Pedagogical approaches to health-related physical education (PE) in the context of digitalisation – a scoping review

ABSTRACT

Introduction

There are varied consequences of digital transformation processes within the fitness and health-related living environments of adolescents (e.g. increased physical activity through wearables, body dissatisfaction through social media) which could potentially provide fruitful health-related learning experiences within different pedagogical approaches to health in PE (e.g. biomedical vs. alternative, Mong and Standal, 2019, “Didactics of Health in Physical Education – a Review of Literature.” Physical Education and Sport Pedagogy 24 (5): 506–518. https://doi.org/10.1080/17408989.2019.1631270). However, concerns have been raised that the integration of digital media into health-related PE could reinforce biomedical approaches to health and lead, for example, to a focus on increasing fitness through technology. This one-sided focus would not be in line with the demands for a comprehensive health education. This paper aims to map the current trend of pedagogical approaches to health-related PE in the context of digitalisation and to identify typical learning goals against this background.

Methods

We conducted a scoping review based on the framework of Tricco et al. (2018, “PRISMA Extension for Scoping Reviews: Checklist and Explanation.” Annals of Internal Medicine 169 (7): 467–473. https://doi.org/10.7326/M18-0850). We searched nine databases using a search term covering three topic areas: digitalisation, health, and physical education. Considering the publication years from 2013 to 2023, we selected papers in a three-step process (title-, abstract-, and full-text-screening). In total, we included 103 empirical and theoretical papers in the analysis using qualitative content analysis (Kuckartz, 2019, “Qualitative Text Analysis: A Systematic Approach.” In Compendium for Early Career Researchers in Mathematics Education, edited by G. Kaiser and N. Presmeg, 181–197. Cham: Springer). To map the pedagogical approach to health, we applied the following main deductive categories: conceptualisation of health, paradigmatic approach to health and envisaged learning goals. To analyse learning goals with regard to digitalisation, we used the distinction between learning with and about digital media as a focus of analysis.

Results

The scoping review shows that most of the papers discussed a broad conceptualisation of health for PE by addressing biopsychosocial aspects of health. Many of the implications for health- and digitalisation-associated learning goals related to pre-reflective and functional-reflective learning goals in the area of learning with digital media. They mainly focused, from a pathogenic viewpoint, on how digital media can increase health-enhancing physical activity, affective determinants of health behaviour and health-related knowledge. Parts of these learning goals have already been empirically investigated. Only a few papers proposed critical-reflective learning goals in the area of learning about digital media, aiming at a socio-emancipatory engagement with digital media, health and society. No empirical study within the scoping review investigated the effectiveness of such critical health- and digitalisation-related PE.

Discussion and conclusion

In light of the results, it is important that future genuine pedagogical research about health- and digitalisation-related PE increasingly focuses on the development and empirical evaluation of theoretically sound concepts for PE that are in line with the educational demands of comprehensive – thus also critical and salutogenic – health and digital education.

KEYWORDS:

• Pedagogy
• health education
• physical education
• digital media
• review

Introduction

Currently, digital transformation processes are changing the health- and fitness-related living environments of adolescents. This development holds both potential (e.g. increased physical activity (PA) through fitness apps) and risks (e.g. body dissatisfaction through the consumption of fitness-related content on social media) for the health-related decisions and behaviour of adolescents (Casey, Goodyear and Armour 2017; Goodyear, Kerner, and Quennerstedt 2019; Kerner and Goodyear 2019). These mixed consequences have already partly been made pedagogically fruitful in the scientific literature on health-related PE. Thereby, the selection of the digitalisation-related content, as well as how it is addressed and for what purpose, seem to depend on the pedagogical approach to health-related PE.

In this regard, Mong and Standal (2019) have distinguished between biomedical and alternative approaches to health. Biomedical approaches, on the one hand, tend to focus on improving physical health through a sufficient amount of moderate to vigorous PA. In this line of research, the potential of digitalisation is mainly discussed in terms of how digital media can increase PA or improve fitness in PE (e.g. Lee and Gao 2020; McDonough et al. 2021). Alternative approaches, on the other hand, aim rather to promote a broad and critical engagement with health, focusing on each individual developing and strengthening their own health resources (Mong and Standal 2019). From this perspective, suggestions have been made about how the inclusion of digitalisation-related issues in PE, e.g. the examination of health messages and body norms conveyed by social media, can enhance critical engagement with health (e.g. Almqvist et al. 2016; Cale, Harris, and Hooper 2020; Kirk 2019).

