The effect of social media interventions on physical activity and dietary behaviours in young people and adults: a systematic review

Background The objectives of this systematic review were to update the evidence base on social media interventions for physical activity and diet since 2014, analyse the characteristics of interventions that resulted in changes to physical activity and diet-related behaviours, and assess differences in outcomes across different population groups. Methods A systematic search of the literature was conducted across 5 databases (Medline, Embase, EBSCO Education, Wiley and Scopus) using key words related to social media, physical activity, diet, and age. The inclusion criteria were: participants age 13+ years in the general population; an intervention that used commercial social media platform(s); outcomes related to changes to diet/eating or physical activity behaviours; and quantitative, qualitative and mixed methods studies. Quality appraisal tools that aligned with the study designs were used. A mixed methods approach was used to analyse and synthesise all evidence. Results Eighteen studies were included: randomised control trials (n = 4), non-controlled trials (n = 3), mixed methods studies (n = 3), non-randomised controlled trials (n = 5) and cross-sectional studies (n = 3). The target population of most studies was young female adults (aged 18–35) attending college/university. The interventions reported on positive changes to physical activity and diet-related behaviours through increases in physical activity levels and modifications to food intake, body composition and/or body weight. The use of Facebook, Facebook groups and the accessibility of information and interaction were the main characteristics of social media interventions. Studies also reported on Instagram, Reddit, WeChat and Twitter and the use of photo sharing and editing, groups and sub-groups and gamification. Conclusions Social media interventions can positively change physical activity and diet-related behaviours, via increases in physical activity levels, healthy modifications to food intake, and beneficial changes to body composition or body weight. New evidence is provided on the contemporary uses of social media (e.g. gamification, multi-model application, image sharing/editing, group chats) that can be used by policy makers, professionals, organisations and/or researchers to inform the design of future social media interventions. This study had some limitations that mainly relate to variation in study design, over-reliance of self-reported measures and sample characteristics, that prevented comparative analysis. Registration number: PROPSERO;CRD42020210806. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01138-3.

Conclusions: Social media interventions can positively change physical activity and diet-related behaviours, via increases in physical activity levels, healthy modifications to food intake, and beneficial changes to body composition or body weight. New evidence is provided on the contemporary uses of social media (e.g. gamification, multi-model application, image sharing/editing, group chats) that can be used by policy makers, professionals, organisations and/or researchers to inform the design of future social media interventions. This study had some limitations that mainly relate to variation in study design, over-reliance of self-reported measures and sample characteristics, that prevented comparative analysis. Registration number: PROPSERO;CRD42020210806.
Keywords: Physical activity, Diet, Social media, Facebook, Instagram, Reddit, Twitter, Young adults, Systematic review, Narrative review Background Social media is positioned as a powerful medium to reach, influence and change physical activity and dietrelated behaviours [1,2]. For example, the recent World Health Organisation (WHO) Global Action Plan for Physical Activity identified the potential of social media to reach and target large audiences to promote physical activity engagement [3]. Similarly, Public Health England's social marketing strategy emphasised the use of social media to target diverse groups more effectively, engage populations and support health-related behaviour changes [4]. Across international contexts there is also evidence that social media is being used in education, clinical, workplace and community settings to influence physical activity and dietary behaviours in young people and adults [2,5,6]. However, there is currently no guidance available for policy makers, professionals or organisations on how to responsibly and effectively use social media in physical activity and diet interventions [2,7,8], and there is little robust evidence on how social media interventions inform changes to behaviours related to physical activity and diet [9,10]. As such, there is a gap in research and policy that leaves researchers, practitioners, and individual users illequipped to optimise the potential benefits of social media in promoting and supporting healthy physical activity and diet-related behaviours.
Interventions that improve physical activity and dietrelated behaviours are of vital importance in optimising public health [11]. Engaging in regular physical activity and consuming a healthy diet can lead to a reduction in the burden of non-communicable diseases and improve daily functioning, mental health and wellbeing [11,12]. However, one in four adults (age 18 and older) and three in four adolescents (age 11-17) worldwide do not currently meet the global recommendations for physical activity set by the WHO [3]. Globally, it is also estimated that poor diets are responsible for 22% of all adult deaths, with the main unhealthy dietary factors identified as high sodium intakes and low intakes of wholegrains and fruits [12].
The benefits of social media for physical activity and diet interventions are grounded in social media's extensive reach and the affordances of interaction, information and entertainment [2,6]. Over a third of the world's population (38%) use social media sites such as Facebook, Instagram and WhatsApp [13], with high rates of social media use not confined to the young and/or specific ethnicities, cultures, genders and/or socio-economic groups [4,14,15]. Previous systematic reviews on social media use and/ or health-related social media interventions identified that social media can positively impact physical activity and diet-related behaviours [7-10, 16, 17]. These reviews report numerous health-related benefits of social media use for behaviour change, including: increased interaction; more available, shared and tailored information; increased accessibility to health information; peer/social/emotional support; and health surveillance. There is therefore evidence to suggest that social media interventions may have the potential to inform changes to behaviours related to physical activity and diet.
While systematic reviews on social media interventions for physical activity and diet have been published [7-10, 16, 17], none have identified the characteristics of social media use that are associated with positive physical activity and diet-related outcomes. Furthermore, most of the published reviews focused on clinical settings and clinical population groups, and there is little evidence across non-clinical groups, ages, genders and other demographic factors [7-10, 16, 17]. In turn, our understanding of how best to design social media interventions to reach mass audiences, and how to tailor interventions to target the needs of specific demographic groups, is currently limited. Finally, previous systematic reviews on social media interventions have included research published prior to 2014 [7,10,17]. While these reviews provide important evidence on the potential of social media for behaviour change, these findings may quickly become irrelevant due to the exponential growth in social media use and access [14,15], and the technological advancement of social media sites since 2014. Notably, there has been a systemic shift from text-based social media communication toward communication via images and videos, where opportunities for anonymity, multi-platform interaction and temporal content are dominant and contemporary uses of social media [2,18,19].
To address these limitations in the published literature, the objectives of this systematic review were to update the evidence base on social media interventions for physical activity and diet since 2014, analyse the characteristics of interventions that resulted in changes to physical activity and diet-related behaviours, and assess differences in outcomes across different population groups. The research question was: does the use of social media influence diet-related (eating or nutrition) and physical activity behaviours in young people and adults, and if so, how? The findings from this review can be used to inform the development of robust guidance on the design of social media interventions to increase their potential to elicit positive changes in physical activity and diet-related behaviours.

