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Brazilian Journal of Motor Behavior
Special issue:
“Control of Gait and Posture: a tribute to Professor Lilian T. B.
Gobbi”
!
Tessari et al.
2023
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Effects of smartphone use on postural control and mobility: a dual-task study
GIOVANNA M. F. TESSARI
1
| SARAH J. L. MELO
1
| TAYLA B. LINO
2
| SIDNEY A. SOBRINHO JUNIOR
2
| GUSTAVO
CHRISTOFOLETTI
1,2
1
Institute of Health, CNPq-AIFN Research Group, Program in Movement Sciences, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
2
Faculty of Medicine, Program in Health and Development, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
Correspondence to:!Prof. Dr. Gustavo Christofoletti, Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul (INISA/UFMS), Cidade Universitária,
CEP: 79060-900, Brazil.
email: g.christofoletti@ufms.br
https://doi.org/10.20338/bjmb.v17i4.362
HIGHLIGHTS
• This study examined potential risks of using a
smartphone while standing or walking.
• Using a smartphone had a negative impact on both
postural control and mobility.
• Participants faced great challenge on postural stability
when talking on the phone.
• Texting message or talking on the phone had a similar
impact on mobility.
• Further studies should be conducted among different
population groups.
ABBREVIATIONS
None
PUBLICATION DATA
Received 25 04 2023
Accepted 19 06 2023
Published 20 06 2023
BACKGROUND: Smartphones have become an integral part of our lives, providing a wide
range of useful features. However, it is important to address the potential risks of using a
smartphone while performing motor tasks.
AIM: To investigate the effects of smartphone use on postural control and mobility in young
adults during standing or walking activities.
METHOD: Forty-five individuals, mean age of 22.1 ± 1.5 years, were enrolled in this study.
The impact of using smartphone was assessed during a static (performed on a force platform)
and a dynamic (timed up and go) test. The participants were instructed to text a message and
talk on the phone while standing or walking. Multiple analyses of variance were applied to
verify main effect of task. Effect sizes are reported. Significance was set at 5%.
RESULTS: Using a smartphone with a simultaneous motor task had a negative impact on
both static and dynamic tests (effect size of 0.820 and 0.788, respectively). Participants were
at similar risks when walking while texting messages or talking on the phone. Conversely,
when standing, talking on the phone caused greater risks compared to the texting condition.
INTERPRETATION: In a sample of young adults, smartphone usage was found to affect the
performance of motor tasks. The impact varied depending on whether the participants were
walking or standing. Further studies should be conducted to investigate the risks associated
with performing motor tasks with a smartphone among different population groups, including
older individuals and subjects with physical disabilities.
KEYWORDS: Smartphone | Postural balance | Gait | Multitasking behavior
INTRODUCTION
Smartphones have become increasingly accessible over the years. The device, which at first was used for conversation, now
have a variety of useful features. The popularity of smartphones is related to several factors. First, they tend to be more affordable than
laptops and computers. Second, they are easy to carry and use. Third, they offer a wide range of entertainment options. Finally, they
allow online access wherever the person is
1
.
With the recent crisis caused by the COVID-19 pandemic, the use of smartphones gained prominence. Prior to the pandemic,
smartphones were commonly used for online shopping, ordering food, listening to music, playing games, performing bank transactions,
and chatting. Nowadays, they have become even more important, serving as a tool for monitoring one's health, receiving exercise
instructions and performing academic and professional activities
2,3
.
Today, people often find any excuse to check their phones during their free time. Wherever a person goes, there is always
someone accessing internet or having fun with a smartphone
4
. However, dividing one's attention between multiple tasks can be harmful
because the conflicts in prioritization may affect motor performance
5
.
The ability to perform more than one activity at the same time is called dual task. Dual tasks activate the prefrontal cortex on a
demand that should be automatic and with little activation of the cognitive areas of the brain. As consequence, executive processes are
stimulated and the focus of attention is divided between the simultaneous tasks
5,6
. Several studies investigated the impact of dual tasks
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on motor and cognitive functions. However, there is still a limited body of research specifically investigating the impact of smartphones as
a dual-tasking mechanism, particularly when individuals are engaged in activities like talking or texting while standing or walking
7,8
. This
aspect warrants further discussion, as it contributes to our understanding of the potential consequences of smartphone use on
individuals' balance and mobility.
In this study, we investigated the impact of texting messages and talking on the smartphone while individuals were walking or
simply standing. We hypothesized that engaging in typing and talking tasks on smartphones would have a detrimental effect on
participants' postural balance and mobility, resulting in both static and dynamic instabilities. We anticipate that individuals using a
smartphone will exhibit an increased center of pressure sway area and imbalance speed while standing, as well as require more steps
and time to complete the walking task. This hypothesis was based on the assumption that dividing attention between the motor task of
walking or standing and the cognitive demands of using a smartphone would negatively impact their ability to maintain the static balance
and move effectively.