In the pedagogical discourse on health-related PE, concerns have been raised that the integration of digital media such as fitness apps or wearable technology in PE reinforces tendencies towards biomedical approaches to health (Gard 2014; Parris et al. 2022). Such a focus would not be in line with an increasingly demanded comprehensive health education in PE, one which integrates aspects of both pedagogical approaches: the physical aspect of being active as well as the cognitive aspect of critical thinking about health (Fitzpatrick 2023; Mong and Standal 2019; Quennerstedt 2019b). However, the focus on biomedical approaches has not yet been systematically investigated in the discourse on health- and digitalisation-related PE.

Therefore, this scoping review examines how the consequences of digitalisation have already been addressed in the scientific literature on health-related PE. By systematically reflecting on theoretical considerations and reviewing empirical studies on digitalisation- and health-related PE, this study aims to map the current trend of pedagogical approaches to health-related PE in the context of digitalisation, to identify typical learning goals regarding digitalisation in health-related PE, and in turn, to establish theoretical and empirical research gaps.

Pedagogical approaches to health-related PE

Based on the distinction between biomedical and alternative approaches, different criteria can be drawn upon and further complemented to characterise pedagogical approaches to health-related PE (Mong and Standal 2019; Wiklander, Fröberg, and Lundvall 2023): inter alia their conceptualisation of health (e.g. Fitzpatrick 2023; McCuaig, Quennerstedt, and Macdonald 2013), their paradigmatic approach to health (e.g. Antonovsky 1979; Quennerstedt 2008) and their envisaged learning goals (e.g. Fitzpatrick 2023; Quennerstedt 2008).

Concerning the conceptualisation of health, biomedical approaches on the one hand mainly address physical aspects of health (e.g. physical fitness) in PE, the focus on which is often described as a narrow concept of health. Alternative approaches on the other hand address health in a broader sense (McCuaig, Quennerstedt, and Macdonald 2013), further thematising psychosocial aspects of health and wellbeing, e.g. body satisfaction or social support (Gray, MacIsaac, and Jess 2015; Wiklander, Fröberg, and Lundvall 2023).

Regarding the paradigmatic approach to health, biomedical approaches focus on risk factors and deficits associated with physical inactivity (e.g. muscular imbalances, obesity) and aim – from a pathogenic perspective – to preventively compensate for these risk factors and diseases through sufficient PA (Mong and Standal 2019; Quennerstedt 2008). In contrast, alternative approaches aim – from a salutogenic perspective – to empower each individual to develop and strengthen their own health resources in order for them to live a good and healthy life (Quennerstedt 2019a; Wiklander, Fröberg, and Lundvall 2023).

In terms of learning goals, biomedical approaches aim to improve physical health and PA for life. Some of the approaches address this goal mainly through behaviouristic (e.g. increased PA, improved behavioural determinants like exercise self-efficacy) and physical (e.g. improved fitness) outcomes (Fitzpatrick 2023). This has been criticised for its public health, interventional and thus non-educational focus leaving little room for the needs, opinions and agency of adolescents (Ennis 2013; Fitzpatrick 2023). Following the terminology of Gogoll (2013), we will refer to these kinds of outcomes as pre-reflective goals.

Other approaches, which go beyond a purely biomedical approach, address a healthy and active lifestyle rather through acquisition, appraisal, and application of knowledge about health and PA, which is broadly compatible with the concept of functional health literacy (Nutbeam 2000). Knowledge, in this regard, takes on a functional role of enabling students to optimise their own PA behaviours within a paradigm, in which a predetermined level of PA equals better health. This approach is often perceived as more educational due its integration of cognitive learning goals, yet it still mainly implies an individualistic responsibility for and a moral obligation to health (Fitzpatrick 2023). We will refer to these kinds of outcomes as functional-reflective goals.

Alternative approaches – as categorised by Mong and Standal (2019) – rather aim at fostering a critical and reflective engagement with health and health information, e.g. by examining social determinants of health (Mong and Standal 2019; Wiklander, Fröberg, and Lundvall 2023). Furthermore, they do not imply normative, individualistic health imperatives (Quennerstedt 2019a; Stroß 2021). In the didactic discourse of German-speaking countries, the concept of health-oriented ‘Bildung’ (Ruin and Stibbe 2021, 136) takes up the critical-reflective component and clarifies that health-related PE for young people should lead to an emancipative self-reflection of what a healthy lifestyle could be. In this sense, students should be able to critically interact with cultural framings of health (e.g. body ideals in the context of health; Almqvist et al. 2016) as well as with their own ideas, needs and values related to PA and health (McCuaig, Quennerstedt, and Macdonald 2013; Schierz and Thiele 2013; Wibowo et al. 2023). This idea is broadly compatible with the concept of critical health literacy (CHL), which is defined as ‘the ability to reflect upon health determining factors and processes and to apply the results of the reflection into individual or collective actions for health in any given context’ (Abel and Benkert 2022, 2). Following this empowerment-led, socio-emancipatory understanding of CHL, we will refer to these learning goals as critical-reflective goals.