Protocol and registration
The protocol for this review was registered with the International Prospective Register of Systematic Reviews (PROPSERO; CRD42020210806). The report follows the PRISMA guidelines and checklist for systematic reviews [20].

Eligibility criteria
For inclusion in this review, studies fulfilled the following PICOS statement: P (Participants): age 13 years and older in the 'general population' (i.e. non-clinical populations) I (Intervention): use of one or more commercial social media platforms: for example, Facebook, YouTube, Reddit, Twitter, Instagram, SnapChat, WhatsApp, Pinterest and TikTok C (Comparison): no engagement with or use of social media; or no comparison (such as in crosssectional study designs) O (Outcomes): changes to diet/eating and/or physical activity knowledge, attitudes or behaviours S (Study Type): Quantitative, Qualitative or Mixed Methods studies, including randomised controlled trials (RCTs), non-randomised interventions, and observational studies.
Studies were included if they were peer-reviewed publications and were written in the English language. The exclusion criteria for this review included grey literature and articles reporting on clinical population groups. Clinical population groups refer to participants who were recruited from a medical facility and/or were receiving medical treatment. Studies reporting on participants who were obese or overweight and were not receiving medical treatment were included. Furthermore, articles were excluded if they reported on non-commercial social media platforms and bespoke social media platforms created specifically for the intervention. This review also applied a definition of social media [21] as platforms for interaction that require users to create a profile and involve the consumption and production of user-generated content; thus, papers reporting on video conferencing platforms such as Zoom or Skype were excluded.

Search strategy
Five electronic databases were searched, including Medline, Embase, EBSCO Education, Wiley and Scopus, between December 2020 and February 2021. Titles, abstracts and keywords were searched using the following terms: 1) Social media (e.g. "social media", "social network", Facebook, Instagram, etc); 2) Physical activity (e.g. "physical activity", Exercise, workout, etc); 3) Diet (e.g. Diet, Nutrition, "Dietary Behaviour", Eating, etc); 4) Age Groups (e.g. "High School" "Young Adult", "Adult', etc). A full overview of the search terms is provided in the Supplementary materials. Articles retrieved from the databases were limited to those published from 2014 onwards. This limitation was in place due to: a) previous reviews including peer review articles up until this time point [7,10]; b) the exponential change in social media from 2014 onwards; and c) the types of social media adopted and used in society expanding from 2014 onwards, shifting from predominantly Facebook toward more interactive and visual forms of social media, including Instagram, WhatsApp and YouTube [14,18].

