Effectiveness of ecological momentary interventions for improving 24-hour movement behaviors in older adults: A systematic review and meta-analysis.

Introduction: The 24-hour movement behavior, which integrates physical activity, sedentary time, and sleep, is an emerging health framework important for older adults’ health and function. Ecological momentary interventions offer an innovative digital approach to enhance such behaviors through real-time, contextually tailored feedback. However, whether ecological momentary interventions can effectively improve 24-hour movement behavior in older adults remains unclear, due to a lack of systematic reviews. Aim: This review comprehensively analyzes the effects of ecological momentary interventions on components of 24-hour movement behaviors in older adults. Method: A systematic search was performed in PubMed, Web of Science, the Cochrane Library, CINAHL, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Data from inception to September 2025. The revised Cochrane Risk of Bias tool for randomized trials was applied to assess the methodological quality of included studies. The effect of the intervention was estimated as the standard mean difference (SMD) with 95% confidence interval (CI) using Stata software, and heterogeneity was assessed using the I2 statistic. Narrative syntheses were adopted when meta-analysis was inappropriate. The overall certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The protocol was registered in PROSPERO (CRD420251144447). Results: Out of the identified records, 12 studies were eligible. Meta-analysis of five studies revealed that ecological momentary interventions significantly increased daily moderate-to-vigorous physical activity (SMD = 0.24, 95% CI 0.09 to 0.39, p = .002; I2 = 0%; moderate certainty of evidence). Exploratory subgroup analyses did not identify significant moderators, and sensitivity analyses supported the robustness of these findings. Narrative analysis of two studies indicated that ecological momentary interventions have the potential to improve both sleep quality and sleep efficiency. Meta-analysis of six studies revealed no statistically significant effects of sedentary behavior. Conclusions: The evidence of this review suggests that ecological momentary interventions may increase daily moderate-to-vigorous physical activity and improve sleep quality among older populations. Additional rigorous trials are needed to further confirm these findings. © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.