The effects of gain-loss framed message on physical activity attitudes, intentions, and behaviors in physically inactive adults: a systematic review and meta-analysis

Background Physical inactivity poses serious health risks. Message framing is a strategy to encourage healthy behaviors, but its effectiveness in promoting physical activity (PA) is unclear, creating challenges for professionals in choosing optimal strategies. Objective To compare the effects of gain-framed versus loss-framed messages on PA attitudes, intentions, and behaviors among inactive adults. Methods Seven electronic databases were searched from inception to December 15, 2024. Randomized controlled trials examining gain- versus loss-framed messages targeting physically inactive adults were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) werepooled using random-effects models. Heterogeneity was assessed using I 2 and Q statistics. Subgroup and sensitivity analyses were conducted to explore heterogeneity sources and assess result stability. Results Ten RCTs involving 1,355 participants were included. Three articles tested the gain-loss framing effect through PA attitudes, and eight studies each tested message framing through PA intentions and behaviors. There were no statistically significant differences between gain-framed and loss-framed messages in promoting PA attitudes [SMD:−0.60, 95%CI: (-2.09, 0.90), P = 0.44], intentions [SMD: 0.10, 95%CI: (-0.12, 0.33), P = 0.37] and behaviors [SMD: 0.15, 95%CI: (-0.04, 0.34), P = 0.13]. Subgroup analyses suggested that gain-framed messages may have a potential advantage in promoting PA behaviors among general populations [SMD: 0.39, 95%CI: (0.03, 0.55), P = 0.03] and young adults [SMD: 0.38, 95%CI: (013, 0.63), P = 0.003]. Conclusions Current evidence does not demonstrate a clear overall advantage of gain- over loss-framed messages in promoting PA among inactive adults. However, gain-framed messages may be more promising for general and young populations. Further high-quality trials with standardized methodologies and longer follow-up periods are needed to clarify their effectiveness. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023482474 , identifier CRD42023482474.