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

Background: Coronary heart disease is the leading cause of death worldwide. Adequate physical activity is a well-known protective factor against recurrent cardiac events. Emerging evidence also showed that sedentary behaviour is an independent cardiovascular risk factor. It is thereby essential to identify effective strategies that improve these movement behaviours, physical activity and sedentary behaviour, among patients with coronary heart disease. Aims: This systematic review aims to identify the best available evidence on the effectiveness of non-pharmacological interventions in promoting physical activity and/or reducing sedentary behaviours among patients with coronary heart disease. Methods: Randomised controlled trials that examine the effects of non-pharmacological interventions on physical activities or sedentary behaviours or both among patients with coronary heart disease were included. A systematic search was conducted in eight English and Chinese electronic databases from inception to July 2025. Version 2 of the Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias in included studies. Meta-analyses were performed by using the Review Manager 5.4 when appropriate. A narrative summary was provided when meta-analysis was not feasible. Results: A total of 25 studies (28 articles) involving 5608 coronary heart disease patients were included. The interventions were categorised into two types: those using behavioural change techniques alone (k = 17) or those combining motivational strategies and behavioural change techniques (k = 8). Nineteen included studies provided sufficient information for meta-analyses, with narrative summaries provided for the remaining studies. Meta-analyses showed that interventions combing motivational strategies and behavioural change techniques (k = 2, SMD 0.34, 95 % CI: 0.24, 0.45, p < 0.001, I² = 9 %) and those using behavioural change techniques alone (k = 4, SMD 0.30, 95 % CI: 0.12, 0.47, p < 0.001, I² = 0 %) both significantly increased the total physical activity time. Both types of interventions demonstrated significant improvement in the moderate-to-vigorous physical activity time (k = 12, SMD 0.23, 95 % CI: 0.12, 0.35, p < 0.001, I² = 0 %). However, no significant improvement in sedentary behaviours (k = 10) was found in the meta-analysis. Conclusions: The review suggests that interventions that adopt both motivational strategies and behavioural change techniques could increase the time spent in total physical activity and moderate-to-vigorous physical activity. Further studies on developing and examining the effects of interventions aimed at improving movement behaviours are warranted for the coronary heart disease population. Registration: PROSPERO CRD42024500076.