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Journal Article Network Meta-Analysis Systematic Review Epublish

PubMed: 40696422 DOI: 10.1186/s12916-025-04240-6

Effectiveness of different intervention designs for improving physical activity in adults with cardiometabolic conditions over time: a systematic review and network meta-analysis of randomised controlled trials.

BMC Med 23(1):437

Authors: Alexander Hodkinson, Harsini Raaja Sulochana, Evangelos Kontopantelis, Charles Adeniji, Harm van Marwijk, Brian McMillan, Peter Bower, Maria Panagioti

Affiliations

  • Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, National Institute for Health and Care Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
  • Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK.
  • Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, National Institute for Health and Care Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
  • Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK.
  • Division of Informatics, NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
  • Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Room 318a, Watson Building, Brigton, UK.

Abstract

BACKGROUND

An active lifestyle can lessen the risk of cardiometabolic conditions and improve overall life quality. To support lifestyle change and help healthcare providers deliver optimal physical activity interventions, we aimed to compare the effectiveness of four different physical activity intervention designs (education, behaviour-change, motivational/goal-setting and multi-component) against usual care/minimal intervention in increasing physical activity among adults with cardiometabolic conditions.

METHODS

A systematic review and network meta-analysis of randomised controlled trials (RCTs) were conducted. Four databases were searched (January 2000-February 2025).

PRIMARY OUTCOMES

steps per day, moderate-vigorous physical activity (MVPA) and combined physical activity.

SECONDARY OUTCOMES

sedentary time, HbA1c, BMI, weight loss, SBP, DBP, cholesterol, LDL-C and HDL-C. Steps per day were analysed via time-course model-based meta-analysis. Bayesian random-effects network meta-analysis estimated mean differences (MD)/standardised mean differences (SMD) and 95% credible intervals (CrIs). Evidence quality was assessed using CINeMA.

RESULTS

Sixty-two trials comprising 8952 participants were included, 51 were analysed in the meta-analysis. Behaviour-change (MD = 3287, 95% CrI 1576 to 4997 steps per day), multi-component (MD = 2939, 95% CrI 1714 to 4164), education (MD = 2054, 95% CrI 369 to 3740) and motivational/goal-setting (MD = 1344, 95% CrI 243 to 2445) interventions were significantly more effective than usual care in increasing steps per day. Overall, combined physical activity interventions excluding minimal interventions and when compared to usual care only, increased steps per day significantly from baseline by 143 (95% CrI 114 to 182; median 18 weeks), with the highest number of steps per day predicted at around 75 weeks from baseline (MD = 738, 95% CrI 581 to 893). Only multi-component interventions were consistently found to significantly increase physical activity across all primary measures-steps per day, MVPA and combined physical activity-compared to usual care or minimal care. In terms of secondary outcomes, motivational (MD = - 0.28%, CrI = - 0.46 to - 0.10%) and multi-component interventions were associated with significant HbA1c reductions (MD = - 0.24%, CrI = - 0.47 to - 0.02%) compared to usual care; no significant effects were found on other secondary outcomes.

CONCLUSIONS

Multi-component interventions were most effective at improving physical activity levels among people with cardiometabolic conditions. The crucial next step for patients, clinicians and policymakers is to enhance the understanding of how to tailor and implement these interventions effectively for sustained improvements in long-term physical activity levels.

TRIAL REGISTRATION

PROSPERO number CRD42023405306.

MeSH

Exercise, Life Style, Multiple Chronic Conditions, Network Meta-Analysis, Education