Data extraction
All papers from the database search were collated using EndNote (X9, 2019) reference management software. The screening processes were completed independently by three reviewers (authors GW, BS and VG), with conflicts or undecided articles reviewed by a fourth reviewer (author JLT) for their inclusion or exclusion. Titles were initially screened, followed abstract screening and articles were excluded if they did not meet the inclusion criteria. Full text reviews of articles were then completed by three reviewers independently (GW, BS and VG) with the reasons for exclusion recorded (Fig. 1). Article data were extracted from the final set of included articles by one reviewer (GW), and checked independently by two reviewers (VG and BS). The data extracted included: 1) Details of Intervention (e.g. aims, study design, setting); 2) Participant characteristics; 3) Methods (e.g. general overview of methods, social media used and defined, context and forms of social media use, type of data, etc); 4) Outcomes (e.g. Health outcomes for physical activity or diet, social media outcomes, forms of social media use, and associations between social media and health outcomes); and 5) Key Conclusions, including limitations and key recommendations.

Assessment of quality
Included articles were critically assessed for quality and bias. The Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool [22] was utilised for the multiple study designs for included articles. Mixedmethods studies were assessed using the Mixed Methods Appraisal Tool [23], and the three cross-sectional studies were assessed using the Joanna Briggs Institute Critical Appraisal checklist for analytical cross-sectional studies [24]. Articles were grouped and weighted based on the outcomes from these three tools. All studies were independently rated by GW, BS and VG, and disagreements resolved through discussion with JLT.

Data analysis
The study designs, outcome measures and variables for physical activity and diet varied across the studies. As such, it was not possible to perform a meta-analysis. A narrative synthesis was completed following Cochrane guidelines [25]. Findings from quantitative and mixed methods studies were described numerically and/or textually to provide a summary of evidence on the: (i) characteristics of the social media interventions; and (ii) effects on physical activity and diet. Relationships were then qualitatively examined between studies with the aim of identifying factors that related to intervention effectiveness, such as characteristics of social media use, intervention design, and variability in populations.

Characteristics of social media interventions
As highlighted in Table 1, there was much heterogeneity across the 18 studies regarding the social media platform used for interventions. Twelve of the 18 studies used Facebook, with 10 of these studies using Private Facebook groups [26-30, 32, 34-36, 40]. The remaining six studies reported on the use of Twitter [33], Reddit [31], WeChat [38], Instagram [37] and the use of multiple social media platforms, where the specific platform used was not specified (although Instagram and Facebook were mentioned) [41].
Information related to how social media was used within the intervention to elicit changes to physical activity and diet varied across the papers. The analysis identified three overarching types of social media use within interventions: (i) interactionsocial support, interactions between participants and/or live counselling sessions; (ii) informationthe sharing of guidance, advice and educative materials related to physical activity and diet, delivered through text, videos, tailored/personalised content, detailed instructions, an electronic newsletter, notifications and/or reminders; (iii) gamificationencouraging and motivating participants to change physical activity and diet-related behaviours through gamification principles, such as competitions, challenges and rewards. Across all of these types of social media use, none of the studies reported on the use of paid content and/or the use of advertisements and commercial campaigns. However, there is potential that in the studies that explored engagement with established social media communities and groups and/or that focused on general social media use (i.e. time spent on social media), participants could have been exposed to commercial content [31,37,39,41]. All of the 18 studies reported on the uses of interaction, information and gamification in relation to organic content and the content shared between participants and/or by the research team.
Most of the studies (12 of 18) reported on using more than one of the types of social media (i.e. interaction, information, gamification) within the intervention [26,27,[29][30][31][32][33][34][35][36]38]. Eight of the 18 studies reported on the use of social media for interaction and information [26,27,29,32,[34][35][36]41], of which Facebook was the main platform used. Two studies used a combination of interaction, information and gamification [33,38], and two used information and gamification [30,31], and of these studies, three used contemporary mediums of Twitter, WeChat and Reddit and were published between 2017 and 2020. In the Twitter intervention, information involved the sharing of text-based tweets by the intervention team focused on increasing physical activity, increasing fruit and vegetable intake and decreasing sugar sweetened beverage intake, and photo-based tweets of pictures and infographics related to healthy food options and healthy lifestyle tips [33]. Interaction in this particular intervention involved encouraging participants to ask questions within a private Twitter group created specifically for the intervention [33]. In relation to gamification, the participants' Twitter accounts were linked with a Fitbit tracking device, and individual and group challenges with prizes were developed in relation to physical activity and included step challenges, such as most steps/day or per week, where the results were shared via Twitter [33]. In the intervention that used

