Abstract
BACKGROUND: Physical activity (PA) is a key contributor to the neurocognitive and psychological development of children and adolescents. With the rapid integration of digital technologies in educational and recreational contexts, technology-enhanced PA (TEPA) interventions have emerged as promising tools for promoting mental and cognitive health. However, the effectiveness of various TEPA modalities-such as virtual reality (VR), mobile applications, and biofeedback systems-remains unclear. Prior findings are fragmented across systematic reviews with inconsistent methodologies. This umbrella review was conducted to synthesize current evidence and evaluate whether specific TEPA modalities yield differential benefits. We hypothesized that TEPA interventions with immersive and self-regulatory features provide greater enhancements in executive function (EF), cognitive function (CF), and mental health (MH) than passive or minimally interactive formats. AIM: To determine the effects of TEPA interventions and modality-specific characteristics on EF, CF, and MH outcomes in children and adolescents. METHODS: An umbrella review of systematic reviews and meta-analyses was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Five databases (PubMed, Web of Science, EMBASE, EBSCOhost, and Cochrane Library) were searched up to March 2025. Eligible reviews included participants aged ≤ 18 years, assessed TEPA interventions, and reported EF, CF, or MH outcomes. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews 2. Data synthesis was stratified by intervention modality, and heterogeneity was evaluated using the I² statistic. RESULTS: A total of 11 systematic reviews and meta-analyses were included. Interventions using VR (2/2), game-based formats (2/2), biofeedback (2/2), and multicomponent programs (1/1) showed consistent evidence of improvements in EF and MH (e.g., EF: 6.92 ± 3.86 vs 3.61 ± 1.67, P < 0.001). App-based interventions (3/3) demonstrated mixed or modest effects, while augmented reality-based formats showed limited efficacy. MH outcomes were most frequently improved (9/11 reviews), followed by EF (6/11 reviews) and CF (5/11 reviews). Heterogeneity ranged from moderate to high (I² = 42%-78%) across modalities. CONCLUSION: TEPA significantly improves MH and selectively enhances executive and CF in youth. Immersive, interactive, and biofeedback-driven modalities are particularly effective.