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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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“On this basis, we excluded some studies [22, 23, 40] which others described as JITAIs.”
BackgroundResultA meta-analysis of computer-tailored interventions for health behavior change
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“For instance, fitness apps could incorporate just-in-time adaptive interventions (JITAIs), delivering a brief mindfulness or self-compassion exercise when a user logs an unusually long or intense workout session, which might signal obsessive patterns (Hardeman et al., 2019; Vogel et al., 2025).”
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“JITAIs have already been applied in different research areas, for example, to increase physical activity [4].”
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“This new, promising type of intervention is called a just-in-time adaptive intervention (JITAI) [8].”
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“…de este videomanual estuvo motivada por el concepto de apoyo oportuno y puntual ( just in time ), generalmente mediante el uso de tecnología (Hardeman et al., 2019; Nahum-Shani et al., 2018), al que el encargado de implementar la intervención puede acceder en el preciso momento en el que lo…”
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“There is increasing research into the use of JITAIs (eg, [17,18]).”
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“Just-in-time adaptive interventions (JITAIs) aim to address this gap by delivering timely, tailored support during high-risk moments [12,13].”
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“This knowledge is important for BITs adherence and engagement, optimization and personalization (Perski et al., 2017; Yardley et al., 2016), or for more temporally and contextually sensitive intervention delivery (Hardeman et al., 2019; Nahum-Shani et al., 2015, 2022).”
Firkin, C. J., Vemuri, A. K., Rahman, T., Bodt, B., Orsega-Smith, E. M., Decker, K., & Dominick, G. M. (2025) · JMIR Research Protocols · doi:10.2196/79022 · Cited by 1
“Thus, user-specific receptiveness is a key feature of a JITAI [24].”
InfluentialWillms, A., Sui, A., Jantzen, R. R., Chester, S., Vanderloo, L. M., Rhodes, R. E., & Liu, S. (2025) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.70096 · Cited by 1
“In particular, just-in-time adaptive interventions (JITAIs) delivered through mobile applications (apps) can use real-time data and algorithms to provide personalized support to parents in promoting their children's PA (Hardeman et al., 2019; Wang & Miller, 2020).”
Oba, T., Moriishi, C., Takano, K., Katahira, K., & Kimura, K. (2025) · JMIR Formative Research · doi:10.2196/79360 · Cited by 1
“Regardless of its theoretical advantages, mixed evidence has been found for the efficacy of EMI for PA [15].”
Thal, S. B., Ntoumanis, N., Bright, S. J., MYERS, B. J., Kwaśnicka, D., Verboon, P., Clarke, J., & Quested, E. (2026) · Psychology and Health · doi:10.1080/08870446.2025.2610270 · Cited by 1
Emotion regulation variability and chronic pain: An ecological momentary assessment study
Rogers, A. H., Zvolensky, M. J., Aaron, R. V., Lackner, J. M., Smit, T., Bakhshaie, J., & Gerhart, J. I. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.104977 · Cited by 1
Chen, M., Movia, M., Chua, X. H., Tan, S. Y. X., Zheng, S., Jin, K., Topothai, T., Padmapriya, N., Müller‐Riemenschneider, F., & Edney, S. M. (2026) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-026-00097-z · Cited by 1
Shah, A., Hooshyar, D., & Tomberg, V. (2026) · ACM Transactions on Computing for Healthcare · doi:10.1145/3797877 · Cited by 3
“Such limitations underscore the need for more objective, continuous, and scalable methods to measure psychosocial factors (Hardeman et al., 2019).”
Kuru, O. (2026) · Public Opinion Quarterly · doi:10.1093/poq/nfag006 · Cited by 1
Chen, J., Nie, K., Zhang, M., Yu, C., Gao, Z., Yue, K., Shi, Y., & Liang, C. (2026) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3772318.3791020 · Cited by 1
“While JITAIs have been widely applied in health domains [18, 25, 50, 67, 72, 89], their use for addressing SVIs remains largely unexplored.”