Pedagogical approaches to digitalisation-related PE

In order to analyse health-related learning goals regarding digitalisation, we draw on interdisciplinary approaches to digital education that describe how phenomena of digitalisation can be comprehensively integrated into PE. One approach is detailed by the distinction between learning with and learning about media (Jastrow et al. 2022). Learning with digital media describes the use of digital media as a set of learning tools to achieve subject-specific outcomes (e.g. the use of exergames to increase PA in PE; McDonough et al. 2021). In that sense, digital media can enhance learning goals in the physical, cognitive, social, and affective domain (Jastrow et al. 2022; Kirk 2012).

In the area of learning about digital media, digital media and digitalisation-related topics become the subject matter of learning (e.g. health-related messages conveyed by social media; Araújo, Knijnik, and Ovens 2021). Learning about digital media adopts the goal of comprehensive media education to promote qualified, self-determined and reflective use of digital media (Jastrow et al. 2022) and can be further differentiated into three perspectives (Brinda and Diethelm 2017): (a) The structural perspective questions the way digital media and technology work from a computer science point of view, (b) the application-oriented perspective focusses on a qualified use of digital media, and (c) the socio-cultural perspective aims to promote a critically reflective use of digital media.

The current scoping review

To get a systematic and broad overview on the research landscape regarding digitalisation- and health-related PE, we conducted a scoping review based on the PRISMA-ScR-Checklist (Tricco et al. 2018). The general question of which consequences of digitalisation have already been addressed in the scientific literature with respect to health-related PE was subdivided into two concrete research questions:

1. Which pedagogical approaches to health exist in scientific literature concerning health- and digitalisation-related PE?

2. Which typical learning goals are identified for learning with and about digital media through different pedagogical approaches to health-related PE?

Methods

To cover a wide range of scientific disciplines, nine databases were searched, four of which had an educational focus (Education Source, ERIC, FIS-Bildung, Teacher Reference), two had a sports science focus (Bisp-SURF, SPORTDiscus), two had an interdisciplinary focus (Academic Search Premier, Web of Science) and one had a medical focus (Pubmed). We used a search term consisting of German and English terms from three different topic areas: digitalisation, health, and physical education. The final search-term was as follows: (health* OR gesundheit*) AND (digital* OR technolog* OR wearable* OR ‘tracking device*’ OR ‘tracking app*’ OR ‘fitness app*’ OR ‘health app*’ OR ‘Gesundheits-App’ OR ‘social media’ OR ‘soziale medien’ OR exergam*) AND (Sportunterricht OR ‘physical education’). We limited the search to German- and English-language literature published between 2013 and 2023. All hits were imported into the literature management programme CITAVI and duplicates were removed.

Selection of studies

The papers were selected in a three-step process, in which titles, abstracts and full texts were checked for their suitability using inclusion and exclusion criteria. These criteria were defined based on the PCC characteristics population (P), context (C), and concept (C) (Peters et al. 2020; Tricco et al. 2018) and extended by further criteria:

• Scientific empirical and theoretical literature dealing with digitalisation- and health-related PE was included (concept). Literature about digitalisation- and health-related PE had to describe experiences with or discuss implications for PE at the intersection of health and digitalisation.

• Studies about PE in general schools (context) for students between 10 and 19 years old (population) were included. Studies about PE at university level or vocational schools as well as whole-school-programmes were excluded.

• Monographies, dissertations as well as literature published in journals and edited volumes were included. Abstracts were excluded due to their expected limited details and content.

Title- and abstract-screening were independently undertaken by two researchers (BT & VB). Inconsistently rated titles and abstracts were validated by consensus through joint discussion. The eligibility of the full texts was initially assessed by one researcher (BT) against the inclusion and exclusion criteria, and these assessments were then validated by consensus in regular exchanges with two other researchers (GS & JH).

Charting and analysing the data

The selected articles were analysed using qualitative content analysis (Kuckartz 2019). In a first descriptive analysis step, data on authors, year of publication, title, country, type of publication, research question and suggested digital media were collected and extracted into an excel spreadsheet. Subsequently, concept-driven (deductive) categories of analysis were defined based on the state of research presented above on (1) different pedagogical approaches to health (Mong and Standal 2019; Wiklander, Fröberg, and Lundvall 2023) and (2) learning goals in relation to digitalisation (Jastrow et al. 2022). Figure 1 shows the main categories of analysis and their intersection.

Figure 1. Main categories of qualitative content analysis of the papers included in the scoping review.

