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

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.

Keywords: Cardiometabolic conditions; Intervention design; Network meta-analysis; Physical activity; Systematic review.

Fig. 1

PRISMA flow diagram of literature selection

Fig. 2

Network meta-analysis for Steps per day. Network and forest plot for steps per day outcome with head-to-head comparisons of interventions and effect estimates (MD (95% CrI)) and CINeMA judgement. Footnote: The numbers in the upper network plots indicate the number of studies providing direct evidence between intervention options. In the network forest plots, the title “Comparison: Other vs Usual Care” signifies that all interventions—including minimal interventions—were compared against usual care. Minimal interventions were included to ensure all active treatments could be evaluated relative to usual care. In the league table, statistically significant head-to-head comparisons are shown in bold

Fig. 3

Meta-analysis of time-course spline model: physical activity interventions vs. usual care over 104 weeks. (note: the shaded zones represent the number of observations in the original dataset at each predicted time point). Footnote: Time is measured in weeks, and the predicted response outcome represents daily step count. MBNMA stands for model-based network meta-analysis

Fig. 4

Network meta-analysis for MVPA. Network and forest plot for MVPA outcome with head-to-head comparisons of interventions and effect estimates (SMD (95% CrI)) and CINeMA judgement. Footnote: The numbers in the upper network plots indicate the number of studies providing direct evidence between intervention options. In the network forest plots, the title “Comparison: Other vs Usual Care” signifies that all interventions—including minimal interventions—were compared against usual care. Minimal interventions were included to ensure all active treatments could be evaluated relative to usual care. In the league table, statistically significant head-to-head comparisons are shown in bold

Fig. 5

Network meta-analysis for physical activity combined. Network and forest plot for physical activity combined with head-to-head comparisons of interventions and effect estimates (SMD (95% CrI)) and CINeMA judgement. Footnote: The numbers in the upper network plots indicate the number of studies providing direct evidence between intervention options. In the network forest plots, the title “Comparison: Other vs Usual Care” signifies that all interventions—including minimal interventions—were compared against usual care. Minimal interventions were included to ensure all active treatments could be evaluated relative to usual care. In the league table, statistically significant head-to-head comparisons are shown in bold