Ulloa, M., Kamali, N., Fernandes, G. J., Soyemi, E., Beltzer, M., Alshurafa, N. I., & Jacobs, M. L. (2026) · ACM Transactions on Computing for Healthcare · doi:10.1145/3808695 · Cited by 1
Baretta, D., Mazéas, A., Chalabaëv, A., Inauen, J., & Chevance, G. (2026) · npj Exercise Medicine and Health · doi:10.1038/s44437-026-00003-4 · Cited by 1
“Anticipating these vulnerable periods of reduced activity is therefore a key challenge in designing timely and adaptive physical activity promotion strategies 9,10 .”
Yang, S., Li, M., Li, Y., Chang, Y., Hu, S., Kou, X., & Liu, X. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1934024 · Cited by 1
“Hardeman et al. conducted the first systematic review of JITAIs for physical activity, including 19 studies up to 2018, and concluded that the field was in its early stages, characterized by a weak evidence base and heterogeneous study quality (16).”
Valuing the role of educators in practice: Greater Manchester's framework
Williams, C., Leigh, J., Burns, D., Halse, J., Haydri, S., Collins, S., McManus, E., Grundy, J., Sutcliffe, K., Bowler, H., et al. (2022) · British Journal of Nursing · doi:10.12968/bjon.2022.31.3.174 · Cited by 1
Mitra, S., Kroeger, C. M., Xu, J., Avery, L., Masedunskas, A., Cassidy, S., Wang, T., Hunyor, I., Wilcox, I., Huang, R., et al. (2023) · JMIR Research Protocols · doi:10.2196/46082 · Cited by 1
“A unique feature of an MRT is that an individual can be repeatedly randomized multiple times throughout the duration of the study [14,15].”
BackgroundDigitale und technische Unterstützungssysteme zur Gesundheitsförderung in der Pflege
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Eckert, T., Wunsch, K., Fiedler, J., & Wöll, A. (2021) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-021-00873-6 · Cited by 1
“Um die Wirksamkeit von SF und SF 2.0 zu überprüfen, werden zwei clusterrandomisierte, kontrollierte Studien (RCT) mit Interventions- (IG) und Kontrollgruppe (KG) durchgeführt.”
BackgroundInfluentialSmit, E. S., & Hoving, C. (2022) · The International Encyclopedia of Health Communication · doi:10.1002/9781119678816.iehc0727 · Cited by 1
Leenaerts, N., Soyster, P. D., Ceccarini, J., Sunaert, S. G., Fisher, A. J., & Vrieze, E. (2023) · doi:10.31234/osf.io/9utrv · Cited by 1
Exploring boundary conditions of sustained physical activity: implications for theory and practice.Preprint
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Goal-Directed Self-Tracking in the Management of Chronic Health Conditions
Schroeder, J. (2020) · ResearchWorks at the University of Washington (University of Washington)
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“A newer, but equally growing area of research involves Just-In-Time Adaptive Interventions (JITAIs) [2], which use data collected via mobile/wearable devices, such as symptoms and behaviors, to identify opportune moments for delivering personalized interventional content in real time.”
BackgroundDynamical Outcome Modeling of Fragmented Intensive Longitudinal DataPreprint
Lagoa, C. M., Hojjatinia, S., & Conroy, D. E. (2021) · OSF Preprints (OSF Preprints) · doi:10.31219/osf.io/3d5n9
Purpose and Social Relationships in Later Life: An Intraindividual Variability Approach
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Mobile Health, Behavior Change
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Maintaining Driver’s Alertness with Linear Contextual Bandits
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هل من العدل استخدام اختبار الذكاء لقياس ذكاء الأشخاص: مراجعة أدبيات
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“JITAI’s and related adaptive study design have been applied in multiple critical health domains including physical activity [Hardeman et al., 2019], smoking cessation [Battalio et al., 2021, Yang et al., 2023] and addiction [Per-ski et al., 2022].”
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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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