The (1) pedagogical approach to health consisted of three categories: conceptualisation of health (narrow or broad; Fitzpatrick 2023; McCuaig, Quennerstedt, and Macdonald 2013), paradigmatic approach to health (pathogenic, salutogenic, combined, no clear reference; Antonovsky 1979; Quennerstedt 2008) and learning goals (pre-reflective, functional-reflective, critical-reflective; Fitzpatrick 2023; Quennerstedt 2008; Ruin and Stibbe 2021).

The (2) learning goals were differentiated regarding learning with and learning about digital media (Jastrow et al. 2022). Learning with digital media was divided into physical, cognitive, social, and affective domains (Jastrow et al. 2022; Kirk 2012). Learning about digital media was divided into a structural, an application-oriented, and a socio-cultural perspective (Brinda and Diethelm 2017).

To increase the reliability of the results, the papers were coded independently by two researchers out of a pool of five sport scientists (BT, FH, LS, MS & SM) in a two-step process. In a first step, each text passage within a paper that referred to a main category was coded using the sub-categories. In a second step, the entire paper was assigned to a particular sub-category taking into account all coded passages. The categories and codes were transferred to the excel spreadsheet and compared. In case of divergences, a consensus was found through joint discussion. With regard to the conceptualisation of health, papers were classified as presenting a narrow conceptualisation of health if they exclusively proposed physical aspects of health as content for PE. In contrast, papers were classified as presenting a broad conceptualisation of health if at least one identified text passage referred to psychological or social aspects of health, regardless of whether physical aspects were mentioned. Broad in this sense does not mean comprehensive but going beyond the physical understanding of health. In terms of the paradigmatic approach to health, papers were coded as pathogenic if they focused exclusively on the prevention of disease or risk factors, and as salutogenic if they exclusively focused on the promotion of health resources in PE. A combined approach was coded if at least one text passage within a paper referred to a pathogenic and one to a salutogenic perspective, and no clear reference was coded if no part of the text clearly referred to the corresponding category. With regard to learning goals, papers were assigned to the different sub-categories if at least one text passage referred to the corresponding sub-category.

After completing the coding process, a quantitative analysis was first carried out to determine how many papers from the scoping review were assigned to each of the main categories of analysis. In a second step, the health-related learning goals were evaluated qualitatively in terms of the above-mentioned pedagogical approaches to digitalisation-related PE.

Results

The final search yielded 6041 hits. After removal of duplicates and the screening process, 103 papers were eligible for qualitative content analysis (Figure 2), of which 98 were published in English and five in German. In terms of research type, 60 empirical studies were included (29 quantitative, 20 qualitative, 11 mixed methods), 33 theoretical papers (17 recommendations for practice, 16 hermeneutic papers), eight literature reviews, and two combinations of an empirical study and a literature review. Concerning the type of digital media considered for health-related PE, most learning goals focussed on wearable technology (n = 37), fitness apps (n = 34) and exergames (n = 32), followed by learning platforms or specific computer programmes (n = 16), social media (n = 14), and learning videos (n = 13).

Figure 2. Selection and screening process of the scoping review.

Detailed information on all included papers as well as their allocation to categories of the didactic approach to health and learning with and about digital media are presented in Supplement 1. The following sections focus on an overarching presentation of the results illustrated with corresponding papers as examples.

Conceptualisation of health

Fifteen out of 103 papers (14.6%) exclusively referred to a narrow conceptualisation of health in their implications for health-related PE. For example, in some cases, physical health was described as a desirable direct effect of PE with a focus on increasing health-related physical fitness or PA (e.g. Filenko et al. 2018). In other cases, aspects of physical health were proposed as a knowledge or learning object. For instance, a discussion with students on the importance of sufficient PA for fitness was suggested (e.g. Da Lopes Silva et al. 2022).

In contrast, 88 papers (85.4%) addressed health in a broad way. In 31 of them, biopsychosocial aspects were discussed at a general level for PE, but not in relation to digital media (e.g. Ashanin et al. 2018), whereas in 57 papers, biopsychosocial aspects of health were directly linked to implications for digital media. Among these 57 papers, biopsychosocial aspects of health (e.g. positive affect, social support) were either discussed as an effect of digitalisation-related PE (e.g. Barron and Chorney 2014), or as a knowledge object and as something to think about, e.g. one’s own possible negative feelings when using fitness technologies (e.g. Goodyear, Armour, and Wood 2019).

Paradigmatic approach to health

Fifty-one out of 103 papers (49.5%) referred exclusively to a pathogenic perspective to health. They described, among other things, high rates of obesity and inactivity as a major social health problem that teachers could and should counteract through PE (e.g. Ainsworth et al. 2018). Technology and digital media were seen as both a driver of sedentarism (e.g. through increased screen time) and as a solution to it (e.g. using e-health technologies that initiate PA). Some of the papers linked disease prevention in PE not only to physical but also to psychosocial aspects of health. In these cases, they described PE as a subject that could contribute to the reduction of stress, social isolation, and mental health issues (e.g. Toto and Strazzeri 2019).

