Effectivess of non-pharmacological interventions on physical activity and sedentary behaviour among patients with coronary heart disease: a systematic review and meta-analysis

Abstract

Abstract Background Coronary heart disease (CHD) is the leading cause of death worldwide. Adequate physical activity has been firmly established as a protective factor against recurrent CHD events. However, emerging evidence highlights sedentary behaviour as an independent contributor to cardiovascular health. It is thereby imperative to identify effective strategies that promote adequate physical activity while currently reducing sedentary behaviour among patients with CHD. Purpose This systematic review aims to identify the best available evidence on the effectiveness of non-pharmacological interventions (NPIs) on promoting physical activity and/or sedentary behaviours among patients with CHD. Methods This review included randomized controlled trials that examine the effects of NPIs on physical activities or sedentary behaviours or both among patients with CHD. Systematic search was conducted in eight electronic databases (Scopus, MEDLINE, Embase, PsycINFO, Web of Science, CENTRAL, CNKI and WanFang) from inception to December 2023. The version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias of included studies. Meta-analysis was performed by using the Review Manager 5.4, when deem appropriate. A narrative summary was conducted to address studies that could not be included in the meta-analysis. Results A total of 24 articles of 22 studies, involving 5454 patients with CHD were included. The interventions were categorised as motivational interventions (k=6) and behavioural change technique-based interventions (k=18). The findings of this review involved pooling the results from 18 studies through meta-analysis, while a narrative summary was conducted for the remaining 4 studies. Results showed that both motivational interventions (SMD 0.34, 95% CI: 0.24, 0.45, P= 0.02, I2= 48%) and behavioural change techniques-based interventions (SMD 0.23, 95% CI: 0.10, 0.37, P= 0.0008, I2= 0%) increased the total physical activity time. Additionally, motivational interventions improve the moderate-to-vigorous physical activity time (SMD 0.42, 95% CI: 0.19, 0.65, P= 0.0004, I2= 41%). However, no significant improvement on sedentary behaviours was found from the meta-analysis. Conclusions The findings of this review suggests that motivational interventions have the potential effects to enhance total physical activity time and increase the duration of moderate-to-vigorous physical activity. Further studies on effective intervention that improve the physical activity and concurrently reduce sedentary behaviour are warranted for CHD population.Table 1.Charateristics of studiesFigure 1.Forest plot of outcomes