Medium: Facebook
Type of Social Media: Interaction and Information-content related to how to maintain a healthy weight content was shared and posted, and group members interacted with one another. Control Group: Used Facebook but did not receive information on healthy weight maintenance. Duration: 9 Weeks A significant increase in weight control strategies postintervention was observed for intervention group (− 1.1 ± 3.4; P = .003). These included selfweighing (P = .005), cutting out snacking (P = .001), reducing carbohydrate intake (P = .02), graphing weight (P = .01), reducing calorie intake (P = .02), reducing fat intake (P = .02), and increasing exercise (P = .02) Overweight students in the intervention group lost 1.8 ± 0.7 kg over 9 Goodyear et al.   WeChat for interaction, information and gamification, daily information was shared to participants, discussions were initiated within the community through images of food and exercise and mini exercise challenges were assigned [38]. A similar approach was adopted in the studies that focused on information and gamification [30,31]. In the intervention that used Reddit, the focus was on the sharing of information related to weight loss, and participants were encouraged to share posts, comment and vote on posts (by liking or disliking posts) within the community [31]. The Facebook intervention involved the sharing of information three times a day and challenges were created in relation to data that could be tracked and shared to Facebook from participants' Fitbits, and included daily step totals, where prizes for highest number of steps were awarded [30]. Participants were also challenged to share a healthy adaptation of their favourite meal to Facebook [30]. Only a few of the studies (4 of 18) used one type of social media [28,37,40]. Two studies focused on information, which involved the researchers posting health education content within Facebook groups two or three times a week [28,40]. The two further studies focused on interaction through participants sharing images on Instagram [37]. Two studies did not focus on information, interaction or gamification because the focus was on general Facebook whereby participants were encouraged to access Facebook (study 1) and then use Facebook for 20 min (study 2) [39].

Participant use and engagement with social media
Half of the studies reported on social media use as a measure of intervention engagement. In these studies [26,[31][32][33][34][35][36][37]39], engagement was measured through participation in social media groups, hours spent on social media and/or frequency of views, posts, comments and likes. Between 50 and 100% participation was reported in studies that measured engagement through social media groups and by using metrics related to members joining the group and/or number of views on weekly posts to the group [26,32,34]. For studies measuring time spent on social media, engagement ranged from 1 h per day to 2 h per week [37,39]. In relation to posts, one study reported on the number of tweets made by participants during the intervention and reported marginal differences between an overweight/obese intervention group (233 tweets) vs healthy weight intervention group (208 tweets) [33]. In relation to likes and comments per week, these were relatively similar across the studies reporting on these measures of engagement, and were reported as 3.3 ± 1.4 likes and comments combined per week [36]  week [35]. In a cross-sectional study of a natural intervention in an established community on Reddit over a 4-year period, 0.7 ± 1.8 posts per participant and 7.9 ± 34.4 comments per participant were reported [31].

Effect of social media interventions on physical activity and diet
As highlighted in Tables 1 and 2, multiple types of study designs were included in this review. The effects of the social media interventions are grouped and described below according to study design.
Three of these RCT studies also reported on physical activity outcomes [26][27][28]. Three studies reported statistically significant increases in physical activity and/or improvements in diet behaviours [26,27,29] in relation to moderate-to-vigorous physical activity (MVPA), daily vegetable servings, readiness to increase fruit and vegetable consumption, change in weight (decrease), increased percentage of weight loss, and a reduction in waist circumference, BMI, fat mass and blood cholesterol. In these studies, social media was used for interaction and information.
Three of these studies reported no change or nonstatistically significant increases in physical activity and/or diet quality [26][27][28]. Specifically, there were no changes in steps per day or overall step counts, and non-significant increases in MVPA and self-reported food, fat or alcohol intake. These studies focused on the use of social media for interaction and/or information. One study reported non-statistically significant decreases in physical activity and diet [28] outcomes, related to MVPA, daily energy intake, and vegetable consumption. This study focused on the use of social media for sharing information using private Facebook groups and smartwatches.
All 3 of the NCBA studies reported no change and/or non-statistically significant increases in physical activity and/or diet, for outcomes related to overall step count, fruit and vegetables intake (self-reported), weight loss or weight change, BMI, waist circumference, enjoyment of physical activity and time spent in physical activity. The focus of these interventions varied. Two of these studies focused on the use of social media for interaction and information [34,35], and the other on interaction, information and gamification [33]. One of the NCBA studies reported non-statistically significant decreases in relation to steps count and sugar-sweetened beverage intake [33]. This study focused on the use of Twitter for interaction, information and gamification over an 8-week intervention.