METHODS
This is a cross-sectional study conducted with 45 participants, 25 women, mean age of 22.1 (standard deviation:1.5) years. The
participants were recruited in the city of Campo Grande-MS, Brazil. All individuals provided written consent prior the assessments. Ethical
approval was obtained from the institutional research ethics committee (# 3,584,933).
The recruitment was carried out through direct contact with potential participants and through social media. The inclusion
criteria involved young adults aged between 18 and 25 years, of any sex, religion, race, or educational level, without any walking
problems, and not using any continuous medication, such as for hypertension, diabetes, or depression. The exclusion criteria involved
individuals who were unable to attend the data collection center, participants with cognitive scores below normative values on the Mini-
Mental State Examination
9,10
and the Frontal Assessment Battery
11,12
, and subjects who did not own or who had never used a
smartphone.
A total of 60 individuals were initially assessed for eligibility. However, the final sample size was reduced to 45 participants due
to difficulties encountered by some individuals in attending the research location. Table 1 provides information on individual
characteristics, including sex, age, weight, height, body mass index, cognition, duration of smartphone usage, and daily hours of using
the device.
Table 1. Anthropometry characteristics, cognition, and smartphone use by the participants.
Variables
Values
95% Confidence Interval
Sample size, n (men:women)
20:25
---
Age, yrs
22.1 (1.5)
21.7 ; 22.7
Weight, Kg
70.5 (14.9)
66.1 ; 75.0
Height, m
1.7 (0.1)
1.6 ; 1.7
Body Mass Index, Kg/m
2
24.4 (4.0)
23.2 ; 25.6
Mini-Mental State Examination, score
28.9 (1.2)
28.5 ; 29.3
Frontal Assessment Battery, score
17.3 (0.9)
17.0 ; 17.6
Time of using smartphone, yrs
10.4 (2.8)
9.6 ; 11.3
Hours per day using smartphone, h
5.2 (2.6)
4.4 ; 6.0
Data are expressed in absolute frequency value for sex and as mean (standard deviation) for other variables.
Methodological procedures
The methodological procedures are described following the STROBE Statement checklist. To evaluate static upright postural
control, participants underwent a balance task using a force platform consisting of a 500 mm
2
plate and four load cells (BIOMEC
400_V4
®
, EMG System). The test was performed barefoot, with participants instructed to maintain their standing position on the platform
for 60 seconds. The following variables were assessed: maximum sway in the anterior-posterior and medial-lateral directions (cm), center
of pressure sway area (cm
2
), and imbalance speed (cm/s). The data were processed using a sampling rate of 100 frames per second and
a 2
nd
order digital low-pass Butterworth filter. Higher values in these variables indicate poorer postural control performance by the
participants.
To investigate motor performance on a dynamic walking task, we used the Timed Get Up and Go test
13
. This test measures the
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time and number of steps necessary to get up from a chair, walk three meters, return and sit down in the same chair. Longer time to
perform the task and greater number of steps indicate poorer mobility.
During the assessment, participants performed a series of tasks with and without a smartphone. The tasks included answering
a phone call and texting the message: "Hello, I will be late for our appointment" (“Olá, eu chegarei atrasado para nosso compromisso”,
Portuguese version). Participants kept their smartphones in their front pockets prior to each assessment. The tasks were completed in a
randomized order. To minimize any learning effect, participants performed only one trial per task. The focus of this study was to examine
the impact of smartphone use on static and dynamic tasks. We did not investigate the cognitive costs associated with smartphone use,
such as reduced accuracy in typing and talking tasks.
All assessments were conducted at the Laboratory of Biomechanics and Clinical Neurology of the Federal University of Mato
Grosso do Sul. The laboratory ensured controlled conditions for the evaluations, including floor regularity, lighting (six 9W lights),
temperature (20 to 25°C), and a low noise level (up to 40 dB). The data collection for this study took place between August and
December 2022.
Statistical analysis
The statistical analysis was performed using the SPSS
®
software. The data are presented as mean and standard deviation.
Before conducting the analyses, the authors evaluated parametric assumptions, which included assessing normality and homogeneity of
variance. Then, to examine the main effect of the task (no smartphone × texting messages × talking on the smartphone), we used
multivariate analyses of variance in association with Wilk's Lambda test. Additionally, univariate analyses were employed to complement
the analyses for each specific factor of the static and dynamic tests. Post hoc tests with Bonferroni correction were conducted for
pairwise comparisons.