Five papers (4.9%) adopted a purely salutogenic approach to health. These papers described the empowerment of youth to reach their full potential emotionally and physically (e.g. Camacho-Miñano et al. 2022) and the development of health resources independent of risk-factors or diseases (Pang and Hill 2018) as important tasks of PE. Furthermore, the importance of focusing on students’ agency in relation to subjective feelings about health and the body, particularly in the context of digitalisation (Goodyear, Armour, and Wood 2019), was highlighted.

In five papers (4.9%), a combined approach was found, including both a pathogenic and a salutogenic perspective on health (e.g. Grieben 2016), whereas in 42 papers (40.8%), no clear reference to the paradigmatic approach to health could be identified. The latter was the case when authors described the promotion of a healthy lifestyle (e.g. Cale, Harris, and Chen 2014) or the improvement of health or wellbeing (e.g. Auerbach, Kleegräfe, and Nettersheim 2020) as important tasks of PE with no indication of whether this should be achieved by reducing risk factors, by strengthening resources or by a combined approach.

Learning goals

Twenty-one out of 103 papers (20.4%) exclusively mentioned pre-reflective goals for health-related PE, thus focusing on direct health effects and on positively influencing PA behaviour through affective and motivational determinants of PA. Eight papers (7.8%) exclusively focused on functional-reflective learning goals, aimed at increasing knowledge about health, the body and PA. Ten publications (9.7%) exclusively highlighted critical-reflective goals addressing a critical engagement with health, society, and oneself. Furthermore, some papers presented learning goals for more than one area: 57 papers (55.3%) suggested pre-reflective as well as functional-reflective goals. Five papers (4.9%) implied a focus on functional-reflective and critical-reflective goals and two texts (1.9%) mentioned learning goals for all three areas.

Regarding the distinction between learning with and about digital media, 62 papers (60.2%) proposed learning goals for the area of learning with digital media, 11 papers (10.7%) for the area of learning about digital media and 30 texts (29.1%) for both areas.

Pre-reflective goals

All the pre-reflective goals were related to learning with digital media, with suggestions within the physical, affective, and social domains.

In the physical domain, digital media was identified as a means of increasing and intensifying the PA time and physical fitness of students in three different ways. First, digital media was itself proposed to be used as an incentive for movement or to increase fitness within PE (e.g. Lee and Gao 2020). Some of the papers suggested that digital media, especially exergames and fitness apps, could furthermore get students to move through the utilisation of homework-activities and could prove especially useful in times of distance learning (e.g. Martin, Melnyk, and Zimmerman 2015). They could also increase long term PA time due to their attractiveness and lifeworld relevance (e.g. Rudella and Butz 2015). Second, some papers proposed that PE teachers could use digital media (e.g. wearables) to objectively measure (and subsequently better adjust) the activity time and intensity level of PA (e.g. Stradze et al. 2020). Third, using digital media was suggested to teach knowledge in a flipped classroom setting, such that the activity time during PE could be maximised (e.g. Killian and Woods 2022).

In the affective domain, many authors proposed digital media as a way to increase motivation to be (more) active during PE (e.g. Vaghetti et al. 2018), and outside of PE (e.g. Krause and Benavidez 2014). They mainly explained the motivational and habit-forming power of digital media (Rotich 2016) through gamification elements, such as challenges and awards (e.g. Blain, Standage, and Curran 2022), and the possibility of individualised learning through digital media (e.g. Alonso-Fernández et al. 2022). Other papers proposed the use of digital media to increase self-efficacy (e.g. Lwin and Malik 2014), enjoyment (e.g. Krause and Jenny 2021) and interest (e.g. Chen et al. 2015) in PA as well as to improve attitudes and beliefs towards physical exercise (e.g. Barbee 2017) or general wellbeing (e.g. Toto and Strazzeri 2019).

In the social domain, digital media was identified as a means to positively influence social interactions (Kooiman et al. 2017), social skills (e.g. Finco et al. 2013), relatedness (e.g. Blain, Standage, and Curran 2022) and social relationships (e.g. Di Palma, Rosa, and Ascione 2019).

Functional-reflective goals

Functional-reflective goals concerned both learning with and learning about digital media.