Mixed-methods
Three of the 18 studies were mixed-methods. Two studies reported on physical activity and diet outcomes [30,32], and one reported on diet outcomes only [31]. Two of the mixed-methods studies used Facebook [30,32] and one reported on Reddit [31].
Two of the mixed-methods studies reported statistically significant improvements in diet quality. Statistically significant increases in the Healthy Eating Index (HEI) and decreases in Dietary Inflammatory Index scores were reported in a 12-week intervention that used Facebook to share information on diet three times per day [30]. Statistically significant increases in fruit and vegetable intake were reported in a 12-week intervention that used Facebook for information and interaction [32]. However, although this Facebook intervention resulted in improvements to diet quality, statistically significant decreases were reported for physical activity, in relation to MVPA and daily step count.
Three of the mixed methods studies reported no change in diet-related outcomes [30][31][32], such as no change to BMI, waist circumference or weight loss. These interventions focused on the use of social media for information and gamification [30], interaction, information and gamification [31], and interaction and information [32].
Three of the CBA studies reported statistically significant improvements in diet-related behaviours and/or physical activity [36,38,40]. For diet, statistically significant improvements were reported in relation to vegetable, fruit, milk and dairy intake [38], weight control strategies (reduced snacking, increased daily self-weighing and graphing of weight and reduced energy and fat intakes) [36], a reduced number of days junk food was consumed per week, and a decrease in BMI [40]. Two studies reported on statistically significant improvements to physical activity indicated by increases in levels of physical activity (changing from low to high) [38], and the steps and miles walked per day [36]. The studies reporting statistically significant improvements to physical activity and diet-related outcomes varied; one study focused on the use of social media for interaction, information and gamification [38], one study focused on information and interaction [36], and the remaining study focused on information only [40]. Statistically significant negative outcomes were associated with social media use in two studies and in relation to disordered eating [37,39]. In study 2 of Mabe et al. [40], disordered eating was associated with the perceived importance of receiving comments on a status or photos, receiving likes, and comparing photos with female friends [39]. In study 2 of Wicks and Keel [38], significant increases in eating disorder cognitions were reported for individuals who posted and edited their photos on Instagram [37]. Negative outcomes were thus associated with interactions on social media in relation to personal information, such as photos or status.

Cross-sectional
Three of the 18 studies were cross-sectional. Two of the studies reported on statistically significant negative outcomes in relation to disordered eating, where a positive correlation was observed in relation to disordered eating between general Facebook use (i.e. time spent on social media) [39] and posting and editing photos on Instagram [37]. One study reported non-statistically significant increases in positive attitudes toward exercise and a healthy diet [41]. This intervention focused on the use of social media for interaction and information, specifically recruiting participants who accessed fitspiration content 1 across different social media sites (although the authors noted Facebook and Instagram). Results indicated that access to fitspiration content improved attitudes toward exercise and diet in the majority of participants. Reported positive benefits included increased motivation to exercise and eat healthfully, increased engagement with a supportive community, and access to health information that participants perceived to be reliable. A minority of participants experienced negative impacts, including feelings of guilt, inadequacy, and failure to meet goals. It is important to note that psychological distress and risks of an eating disorder or compulsive exercise behaviours were common in the study sample [41].