Cognitive scores were not included as a covariate since all participants exhibited normal parameters. However, sex was
included as a covariate to examine its potential significant effect. In cases where significant differences were observed, effect sizes and
statistical power were reported. Significance was set at 5%.
RESULTS
Table 2 provides information on each variable measured on the force platform, along with their respective univariate analyses.
The multivariate analysis of variance showed that using a smartphone while standing had a negative impact on the postural control of the
participants (P = 0.001; Effect size: 0.820; Statistical power: 99.9%). Specifically, participants experienced greater challenges on postural
stability when talking on the phone compared to texting messages or no smartphone use. There was no significant sex × task effect for
frontal sway (P = 0.854), lateral sway (P = 0.715), center of pressure sway area (P = 0.931), frontal imbalance speed (P = 0.433), and
lateral imbalance speed (P = 0.160).
Table 2. Impact of dual tasking with smartphone on postural balance.
Variables
Task
P
Effect
size
Statistical
Power (%)
No Cell
Phone
Texting
Message
Talking on
Phone
Frontal sway, cm
1.9 (0.6)
2.7 (0.9)
Ʝ
3.9 (2.2)
Ʝ
,
ʋ
0.001
0.392
99.9
Lateral sway, cm
1.7 (0.5)
2.6 (0.9)
Ʝ
2.8 (1.0)
Ʝ
0.001
0.376
99.9
Center of pressure sway area, cm
2
2.3 (1.3)
3.7 (2.5)
Ʝ
5.9 (4.9)
Ʝ
,
ʋ
0.001
0.321
99.9
Frontal speed, cm/s
1.1 (0.2)
1.3 (0.1)
Ʝ
1.5 (0.2)
Ʝ
,
ʋ
0.001
0.424
99.9
Lateral speed, cm/s
1.1 (0.2)
1.2 (0.2)
1.3 (0.2)
Ʝ
0.001
0.453
99.9
Data are expressed in mean (standard deviation). P-value, effect size and statistical power of the univariate analyses of variance tests.
Ʝ
Post hoc
analyses indicated differences in each group compared to the “no smartphone” condition.
ʋ
Post hoc analyses indicated differences in each group
compared to the “texting message” condition.
Table 3 details each variable measured on the Timed Get Up and Go test, along with their respective univariate analyses. The
multivariate analysis of variance showed that using a smartphone while walking had a negative impact on the mobility of the participants
(P = 0.001; Effect size: 0.788; Statistical power: 99.9%). Participants experienced similar challenges in mobility when texting message or
talking on the phone, compared to the no smartphone condition. There was no significant sex × task effect for the time (P = 0.427) or
number of tests (P = 0.580).
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Table 3. Impact of dual tasking with smartphone on mobility
Variables
Task
P
Effect
size
Statistical
Power (%)
No Cell
Phone
Texting
Message
Talking on
Phone
Time, secs
9.2 (1.3)
11.8 (2.1)
Ʝ
11.1 (1.7)
Ʝ
0.001
0.498
99.9
Number of steps, n
13.2 (1.2)
15.5 (1.6)
Ʝ
14.9 (1.7)
Ʝ
0.001
0.612
99.9
Data are expressed in mean (standard deviation). P-value, effect size and statistical power of the univariate analyses of variance tests.
Ʝ
Post hoc
analyses indicated differences in each group compared to the “no smartphone” condition. No statistical difference was seen between the “texting
message” and the “talking on the phone” conditions.
DISCUSSION
The aim of this study was to examine the effects of texting messages and talking on the phone while individuals were
performing a simultaneous motor task. The results suggest that postural stability suffered a negative effect especially when participants
were talking on the phone. Conversely, both talking on the phone and texting messages had a similar negative effect on the mobility of
the participants. Identifying situations where smartphone use leads to increased imbalance is important in ensuring the advantages of this
technology without compromising the user's safety.
The dual task of using a smartphone was assessed during a standing and a walking activity. The authors choose these tasks
because they are seen in ordinary situations, such as waiting for the bus, standing at a bank line or when individuals access their
smartphone while walking. The findings of this study should serve as a warning about the risks of using smartphone on a secondary
motor task.
The target population was young adults. The authors limited the recruitment of participants to those aged between 18 and 25
years for two reasons. First, this segment is known to use smartphones more often than other age groups. Second, during the COVID-19
pandemic, smartphones were used for academic purposes such as online classes and meetings, leading to an increased use of the
device in the daily lives of young adults
14
.
