Effectiveness of physical activity promotion interventions in low-income and middle-income countries: a systematic review and meta-analysis

Objective To evaluate the effectiveness of interventions on physical activity promotion in low-income and middle-income countries (LMICs). Design Systematic review and meta-analysis. Data sources PubMed, EMBASE, CINAHL and Cochrane CENTRAL. Eligibility criteria Randomised controlled trials and quasi-experimental studies published between January 2010 and September 2024. Primary outcomes included standardised mean difference (SMD) in physical activity outcomes reported mainly in metabolic equivalent to task (MET) minutes, physical activity minutes and sedentary behaviour. Data were synthesised using random-effects meta-analysis to calculate the SMD reported in a 95% CI, and the risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-Randomised Studies of Interventions tools (ROBINS-I). SMDs of 0.2, 0.5 and 0.8 were interpreted as small, medium and large effects as per Cohen’s threshold. Results 23 studies involving 12 689 participants from LMICs were included in the meta-analysis. Results indicated a small but statistically significant overall effect on physical activity (SMD=0.29, 95% CI 0.13 to 0.46, I²=96%). Significant improvements were observed for MET minutes (SMD=0.42, 95% CI 0.21 to 0.64, I 2 =94%) and physical activity scores (SMD=0.86, 95% CI 0.38 to 1.35, I 2 =91%), but not in total physical activity minutes, sedentary time or energy expenditure, indicating interventions mainly enhanced activity intensity. Interventions via apps and interactive calls were most effective, though overall evidence certainty was low to very low because of heterogeneity and imprecision. Conclusions Interventions, primarily delivered through mobile apps or interactive calls, led to small improvements in physical activity intensity and could have significant public health benefits in LMICs. Future interventions should be context-specific and backed by robust trials to increase their impact and inform sustainable policy. PROSPERO registration number CRD42023412477.