Physical activity recommendations for adolescents with overweight, high screen time, and low social support – A scoping review

Relevant literature was searched in Medline (via PubMed), SPORTDiscus, EBSCOhost, and Google Scholar. A comprehensive strategy was applied to identify PA interventions targeting adolescents experiencing one or more of the co-occurring challenges described above. Search terms combined synonyms of “recommendations” AND (“physical activity of young people” OR “physical activity adolescents”) AND (“study” OR “intervention” OR “scientific research”) AND (“overweight” OR “obesity” OR “high screen time” OR “low social support”), adapted for each database. Reference lists of included articles were also screened for additional records.

The study was conducted using bibliographic databases, focusing on publications from January 2010 to August 2024. The search was limited to articles published in English or Polish, concerning adolescents aged 13–18 years.

Articles were considered eligible if they reported on PA interventions or recommendations recognized by researchers as most effective in addressing excess weight, reducing screen time, or enhancing social support among adolescents. Eligible studies could focus on various impact strategies. Additionally, studies reporting on implementation conditions of PA interventions considered most beneficial for addressing specific adolescent health issues were included. Studies were excluded if they did not provide an original contribution to the research topic or if the full text was unavailable (e.g., conference abstracts or meeting summaries).

The electronic databases were searched independently by one researcher (M.Ł.) using the predefined search strategy. A second reviewer (J.K.) conducted a blinded verification by screening 5% of titles and abstracts and 10% of full-text articles, achieving complete agreement (100%) with the initial screening results.

Data were extracted using a standardized template developed for this study. A deductive narrative synthesis was employed to summarize the themes and findings across the included studies. Consistent with the objectives of scoping reviews, no critical appraisal of methodological quality or risk of bias was conducted (Arksey & O’Malley, 2005; Tricco et al., 2018). However, missing information in articles was recorded in the data extraction template to assess overall methodological reporting quality. A meta-analysis was not undertaken due to the qualitative nature of most studies and the absence of predefined hypotheses.

The existing literature consistently highlights the social environment as a central determinant of PA engagement and weight-related outcomes among adolescents (Chen et al., 2023; Hu et al., 2021; Tully et al., 2022; Yuan et al., 2025). Qualitative analyses indicate that family support, peer involvement, and community-level engagement play a pivotal role in facilitating behavioral change and sustaining PA participation (Chen et al., 2023; Tully et al., 2022). Interventions that actively involve families appear to be particularly effective for overweight and obese children and adolescents, as parents and caregivers are instrumental in implementing, reinforcing, and maintaining lifestyle changes over time (Tully et al., 2022). A child’s success in adopting more active behaviors is therefore closely linked to the capacity and commitment of the household to support these changes.

Peer relationships also represent a critical influence on PA behavior during adolescence. Evidence suggests that overweight and obese adolescents often form friendships with peers facing similar challenges, which may inadvertently reinforce sedentary behaviors (Chen et al., 2023; Salvy et al., 2012). However, these same social bonds can be leveraged within interventions to promote collective engagement in PA and enhance motivation through shared experiences (Chen et al., 2023). Community-based strategies, such as family sports days, group challenges, and parent–adolescent support groups, further strengthen these social mechanisms by fostering collective accountability and social connectedness (Chen et al., 2023).

Beyond social structures, individualization emerges as a key principle in effective PA promotion. Tailoring recommendations to adolescents’ social context, preferences, abilities, motivation, body awareness, and access to facilities enhances engagement and feasibility (Alberga et al., 2013; Chen et al., 2023; Tully et al., 2022). Physical and psychosocial characteristics interact to shape PA behavior, as illustrated by evidence indicating gender-specific motivational drivers in overweight adolescents – performance and strength among boys, and general health among girls (Alberga et al., 2013; Pescud et al., 2010). These findings underscore the importance of adopting a flexible, person-centered approach rather than uniform PA prescriptions.

A substantial body of evidence highlights psychosocial barriers as major impediments to PA participation in adolescents, particularly among those with health-related challenges (Khan et al., 2018; Moore et al., 2023; Wu et al., 2015). Anxiety, depressive symptoms, broader psychopathology, and poor sleep quality have all been identified as factors negatively associated with PA engagement (Khan et al., 2018; Wu et al., 2015). High screen time, in particular, appears to aggravate these challenges. Adolescents reporting more than 2 h of daily screen time and insufficient PA are more likely to experience psychosocial difficulties than their more active peers (Khan et al., 2018), a finding corroborated by evidence of both independent and interactive effects of low PA and high screen exposure on mental health outcomes (Wu et al., 2015).

Parental involvement plays a decisive role in mitigating excessive screen use (Ofcom, 2020; Zhang et al., 2022). Home-based interventions and those involving parents demonstrate greater effectiveness in reducing screen time among overweight and obese adolescents compared to peer-only approaches (Zhang et al., 2022). Similarly, adolescents with low levels of social support are less likely to meet PA guidelines, whereas strong encouragement from both family and peers is positively associated with daily and weekly PA engagement and participation in organized sports (Gill et al., 2018).