The implications of learning with digital media were all related to the cognitive domain. Many authors proposed the use of digital media in enhancing the acquisition of health-related knowledge (e.g. Martin, Ameluxen-Coleman, and Heinrichs 2015). They especially emphasised the potential of measurement devices – such as wearables – to increase knowledge about one’s own body (e.g. fitness-level; O’Keeffe et al. 2020), one’s own movement performance (e.g. number of steps inside and outside of PE; Frömel et al. 2021) and one’s own motion execution (e.g. the correct execution of strength exercises; Keating et al. 2020).

Furthermore, some papers also suggested digital media as a means of enhancing the application of health-related knowledge. They highlighted that digital media, especially fitness apps, exergames and wearables, could be used to enable students to train themselves, e.g. by supporting the development of individually appropriate fitness-goals (e.g. Eberline and Richards 2013), the choice of appropriate exercises and intensity (e.g. Auerbach, Kleegräfe, and Nettersheim 2020), the self-regulation of exercise load intensity-level (e.g. Barbee 2017) and the monitoring of progress (e.g. Cox, Krause, and Roth 2020). Students confronting their own bodies and activity behaviour was described as particularly meaningful for students (e.g. Chen et al. 2015). It was assumed that the monitoring of physical activity behaviour could increase students’ sense of responsibility for their own health (e.g. Doolittle 2016).

In the area of learning about digital media, implications were offered for the application-oriented and socio-cultural perspectives.

Within the application-oriented perspective, it was proposed that students should acquire application-oriented knowledge about digital media, e.g. knowledge about their range and functions, to be able to choose an appropriate device for their health and fitness goals (e.g. Gibbone, Perez, and Virgilio 2014). In this sense, for example, students could investigate and compare the measurement accuracy of wearables and apps (Garver et al. 2015). Furthermore, it was suggested that students should learn how to use the different functions of the devices properly (e.g. Cox, Krause, and Roth 2020). This included, for example, learning to set security settings of wearables, to track one’s own exercise behaviour, to display the data and to give it meaning for their own training (e.g. Clapham, Sullivan, and Ciccomascolo 2015).

Within the socio-cultural perspective, some papers highlighted the importance of students learning how to search, find and appraise appropriate health and fitness information in digital contexts in light of the large amount of uncertified health information on the internet. In this respect, students could learn how to assess the reliability and relevance of digital sources (e.g. Cox, Krause, and Roth 2020).

Critical-reflective goals

Critical-reflective goals all related to the area of learning about digital media and concerned the socio-cultural perspective.

Within this socio-cultural perspective, different topics for PE were proposed to initiate critical engagement within interactions between digital media, society, and oneself. It was suggested that students should learn to identify the commercial interests of fitness influencers and digital sources and to critically reflect on what they consume online regarding health (e.g. DuPree 2022). In this sense, students could also learn to question narrow health messages conveyed through digital media (e.g. Almqvist et al. 2016), e.g. that health can be quantified through optimisable numbers (e.g. Goodyear, Kerner, and Quennerstedt 2019) or that health equates body ideals and happiness (e.g. Wiklund et al. 2019). Students could furthermore learn to question the influence of such messages on their own thinking, living (Araújo, Knijnik, and Ovens 2021) and subjective feelings (Goodyear, Armour, and Wood 2019) and develop strategies to deal with the potential pressure and negative feelings related to fitness technologies and body ideals (e.g. Goodyear, Kerner, and Quennerstedt 2019). One paper emphasised the importance of teaching potential health issues related to body ideals (e.g. exercise addiction, overtraining, orthorexia) rather as a societal and not as an individual problem (Wiklund et al. 2019).

Furthermore, it was suggested that students should learn to critically reflect on how the collection of biomedical data through e-health-technologies can contribute to the establishment and practice of disciplinary and surveillance practices and create a framework to cultivate habits desired from a public health point of view (e.g. Van Doodewaard and Knoppers 2018). Some papers adopted a gender-perspective in this regard and proposed that students should learn to critically question what can be called postfeminism on social media (Camacho-Miñano et al. 2022), a gendered form of health-related neoliberalism regulating young women’s bodies ‘through a language of choice, empowerment and health’ (Langnes and Walseth 2022, 2). Students could examine their own embodiment of gender in the context of health and fitness and be supported to become aware of their ‘power as producers’ (Camacho-Miñano, MacIsaac, and Rich 2019, 661). This could create spaces for the transgression of dominant meanings about the fit and healthy (gendered) body and gender norms.

