Abstract
Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality globally. Despite preventive community-based interventions (CBIs) seem efficacious in reducing CVD risks, a comprehensive up-to-date synthesis on the effectiveness of such interventions in improving physical activity (PA) is lacking. We performed a systematic review and meta-analysis of community-based CVD preventive interventions aimed at improving PA level. MEDLINE, EMBASE, CINAHL, Cochrane register and PSYCINFO databases were searched in October 2019 for studies reported between January 2000 and June 2019. We assessed the methodological quality of included studies using the Cochrane risk of bias tools. We performed a random-effects meta-analysis and meta-regression to pool estimates of various effect measures. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline. Our study protocol was registered in the PROSPERO database (CRD42019119885). A total of 44 randomized and 20 non-randomized controlled studies involving 98,919 participants were included. Meta-analyses found that CBIs improved the odds of attaining the recommended PA level (at least 150 min of moderate and vigorous PA (MVPA)/week) at 12 month (OR: 1.62; 95%CI: 1.25–2.11) and 18 to 24 months of follow-up (OR: 1.46; 95%CI: 1.12–1.91). Furthermore, interventions were effective in improving metabolic equivalents of task at 12 month (standardized mean difference (SMD): 0.28; 95% CI: 0.03–0.53), MVPA time at 12 to 18 months (SMD: 0.34; 95%CI: 0.05–0.64), steps per day (SMD: 0.32; 95%CI: 0.08–0.55), and sitting time (SMD: –0.25; 95%CI: −0.34 to −0.17). Subgroup analyses found that interventions in low- and middle-income countries showed a greater positive effect on attainment of recommended PA level (OR: 1.40; 95%CI: 1.02–1.92) than those in high-income countries (OR: 1.31; 95%CI: 0.96–1.78). Moreover, interventions targeting high-risk groups showed greater effectiveness than those targeting the general population (OR: 1.76; 95%CI: 1.30–2.39 vs. 1.17; 95%CI: 0.89–1.55). In conclusion, community-based CVD preventive interventions have a positive impact on improving the PA level, albeit that relevant studies in lower-middle and low-income countries are limited. With the rising burden of CVDs, rolling out CBIs targeting the general population and high-risk groups are needed to control the growing CVD-burden.
Highlights
By the year 2030, non-communicable diseases (NCDs) may account for more than 75% of global deaths (World Health Organization (WHO), 2013)
cardiovascular diseases (CVDs) deaths declined in high-income countries (HICs) and some middleincome countries in contrast to most low- and middle-income countries (LMICs) where a steep rise contributed to 75% of all global CVD deaths (World Health Organization, 2017; Roth et al, 2017)
Existing community-based interventions (CBIs) delivered in either individually or in groups appeared to be effective in improving physical activity (PA) level at 12 months
Summary
By the year 2030, non-communicable diseases (NCDs) may account for more than 75% of global deaths (WHO, 2013). With an estimated 523 million cases and 18.6 million deaths (accounting 32.8% of all deaths), cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide (Roth Gregory et al, 2020). Ischemic heart disease and stroke are the first and second leading cause of CVD deaths respectively (Roth Gregory et al, 2020; World Health Organization, 2017). CVD deaths declined in high-income countries (HICs) and some middleincome countries in contrast to most low- and middle-income countries (LMICs) where a steep rise contributed to 75% of all global CVD deaths (World Health Organization, 2017; Roth et al, 2017). The differences in CVD burden observed between countries and regions could be due to demographic changes but as observed after age standardization, the difference is enhanced by socioeconomic changes, epidemiological transition, acquisition of behavioral risks and the influence of global ization and industrialization (World Health Organization, 2017; Roth et al, 2017; Gaziano et al, 2010). Population level lifestyle interventions are likely to be more costeffective than treatment-oriented programs in both LMICs and HICs (Cecchini et al, 2010; Townsend et al, 2016; Checkley et al, 2014)
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