Comparison of the effects of eHealth-delivered sedentary breaks versus physical activity promotion interventions on sedentary time: protocol for a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not applicable - protocol paper

• Effect Size: Not applicable - protocol paper

• Primary Outcome: Sedentary time reduction (objective measurement or self-report)

• Nnt Or Sensitivity: Not applicable - protocol paper

• Confidence Interval: Not applicable - protocol paper

Clinical Application

High feasibility given focus on scalable eHealth interventions suitable for widespread implementation Highly relevant to Australian digital health initiatives and chronic disease prevention strategies, aligning with national physical activity guidelines and telehealth expansion Adults seeking to reduce sedentary behaviour through digital health interventions

Abstract

INTRODUCTION: Prolonged sedentary behaviour (SB) is an independent risk factor for adverse health outcomes, with current WHO guidelines emphasising both increased physical activity (PA) and reduced sitting time. While electronic health (eHealth) interventions offer scalable solutions, the comparative effectiveness of two dominant strategies: sedentary break interventions (frequent interruptions of sitting) versus PA promotion (structured activity sessions) remains unclear. This systematic review and meta-analysis protocol aims to compare the effectiveness of interventions targeting breaks in SB versus increased PA in reducing sedentary time through meta-analysis of randomised controlled trials (RCTs) comparing either intervention to a control condition, while exploring key moderating factors including participant characteristics, intervention type, duration, eHealth delivery mode, theoretical basis, use of behaviour change techniques (BCTs), PA intensity and SB frequency. METHODS AND ANALYSIS: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive search will be conducted in PubMed, Embase, Web of Science and the Cochrane Library from inception to 31 July 2025, with language restrictions limited to English and Chinese publications. RCTs comparing eHealth-delivered interventions promoting sedentary breaks with those increasing PA in adults will be included. The primary outcome is sedentary time (objectively measured or self-reported), and secondary outcomes include health outcomes such as cardiometabolic markers, fatigue and well-being. Two reviewers (SC and XN) will independently screen studies, extract data and assess risk of bias using validated tools. Meta-analyses will be performed if sufficient homogeneous data are available, comparing changes in sedentary time. Subgroup analyses will explore effects by participant characteristics including gender (male vs female), age groups (<60 vs ≥60 years), intervention type (sedentary breaks vs PA), duration (short-term ≤3 months vs medium-term >3 to <6 months vs long-term ≥6 months), eHealth platform/delivery mode (eg, smartphone apps vs websites vs wearable device prompts vs text messages), theoretical basis (eg, theory-driven interventions vs non-theoretical interventions), use of BCTs (eg, interventions incorporating BCTs vs interventions without BCTs), SB break frequency (eg, every 30 min vs every 60 min) and PA promotion intensity (eg, light vs moderate vs vigorous). A narrative synthesis will be conducted for studies unsuitable for quantitative analysis. ETHICS AND DISSEMINATION: Ethical approval is not required as this study involves secondary analysis of published data. Findings will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD420251042994.

References

1. 1.Chen, S., Nie, X., Giovannucci, E., & Yang, L. (2026). Comparison of the effects of eHealth-delivered sedentary breaks versus physical activity promotion interventions on sedentary time: protocol for a systematic review and meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2025-106815