Empirical studies

Most of the empirical studies examining the effectiveness of teaching and learning in PE related to pre-reflective learning goals (n = 33). They investigated how digital media can increase activity time (e.g. Lee and Gao 2020) and improve determinants of PA behaviour such as enjoyment (e.g. Krause and Jenny 2021), self-efficacy (e.g. Cheng and Chen 2018), interest (e.g. Chen et al. 2015) and attitudes and beliefs towards physical activity (e.g. Lwin and Malik 2014). Concerning functional reflective goals, some empirical studies (n = 10) examined how learning videos and wearables can enhance health-related knowledge (e.g. Chen et al. 2014) and improve the ability of students to self-regulate the intensity level of exercise load (e.g. Barbee 2017). Regarding critical-reflective learning goals and learning about digital media, no empirical study within the scoping review investigated the effectiveness of PE in enhancing such learning goals.

Discussion

In the present scoping review, we explored the question of which pedagogical approaches to health exist in scientific literature concerning health- and digitalisation-related PE and which learning goals are identified for learning with and about digital media.

It is evident from the results that there is a widespread adoption of a broad conceptualisation of health that meets at least parts of the educational demands of comprehensive health education (Mong and Standal 2019; Quennerstedt 2019b). This may be explained by the fact that mental health and wellbeing have become very important topics in the last decade (Fitzpatrick 2023), especially in the light of the digitalised ‘fitness hype’ (Wiklund et al. 2019, 445) and the corona pandemic. Very often, pre-reflective and functional-reflective goals were linked to such a broad conceptualisation of health: Either by seeing wellbeing as an outcome of the use of digital media in PE, or by trying to enable students to improve their wellbeing through PA. While PE can certainly make a valuable contribution to these learning goals, particularly in the case of functional-reflective goals, Fitzpatrick (2023) sees this increasing focus on optimising wellbeing in PE as problematic. She criticises such a ‘well-being agenda’ (Fitzpatrick 2023, 5) for often presenting PE as an oversimplified response to the complex phenomenon of mental health issues, and attributing a further instrumental rather than educational role to health-oriented PE (optimising wellbeing in addition to improving fitness).

Regarding the paradigmatic approach to health, our results show that almost half of the papers adopted a purely pathogenic perspective with some of them linking the pathogenic perspective to a narrow and some to a broad conceptualisation of health. Very few papers showed a salutogenic or combined orientation. One of the reasons for this may be the fact that the concept of salutogenic PE and how it can be expressed linguistically when making concrete implications for lesson planning is less clear than that of a pathogenic PE. Nevertheless, the frequent use of positively oriented formulations in relation to health not classified as salutogenic (e.g. to promote health) may indicate that authors are aware of the potential of PE to adopt a broader perspective on health than mere disease prevention.

In terms of learning goals, it can be argued that the vast majority of papers addressed pre-reflective and functional-reflective goals in the area of learning with digital media. These results are in line with previous studies which have found out that biomedical approaches, when compared to the alternative, have already developed and empirically tested many concrete programmes (Mong and Standal 2019; Wiklander, Fröberg, and Lundvall 2023) and that there is a research desideratum with regard to learning about digital media (Jastrow et al. 2022). Taking a closer look at learning about digital media, it is clear that no implications for the structural perspective have been offered in any paper. This may suggest that a technical understanding of the functioning of digital media from a computer science point of view may not (yet) be seen as a task of physical education. In contrast, the teaching of application-oriented knowledge for the competent handling of digital media as well as the initiation of critical examination of digital media have (already) found their way into the academic health-related PE discourse. Within pre-reflective and functional-reflective goals, the potential of digital media in terms of how gamification and monitoring can increase PA and raise the sense of responsibility of students for their own health was mostly seen as exclusively positive. However, within a more critical perspective, it can also be considered problematic in the light of healthism (Crawford 1980) and biopedagogy (Camacho-Miñano et al. 2022). Both discourses can encourage a morally charged and health-related (gendered) imperative towards the optimisation of health, with a high level of individual responsibility that largely ignores the social determinants of health (Camacho-Miñano et al. 2022; Rich 2018).

In this regard, our results show that in total, only 13% of the papers addressed critical-reflective goals which could be considered a small percentage of the papers. On the other hand, some notable ideas for controversial topics in relation to health and digitalisation (such as biopedagogy, healthism, postfeminism, or surveillance) were identified, topics for which existing discussions may have been intensified due to the widespread use of digital media. It is noteworthy that a greater number of controversial topics regarding health- and digitalisation-related PE than those mentioned above were highlighted in the papers, such as privacy issues, misuse of data, and increasing social inequality (e.g. Centeio 2017; Gard 2014; Lupton 2019). However, these issues were not suggested by the authors as concrete learning subjects to be addressed in PE, but were only discussed on a meta-level in terms of ethical and moral concerns regarding the use of digital media in PE.