Autonomy also emerges as a critical psychosocial factor. Allowing adolescents to self-select the type and intensity of PA supports mental health by fostering autonomy, competence, and self-efficacy (Pascoe et al., 2020). Engagement in PA – particularly in socially supportive or nature-based environments – has been shown to improve body image, perceived competence, and social connectedness, all of which contribute to psychological well-being (Kondo et al., 2020; Pascoe et al., 2020). However, these potential benefits are increasingly undermined by persistently high levels of screen use. Contemporary data indicate that adolescents spend multiple hours per day engaging in online activities, television viewing, and gaming, with a marked increase over the past decade (Ofcom, 2020; Sikorska et al., 2021). This trend reinforces the need to address screen time as a distinct and interacting behavioral risk factor.

Evidence suggests that the effectiveness of PA interventions is enhanced when training modalities are aligned with the specific needs of different adolescent subgroups. For adolescents with weight management challenges, combined aerobic and resistance training appear superior to aerobic exercise alone in improving body composition, cardiometabolic markers, and fitness outcomes (García-Hermoso et al., 2018). Sequencing resistance training prior to aerobic exercise may further optimize outcomes, including improvements in VO₂max and long-term PA adherence (Fiorilli et al., 2017). High-intensity interval training (HIIT) also shows promise as a time-efficient strategy, yielding significant improvements in blood pressure and aerobic capacity among overweight and obese adolescents (García-Hermoso et al., 2016).

For adolescents with high screen time, technology-based interventions may serve as an effective engagement tool rather than a competing risk. Smartphone applications designed to promote PA and reduce screen use have demonstrated high acceptability and perceived usefulness among adolescents (Direito et al., 2015; Lubans et al., 2014). However, the literature indicates that such tools are most effective when embedded within multi-component interventions that provide complementary social and behavioral support (Schoeppe et al., 2016).

Among adolescents experiencing low social support or mental health challenges, autonomy-supportive PA programs are particularly beneficial. Allowing participants to choose activity type and intensity enhances tolerance and engagement, even at higher intensities (Pascoe et al., 2020). Structured sport-based programs may also offer psychosocial benefits, supporting social integration and emotional well-being among at-risk adolescents (Lubans et al., 2012).

Despite the growing recognition of PA as a therapeutic and preventive strategy, the literature reveals a notable scarcity of comprehensive, group-specific recommendations for adolescents facing multiple, interacting health challenges (Aubert et al., 2021; Chaput et al., 2020). Nonetheless, several consistent principles emerge. Autonomy-supportive program design – offering meaningful choices and encouraging self-initiation – has been shown to enhance motivation and long-term adherence, particularly among overweight adolescents (Alberga et al., 2013; Deforche et al., 2011; Tully et al., 2022). Enjoyment and pleasure are equally critical, as positive affective responses to PA strongly influence sustained engagement (Angeles et al., 2024).

Current guidelines generally recommend at least an average of 60 min of MVPA per day, although evidence supports gradual progression from lower volumes, with even 20 min of regular aerobic activity producing meaningful reductions in body fat (Davis et al., 2011; Styne et al., 2017). Importantly, psychological comfort and environmental safety must be prioritized to reduce barriers related to weight stigma, embarrassment, and fear of injury (Alberga et al., 2013; Puhl & Luedicke, 2012). Access to supportive outdoor environments further facilitates PA engagement, whereas obesogenic neighborhood features, such as high fast-food density, may undermine intervention effectiveness (Hamano et al., 2017; Oreskovic et al., 2015).

Screen time reduction requires equally targeted strategies. Evidence indicates that interventions focusing specifically on screen use – rather than combining this aim with multiple health behaviors – are more effective in achieving sustained reductions (Andrade et al., 2015; Zhang et al., 2022). Goal-setting and self-monitoring appear particularly influential in modifying screen-related behaviors (Jones et al., 2021).

Based on the reviewed evidence and using the Bronfenbrenner’s socio-economic model (Bronfenbrenner, 2005), a multi-level, integrated conceptual model is proposed to guide future PA promotion interventions for adolescents experiencing overlapping challenges related to overweight, low social support, and excessive screen time.

At the individual level, the model emphasizes autonomy, enjoyment, and competence as core mechanisms driving sustained PA engagement. Interventions should allow adolescents to self-select activity type and intensity, align PA with personal goals (e.g., strength, health, social interaction), and incorporate progressive, achievable targets to enhance self-efficacy.

At the social level, family and peer support function as critical enablers. Parents and caregivers are positioned as co-regulators of behavior, supporting both PA participation and screen time reduction through modelling, encouragement, and environmental structuring. Peer-based strategies, including group activities and sport programs, foster social connectedness and reduce stigma, particularly for adolescents with low perceived support.

At the behavioral interface, PA promotion and screen time reduction are treated as interacting but distinct targets. Technology is reframed as a supportive tool rather than solely a risk factor, with digital applications facilitating self-monitoring, goal-setting, and feedback while limiting passive screen consumption. Structured PA modalities (e.g., combined aerobic–resistance training, HIIT, sport-based activities) are matched to individual needs and preferences.

