H., Park, Y. R., & Lee, U. (2025) · Health Informatics Journal · doi:10.1177/14604582251392455 · Cited by 7
“66,67,68,69,70,71,72 The integration of those acting components enables the implementation of JITAI which decides ‘ when and what to help ’ (Just-in-time) and ‘ how to help (Adaptive intervention).”
Describing Physical Activity Patterns of Truck Drivers Using Actigraphy
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“Interventions involving just-in-time adaptive prompts to engage in PA were reviewed in 2019 [23].”
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An Exploration of Adults Transitioning Into Retirements' Perspectives on Vigorous Intermittent Lifestyle Physical Activity
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“Just- in-time adaptive intervention (JITAI) assists in the delivery of intervention prompts at the ‘right time’ and the ‘right place’, however, it may be challenging in older adults because of lower smartphone literacy [37].”
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“However, technology enabled interventions, such as adaptive and continuous tuning interventions, have shown promise to support a more dynamic approach, where data can be harvested frommultiple timepoints to feed algorithms that refine the intervention content, delivery or timing to the idiosyncrasies of an individual…”
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Exam Eustress: Designing Brief Online Interventions for Helping Students Identify Positive Aspects of Stress
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“We contribute to the growing body of existing work within HCI that focuses on leveraging online technology to promote positive belief change at scale by designing systems that apply various behavioural science approaches to real-world problems such as mental health treatment using online chat tools [3, 40] and convers…”
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Developing personalized algorithms for sensing mental health symptoms in daily life
Timmons, A. C., Tutul, A. A., Avramidis, K., Duong, J. B., Carta, K. E., Walters, S. N., Jumonville, G. A., Carrasco, A. S., Freitag, G. F., Romero, D. N., et al. (2025) · npj Mental Health Research · doi:10.1038/s44184-025-00147-5 · Cited by 7
“Of the JITAI clinical trials conducted to date, most have focused on readily observable and objective physicalhealthbehaviors,suchasweightloss,sleep,andphysicalactivity,or havetargetedsubstanceuse 10,15 .”
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Comparative effectiveness and user-rated helpfulness of digital just-in-time adaptive interventions for psychological distress
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Social Media in Physical Activity Interventions Targeting Obesity Among Young Adults: Trends, Challenges, and Lessons from Instagram, TikTok, YouTube, and Facebook
Hematabadi, A., Rashidlamir, A., Radfar, B., Shourabi, P., Hajimousaei, S., Schauer, M., & Motevalli, M. S. (2025) · Youth · doi:10.3390/youth5040111 · Cited by 9
“These dynamic interventions help reduce user disengagement and promote sustained PA over time (Hardeman et al., 2019; Henry et al., 2025).”
Just-In-Time Adaptive Interventions for Weight Management Among Adults With Excess Body Weight: Scoping Review
Koh, J. Y. J., Tan, S. X., Tan, X. M., Tan, C. Y. H., Chan, S. L., Lee, J. W. K., Lim, A. Y. L., Lin, W., & Chew, H. S. J. (2025) · Journal of Medical Internet Research · doi:10.2196/76625 · Cited by 7
“Consistent with previous JITAI reviews, this review identified a lack of behavioral theories incorporated in weight management JITAIs, potentially stemming from application developers’ limited familiarity with health behavioral theories [8,14].”
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“Further, just-in-time adaptive intervention (JITAI) [26] is a subtype of EMI that delivers “in the moment” support to patients based upon their current behaviors or experiences.”
Development of an Android Mobile Application for Reducing Sitting Time and Increasing Walking Time in People with Type 2 Diabetes
Daryabeygi‐Khotbehsara, R., Islam, S. M. S., Dunstan, D. W., Abdelrazek, M., Markides, B. R., Pham, T. T., & Maddison, R. (2022) · Electronics · doi:10.3390/electronics11193011 · Cited by 6
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Ortega, A., & Cushing, C. C. (2024) · JMIR Formative Research · doi:10.2196/60171 · Cited by 5
“A systematic review [16] revealed that most physical activity JITAIs modified decision points to occur at interventionist-defined times [17-19] or at user-defined times [20].”
Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study
Kumar, D., Haag, D., Jens Blechert, A., Niebauer, J., & Smeddinck, J. D. (2024) · JMIR mhealth and uhealth · doi:10.2196/57255 · Cited by 7
“JITAIs are configured to use real-time data and context awareness to deliver the “right” interventions precisely when they are needed the most [8,9].”
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Kim, M., Mansour-Assi, S., Mistiri, M. E., Park, J.-H., Banerjee, S., Khan, O., Torre, S. A. D. L., Higgins, M., Godino, J., Patrick, K., et al. (2025) · JMIR Research Protocols · doi:10.2196/70599 · Cited by 6
“In particular, previous research shows that DHIs for PA have a moderate short-term effect on PA, are acceptable with good adherence when used in research studies [5,21-28], and show meaningful 12-month results with effect sizes of 0.2 relative to comparators [29,30].”
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“The use of prompts has been shown to facilitate effective behavioral change across various domains, including transportation, healthcare, environmental conservation, and education, both in online and offline settings [130], [131], [132].”
Daily Physical Activity in Older Age
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Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis
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“A recent meta-analysis [18] revealed that most physical activity JITAIs modified decision points based on rational decisions, such as interventionist-defined [19-21] or user-defined times [22].”
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“Current techniques cannot continuously collect personal and contextual data in real-time to deliver adaptive interventions effectively (21).”
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“Future research may implement ambulatory assessment techniques in personalized just-in-time adaptive interventions, as they can promote short walking breaks through triggered prompts in daily life 66 .”

Authors: Hardeman, W., Houghton, J., Lane, K., Jones, A., & Naughton, F.
Affiliations: University of East Anglia (GB)
Corresponding author: Hardeman, Wendy
ORCID: Hardeman, Wendy
Houghton, Julie
Lane, Kathleen
Jones, Andy
Naughton, Felix
Venue: International Journal of Behavioral Nutrition and Physical Activity
Publisher: Springer Science and Business Media LLC
Published: 2019-04-03
Volume: 16
Issue: 1
Pages: 31-31
ISSN: 1479-5868 (ISSN-L)
DOI: 10.1186/s12966-019-0792-7
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: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
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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A systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activity

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