From a pedagogical point of view, it was arguably concerning that only five papers referred to combined paradigmatic approach to health in PE and only seven papers presented critical-reflective as well as pre-reflective and/or functional-reflective learning goals. Quennerstedt (2019b), Mong and Standal (2019), as well as other researchers have already pointed out that health-related PE, from a genuine pedagogical perspective, should ‘straddle the divide’ (Mong and Standal 2019, 516) between biomedical and alternative approaches to health and integrate aspects of both. Nevertheless, the focus in the scientific literature on health and digitalisation-related PE seems to be more biomedical. That said, it should be noted that the authors of papers that exclusively referred to a pathogenic perspective or to only one area of learning goals did not explicitly express their rejection of other approaches (see limitations). A one-sided approach becomes particularly problematic if the conceptualisation of health-and digitalisation-related PE is limited to this and other approaches are neglected. The largely biomedical focus of the papers in this scoping review raises the question of the extent to which critical-reflective learning goals and learning about digital media have been sufficiently addressed in the academic context (theoretically and empirically), and whether these learning goals are perceived to be within the remit of PE by the actors in the field (e.g. teachers and researchers). Regarding the implementation of such health- and digitalisation-related PE, research has shown that many teachers are not and/or do not feel sufficiently equipped and confident to promote a critical engagement with health or digital media (Cale 2019; Goodyear and Armour 2019; Kirk 2019), and that their sometimes sceptical attitudes towards digital media in PE could become an implementation barrier (Roth 2021).

Strengths and limitations

In order to provide a broad overview of pedagogical approaches within the scientific discourse by analysing empirical as well as theoretical literature, we refrained from presenting detailed empirical findings on the effectiveness of digital media for different learning goals. A more nuanced overview of the empirically investigated effectiveness of digital media in general PE is provided by Jastrow et al. (2022) and Sargent and Calderon (2022). Furthermore, the method of qualitative content analysis itself brings with it strengths and weaknesses. On the one hand, it allowed us to characterise the pedagogical approach and learning goals in the context of the whole paper and to in turn establish the implications. On the other hand, the method means that specific passages of the paper may not always clearly express nuances of the underlying understanding or details of the pedagogical approach. The assignment of a paper to a certain category, e.g. pre-reflective learning goals, was based on the available information in the relevant text passages, which does not necessarily mean that the authors do not also recognise the value of other learning goals in general.

Concluding remarks

This scoping review provides an overview of the current state of research on pedagogical approaches to health in PE in the context of digital transformation processes and a summary of discussed learning goals regarding learning with and about digital media.

In order to promote a qualified and critical engagement with health in PE, many researchers have already pointed to the need for a balanced, combined pedagogical approach to health, rather than an either/or approach (e.g. Mong and Standal 2019; Quennerstedt 2019b). Following this, we argue that comprehensive health education in PE also needs to consider digital transformation processes, since digitalisation is deeply rooted in the fitness- and health-related living environment of adolescents (Wiklander, Fröberg, and Lundvall 2023). Therefore, health education and digital education should be thought of and taught as intertwined: On the one hand, learning with digital media can enhance an embedded learning experience of fitness and enjoyment of PA. In this respect, it is necessary to address basic health- and fitness-related skills and knowledge as well as application-oriented knowledge for the correct use of digital media. On the other hand, fitness-related digital media reinforce norms and cultural framings of health, which need to be questioned for socio-emancipatory empowerment. In the area of learning about digital media, students should be enabled to lead a personally meaningful healthy and active life, without implying a moral obligation to sport, health, or the use of fitness technology.

In light of the results of our scoping review, it is important that future research increasingly focuses on the development and empirical evaluation of theoretically sound and concrete concepts for PE that are in line with the educational claims of comprehensive health education and digital education outlined above. This requires firstly that criteria for how salutogenic PE can be designed, described and implemented need to be sharpened (e.g. from a linguistic point of view: how should teachers formulate and communicate learning goals so that a salutogenic perspective becomes clear). Secondly, the canon of health- and digitalisation-related controversial topics in the area of learning about digital media in PE should be systematically expanded to include those aspects that have so far only been discussed in ethical-moral terms on a meta-level in scientific discourse. Thirdly, assessment tools and survey instruments need to be developed and tested, ones which can capture the critical reflective empowerment of young people in PE in the context of health, PA and digitalisation. This will enable the effectiveness of such concepts to be evaluated and the empirical gap in this field to be closed. Fourthly, the promotion of critical-reflective learning goals and learning about digital media needs to be more fully integrated into the (continuing) professional development of teachers to facilitate intertwined health and digitalisation education and to reduce potential barriers to implementation.

Acknowledgements

We would like to thank Felicitas Heil (FH), Leonie Schauber (LS), Manuel Schroth (MS), Sofie Maisch (SM) and Veronika Bernhard (VB) for their support in the selection and coding process of the scoping review.

Disclosure statement

No potential conflict of interest was reported by the author(s).