Efficacy, characteristics, behavioural models and behaviour change strategies, of non-workplace interventions specifically targeting sedentary behaviour; a systematic review and meta-analysis of randomised control trials in healthy ambulatory adults

Abstract

Background: Sedentary behaviour (SB) research has grown exponentially but efficacy for interventions to reduce sedentary behaviour is often contaminated by interventions primarily or co-targeting other behaviours and outcomes. The primary aim of this research therefore, was to systematically review the efficacy of interventions specifically targeting sedentary behaviour reduction, as a sole primary outcome, from randomised control trials in healthy ambulatory adults. This research also sought to identify the successful interventions characteristics, behaviour change techniques (BCT's) and underlying theories, and their relation to intervention effectiveness.

Methods: We followed PRISMA reporting guidelines for this systematic review. Six electronic databases were searched and a grey literature review conducted. Only randomised or cluster randomised controlled trials, from 2000 to 2020, in adult populations with a sole primary outcome of change in sedentary behaviour were included. Data codebooks were developed, data were extracted, and a narrative synthesis and meta-analysis was conducted using mixed methods random effects models.

Results: Of 5589 studies identified, 7 studies met the inclusion criteria. Six studies reported activPAL3 measures of mean daily sitting time, and four reported mean daily standing time, stepping time and number of sedentary breaks. Pooled analysis of weighted mean differences revealed a reduction in mean daily sitting time of -32.4mins CI (-50.3, -14.4), an increase in mean daily standing time of 31.75mins CI (13.7, 49.8), and mean daily stepping time of 9.5mins CI (2.8, 16.3), and an increase in rate of sedentary breaks per day of 3.6 (CI 1.6, 5.6). BCTs used exclusively in two of the three most effective interventions are 'feedback on behaviour' and 'goal setting behaviour' whilst all three most effective interventions included 'instruction on how to perform the behaviour' and 'adding objects to the environment', BCTs which were also used in less effective interventions.

Conclusions: Although limited by small sample sizes and short follow up periods, this review suggests that interventions specifically designed to change sedentary behaviour, reduce overall daily sitting time by half an hour, with an equivalent increase in standing time, in the short to medium term. Effective characteristics and behaviour change strategies are identified for future development of high quality interventions targeting change in sedentary behaviour.

Prospero registration: PROSPERO 2020 CRD42020172457 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172457.

Fig 1. PRISMA flow diagram.

Fig 2. activPAL mean daily sitting time (minutes).

Heterogeneity chi-squared = 10.43 (d.f. = 5) p = 0.064; I-squared (variation in Weighted Mean Difference (WMD) attributable to heterogeneity) = 52.0%; Test of WMD = 0: z = 3.54 p = 0.000.

Fig 3. activPAL mean daily standing time (minutes).

Heterogeneity chi-squared = 2.93 (d.f. = 3) p = 0.403; I-squared (variation in WMD attributable to heterogeneity) = 0.0%; Test of WMD = 0: z = 3.45 p = 0.001.

Fig 4. activPAL mean daily stepping time (minutes).

Heterogeneity chi-squared = 53.25 (d.f. = 3) p = 0.000; I-squared (variation in WMD attributable to heterogeneity) = 94.4%; Test of WMD = 0: z = 2.76 p = 0.006.

Fig 5. activPAL mean daily rate of sedentary breaks.

Heterogeneity chi-squared = 2.04 (d.f. = 3) p = 0.565; I-squared (variation in WMD attributable to heterogeneity) = 0.0%; Test of WMD = 0: z = 3.55 p = 0.000.

Fig 6. Risk of bias summary.