A Systematic Review of Community-based Interventions to Promote Physical Activity or Reduce Sedentary Behavior among Adults in Low- and Middle-Income Countries

Clinical Snapshot

Key Findings

• P Value: Not pooled. Individual study significance reported descriptively: 16/24 studies reported statistically significant PA improvements; 8/9 PA/SB-focused CBIs reported significant effects vs. 8/15 broader lifestyle interventions.

• Effect Size: Range across studies: METs +100 to +2,700; moderate-to-vigorous PA +7 to +60 min/week; steps/day approximately +3,000. No pooled effect size calculable due to narrative synthesis design.

• Primary Outcome: Physical activity improvement: 16 of 24 included studies (66.7%) reported statistically significant improvements in PA outcomes. For sedentary behaviour, only 2 studies directly measured SB as a primary outcome — an insufficient evidence base for conclusions.

• Nnt Or Sensitivity: Not calculable from available data. No NNT, hazard ratio, or diagnostic accuracy metrics reported. Proportion of studies with significant effects used as a proxy measure: 88.9% for PA/SB-focused CBIs vs. 53.3% for broader lifestyle interventions.

• Confidence Interval: Not reported; no meta-analytic pooling was performed. Individual study confidence intervals not synthesised.

Clinical Application

Digital and technology-based CBIs showed the most consistent positive signals and may be feasible in LMIC settings with increasing smartphone penetration. Peer-led and community health worker-facilitated models align with existing community health infrastructure in many LMICs. Environmental restructuring interventions require infrastructure investment and policy support. Implementation fidelity, scalability, and equity considerations are not systematically addressed in the review. Australia is classified as a high-income country and is not directly within the LMIC scope of this review. However, findings have indirect relevance to: (1) Australian communities with LMIC-origin migrant populations, who may respond differently to mainstream PA interventions; (2) Aboriginal and Torres Strait Islander communities, where community-based, culturally adapted PA interventions share conceptual overlap with the LMIC CBI model; (3) Australian global health programs (e.g., DFAT-funded NCD prevention in the Indo-Pacific region). The RACGP supports community-based PA promotion as part of preventive care (RACGP Red Book). TGA and PBS considerations are not directly applicable to behavioural interventions. The digital intervention findings are relevant to Australia's expanding telehealth and mHealth infrastructure. Community-dwelling adults in LMICs with low physical activity levels or high sedentary behaviour, particularly those at risk of or living with non-communicable diseases (NCDs) such as type 2 diabetes, cardiovascular disease, and obesity. Findings are most applicable to short-to-medium term interventions (≤12 months) using digital or peer-led delivery modalities.

Abstract

PURPOSE OF REVIEW: Community-based interventions (CBIs) are widely used to address behavioral risk factors for non-communicable diseases, yet evidence of their effectiveness in low- and middle-income countries (LMICs) remains limited. This study systematically reviewed evidence on the effectiveness of CBIs promoting physical activity (PA) and/or reducing sedentary behavior (SB) among community-dwelling adults in LMICs. We searched PubMed, Embase, Scopus, and the Cochrane Library (2000-2024) for CBIs in LMICs. Primary outcomes were changes in PA and/or SB. Descriptive and graphical depictions were used to draw inferences. RECENT FINDINGS: We selected 24 studies (11 RCTs) from 15,396 for review. Most studies (n = 16) reported significant improvements in PA outcomes. Changes were observed in Metabolic Equivalents (+ 100 - +2,700), moderate-to-vigorous PA (+ 7 to + 60 min/week), and steps/day (+ 3,000). Broadly, interventions were delivered using digital/technology format (n = 10), peer-led/community health worker-facilitated (n = 8), and Environmental restructuring (n = 6), with the digital interventions depicting the most consistent significant improvements. Two studies directly measured SB as a primary outcome. Short- (≤ 6 months; n = 11) and medium-duration (6-12 months; n = 4) interventions more frequently reported significant PA improvements than long-duration interventions (> 12 months; n = 9). PA/SB-focused CBI demonstrated proportions of significant effects similar to those of broader lifestyle interventions (88.9% and 53.3%, respectively). CBIs can be effective in improving PA in LMICs, although evidence is heterogeneous and SB is less addressed. Digital interventions show more consistent positive signals, but high heterogeneity in studies precludes firm conclusions. The impact of duration on effectiveness looks counterintuitive but underscores the need for more rigorous evaluation of longer-duration interventions and SB outcomes. PROSPERO registration number: CRD42024579461.

References

1. 1.Verma, M., Gupta, M., Jeet, G., Bosma, H., & Koster, A. (2026). A systematic review of community-based interventions to promote physical activity or reduce sedentary behavior among adults in low- and middle-income countries. Current Obesity Reports. https://doi.org/10.5888/pcd11.130184