Discussion
The studies included in this review broadly indicate that social media interventions can influence positive changes in physical activity and diet-related behaviours, through increases in physical activity levels, healthy modifications to food intake, and beneficial changes to body composition or body weight. Diverse study designs were included in this review -RCTs, NCBAs, CBA, Mixed Methods and Cross-Sectional -where effects ranged between statistically significant and non-significant/no change. Most papers used self-reported questionnaires to measure physical activity and diet-related behaviours, and these have recognised limitations, including unreliable estimates, recall bias and misinterpretation of questions [42,43]. Overall, only two-thirds of the included studies were assessed to be high quality, with insufficient evidence provided in a third of the studies on the protocol and/or outcome measures. Hence, the evidence from these studies about the effect and direction of social media interventions on physical activity and diet-related behaviours is inconclusive.
The use of Facebook, Facebook groups and the accessibility of information and interaction were the main characteristics of social media interventions used to elicit changes in physical activity and diet-related behaviours. Measures of participant use and engagement with social media also show both passive (viewing posts) and active participation (interactions through sharing posts, likes, and comments) with social media during the interventions. This review has also provided new evidence on the positive influence of contemporary social media sites, including Instagram, Reddit, WeChat and Twitter and their contemporary affordances, such as photo sharing and editing, sub-groups, and group chats. Interventions that used contemporary social media sites tended to focus on multiple types of social media use (i.e. information, interaction and gamification), and often included a focus on gamification, such as through challenges, competitions or rewards. Furthermore, new evidence is provided in this review from studies that reported on the multi-modal uses of social media, whereby data from 1 Fitness inspiration is often abbreviated to 'fitspiration' and this is a popular trend on social media where individuals post or view images, quotes and advice about fitness and nutrition. Some users who follow the fitspiration trend also engage in discussions and shape online fitness cultures about a healthy appearance and optimal dieting and exercise behaviours wearable fitness trackers was connected with participants' social media accounts [30,33]. These studies provide important evidence of the positive effects of the contemporary uses of technology [5,6], in relation to the multimodal connectivity of smart devices, self-surveillance practices, the automation of actions and the role of gamification in social media interventions [44]. Overall, the new evidence reported in this review suggests that the functionality of social media is diversifying, and this provides increased opportunities to reach and engage diverse groups to positively influence physical activity and dietrelated behaviours within social media interventions. The contemporary uses of social media should be explored further and applied to social media interventions to measure and compare effects on physical activity and diet-related behaviours. To measure relationships between social media interventions and health behaviours, we also suggest that future research should improve methods of specifying and reporting the social media intervention, as well as applying established guidance and frameworks for evaluating interventions, such as the UK Medical Research Council's guidance for complex interventions and/or the Behaviour Change Techniques Taxonomy [45].
The main target population of most studies included in this review was young female adults (aged 18-35) attending college/university, and this finding prevented a comparison of outcomes across different population groups. As such, we were unable to address this proposed aim. None of the included papers reported on adolescents (aged < 16), even though this population group use social media extensively [14], and in relation to physical activity and diet [2]. Some of the papers reported on adults aged 40-60 [27,30,32,35], and this reflects increased rates of social media use in society by this population group [15]. Across the papers there was a lack of consistency in reporting of ethnicity and socioeconomic factors, although for the papers where ethnicity was reported, the samples were predominantly white. Evidence on societal uses of social media suggests that rates of use are similar across ethnicities and socioeconomic status, although types of social media use may differ [14,46]. There is therefore a need to design studies that directly assess differences in social media use and the impact of interventions for various ages, genders, ethnic groups, and levels of education and income. Future studies could take the form of targeted interventions for specific groups, as well as recruit large sample sizes that are representative of the population and/or the demographics of societal uses of various types of social media.

Conclusion
The aims of the review were to address current gaps in evidence on how and why social media interventions influence physical activity and diet-related behaviour change, and to understand the uses and effects of contemporary social media mediums. This review has provided a detailed description of all evidence published since 2014, identifying key characteristics of social media use and the target population of interventions, of which the findings indicate much heterogeneity in study design and outcome measures. Overall, new evidence is provided on the affordances of social media that can be used by policy makers, professionals, organisations and/ or researchers to inform the design of future social media interventions to elicit positive changes to physical activity and diet-related behaviours. Further evidence is still required on the use of contemporary social media sites and the contemporary affordances of social media and their effects on physical activity and diet-related behaviours. In addition, this review reveals the need for further methodological rigor to determine the direct effects of social media interventions on physical activity and diet-related behaviours, such as through the use of RCTs, objective measures of physical activity and diet, and the inclusion of representative samples of participants.