Normal cognitive scores were observed in all participants. This is an important factor since simultaneous activities, such as
using a smartphone while performing a secondary motor task, demand a high degree of cognitive processing
15
. In situations where
individuals have cognitive dysfunctions, the results could be negatively impacted.
In the static test, both texting messages and talking on the phone resulted in increased postural instability, which is consistent
with previous studies
16,17
. However, talking on the phone affected more participants' postural balance than the texting task. The authors
hypothesized that texting would result in greater postural instability than talking because texting messages requires constant ocular view
on the text. The results, however, indicate otherwise. Possible reasons to justify this finding refers to a simultaneous activation of
cerebellar-cortical pathways (necessary to stand safety) with the prefrontal and premotor neural pathways, stimulated during
conversation. Additionally, it is possible that the talking activity, which involves the abilities of 1) listening (primary auditory area of the
brain), 2) processing the information (secondary auditory area of the brain), 3) speech planning (secondary motor speech area of the
brain), and 4) speech execution (primary motor speech area of the brain), resulted in a decrease in attentional focus on the activity of
standing up, leading to imbalance18. Further studies are needed to confirm these findings.
In spite of talking while standing have caused greater imbalance to the participants, texting messages had a similar effect to
talking while walking. From a biomechanical standpoint, these findings suggest that texting messages increases muscle tone in the
hands, which, when combined with staring at the cell phone screen, may hinder the corrective sensory feedback mechanism of walking
19,20
.
Significant differences were observed for the type of task (walking vs. standing) across different conditions (no smartphone,
texting messages, talking). To enhance the analyses, we incorporated effect sizes and statistical power. While effect sizes were used to
quantify the magnitude of the observed differences, the statistical power was employed to assess the likelihood of detecting true effects.
The inclusion of these metrics aimed to provide a more comprehensive and meaningful analysis of the statistical differences observed.
Sex did not impact the walking ability of participants while using a smartphone. Although men and women typically have
different motor reference values, the main effect of sex in relation to the task was not found to be statistically significant in this study.
Limitation
The authors recognize some limitations. First, our results are restricted to young adults. Second, this study did not take into
account the potential differences among smartphone brands, apps, and models. Third, we did not assess grammar errors while
participants were engaged in texting and talking activities. Fourth, we employed a general dynamic test to evaluate the walking task.
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Incorporating kinematic analyses would offer additional data. Finally, the lack of cognitive performance measures and the limited number
of trials may have constrained the analysis primarily to motor costs rather than cognitive costs. To gain a more comprehensive
understanding of the impact of smartphone use during motor tasks, we encourage further studies addressing these aspects
CONCLUSION
Young adults exhibit increased instability on postural control and mobility when using a smartphone simultaneously with a
motor task. The extent of the impact varied depending on whether the individuals were walking or standing. While participants faced
comparable risks when texting messages or talking on the phone while walking, standing and talking on the phone posed greater risks
compared to the texting and to the no smartphone condition.
These findings should not discourage individuals to use smartphones but should alert them about the risks involved if the
device is used simultaneously with a walking or standing task. We encourage additional research to explore whether similar effects are
observed in other population groups.
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ACKNOWLEDGMENTS
Office of Research and Graduate Studies (PROPP/UFMS), Office of Extension, Culture and Sports (PROECE/UFMS),
Coordination for the Improvement of Higher Education Personnel (CAPES Financial Code: 001), and the Scientific Foundation of the
State of Mato Grosso do Sul (FUNDECT).
Citation: Tessari GMF, Melo SJL, Lino TB, Sobrinho Junior SA, Christofoletti G. (2023).!Effects of smartphone use on postural control and mobility: a dual-task study.
Brazilian Journal of Motor Behavior, 17(4):158-163.
Editor-in-chief: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil. !
Associate editors: Dr José Angelo Barela - São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia Madalena Rinaldi - Federal University of Espírito Santo
(UFES), Vitória, ES, Brazil; Dr Renato de Moraes – University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Guest editors: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil; Dr Lucas Simieli; Dr Victor Spiandor Beretta - São Paulo State
University (UNESP), Presidente Prudente, SP, Brazil.!
Copyright:© 2023 Tessari, Melo, Lino, Sobrinho Junior and Christofoletti and BJMB. This is an open-access article distributed under the terms of the Creative Commons
Attribution-Non Commercial-No Derivatives 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Funding: This research was funded by the Scientific Foundation of the State of Mato Grosso do Sul (FUNDECT grant n. 275/2022, SIAFEM: 32194, Process N.
71/032.871/2022).
Competing interests: The authors have declared that no competing interests exist.
DOI:!https://doi.org/10.20338/bjmb.v17i4.362