At the environmental level, supportive physical and social contexts – including access to safe outdoor spaces, non-stigmatizing settings, and community-based opportunities – reduce psychological and practical barriers to participation.

Collectively, this integrated model conceptualizes PA behavior as the product of dynamic interactions between individual motivation, social support, behavioral regulation, and environmental affordances. Future interventions grounded in this framework may be better positioned to address the complex, co-occurring challenges of overweight, low social support, and high screen time among adolescents, thereby promoting sustainable improvements in both physical and mental health outcomes.

This review has several limitations that should be considered when interpreting the findings. Given the exploratory nature of a scoping review, the results should be interpreted as a mapping of existing guidance rather than as definitive, evidence-based recommendations. The absence of predefined research questions may have influenced the scope and structure of the search and data extraction processes. While the lack of predefined research questions allowed for a broad exploration of the literature, it may have affected the consistency and focus of the search and data extraction procedures. In addition, gray literature was not included, which may have resulted in the omission of relevant evidence. This may have resulted in publication bias and the under-representation of emerging or practice-based evidence. The review was restricted to studies published in English or Polish, potentially limiting the generalizability of the findings. Moreover, the included studies may be subject to potential risk of bias, primarily due to heterogeneity in study designs and the reliance on self-reported measures of PA and screen time. Despite these limitations, the synthesis provides a comprehensive overview of current recommendations and may serve as a foundation for future intervention studies aimed at promoting PA among at-risk adolescents.

This comprehensive review of the literature demonstrates robust evidence supporting the positive role of PA in addressing key health challenges among adolescents with overweight, high screen time, and low social support. While a substantial body of scientific and practical guidance exists for adolescents with above-normal body mass index, far fewer tailored recommendations are available for those experiencing excessive screen use or limited social support, highlighting an important gap in the literature.

For adolescents with overweight, the evidence consistently emphasizes the central role of family and peer support in facilitating and sustaining behavioral change (Chen et al., 2023; Tully et al., 2022). Effective PA interventions for this group require an individualized approach that accounts for social context, body awareness, personal interests, physical abilities, motivational factors, and access to appropriate infrastructure (Alberga et al., 2013; Chen et al., 2023; Tully et al., 2022). Autonomy-supportive strategies – particularly offering adolescents choice and encouraging self-selection of activities – are strongly associated with improved engagement and long-term adherence (Alberga et al., 2013; Deforche et al., 2011). Moreover, fostering enjoyment and pleasure during PA emerges as a key determinant of sustained participation (Angeles et al., 2024).

Reducing barriers to PA participation is equally critical. Psychological comfort, including protection from weight-related stigma, fear of injury, and unsafe or unsupportive environments, significantly influences adolescents’ willingness to engage in PA (Alberga et al., 2013; Hamano et al., 2017; Puhl & Luedicke, 2012). Evidence supports flexibility in implementation, including gradual progression and shorter activity bouts, particularly for adolescents with low baseline fitness (Styne et al., 2017). The literature further supports a range of training modalities for overweight adolescents, including combined aerobic and resistance exercise, resistance training followed by aerobic activity, and HIIT (Fiorilli et al., 2017; García-Hermoso et al., 2016, 2018).

In contrast, the evidence base for PA recommendations targeting adolescents with high screen time remains limited. Available studies suggest that addressing psychosocial barriers such as anxiety and depression is essential for promoting PA engagement (Khan et al., 2018; Wu et al., 2015). Parental involvement and home-based strategies are consistently identified as effective approaches for reducing screen time (Zhang et al., 2022). The use of digital tools designed to support screen time reduction and promote healthy behaviors appears promising, particularly when combined with goal-setting and self-monitoring strategies (Direito et al., 2015; Jones et al., 2021; Lubans et al., 2014). Importantly, interventions that focus explicitly on reducing screen time, rather than embedding this aim within broader lifestyle programs, demonstrate greater effectiveness (Andrade et al., 2015; Zhang et al., 2022).

For adolescents experiencing low social support, family and peer encouragement remains a critical determinant of PA participation (Gill et al., 2018). Engagement in natural environments and outdoor settings may further enhance motivation and social connectedness (Kondo et al., 2020). Autonomy in selecting activity type and intensity, alongside participation in at least moderate-intensity PA, appears particularly beneficial for this group (Pascoe et al., 2020). Structured sport-based programs focusing on a single discipline may also offer psychosocial and behavioral benefits (Lubans et al., 2012).

Overall, this review highlights that while evidence-based PA recommendations are well established for overweight adolescents, there remains a notable lack of integrated guidance addressing the combined challenges of overweight, excessive screen time, and low social support. Across all groups, the consistent determinants of successful intervention include family and peer involvement, individualized and autonomy-supportive program design, and attention to psychological comfort. The primary challenge for future interventions lies in sustaining long-term motivation and adherence, underscoring the need for integrated, multi-level PA promotion strategies that address both behavioral and contextual determinants of adolescent health.