Effects of theory-based interventions on sedentary behavior, physical activity intensity, cardiometabolic outcomes, and self-efficacy among sedentary older adults: a systematic review and meta-analysis of randomized controlled trials

This study aims to examine the effects of theory-based interventions on sedentary time, physical activity intensity, cardiometabolic indicators, and self-efficacy among older adults with sedentary behavior. Computerized searches were conducted in databases including PubMed, Embase, Web of Science, CINAHLL (EBSCOhost), Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science Journal Database (VIP), Wanfang Data, and China Biomedical Literature Service System (CBM). The search aimed to identify randomized controlled trials of theory-based interventions for sedentary behavior in older adults, from the databases’ inception through July 31, 2025. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, assessed quality, and conducted a meta-analysis using Stata15 software. A total of 17 studies involving 2,344 older adults with sedentary behavior were included. Compared with the control group, theory-based interventions significantly reduced sedentary time in older adults (standardized mean difference [SMD] = -0.24, 95% CI: -0.33, -0.15, p < 0.05); increased moderate-to-vigorous physical activity (MVPA) by 8.43 min per day (95% CI: 4.73, 12.12, p < 0.05), light-intensity physical activity (LPA) (SMD = 0.24, 95% CI: 0.06, 0.43, p < 0.05), and daily step count by 867.30 steps (95% CI: 391.73, 1342.87, p < 0.05); and significantly improved cardiometabolic indicators, including body mass index (BMI) by 0.21 kg/m2 (95% CI: -0.23, -0.19, p < 0.05), glycated hemoglobin (HbA1c) by 0.043% (95% CI: -0.071, -0.014, p < 0.05), and systolic blood pressure by 0.45 mmHg (95% CI: -0.81, -0.10, p < 0.05). Unexpectedly, diastolic blood pressure (DBP) was significantly increased by 0.99 mmHg (95% CI: 0.78, 1.20, p < 0.05). However, there were no statistically significant differences in outcome indicators such as moderate-intensity physical activity (MPA) in physical activity intensity, blood lipids (triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol) among cardiometabolic indicators, and self-efficacy (p > 0.05). Theory-based interventions can effectively reduce sedentary time, increase MVPA, LPA, and daily step count in older adults with sedentary behavior, and significantly improve cardiometabolic indicators, including BMI, HbA1c, and SBP. Additionally, the increase in DBP remains a potential safety concern requiring clinical attention. However, they do not show advantages in moderate-intensity MPA, blood lipid indicators (triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol), or self-efficacy. In the future, more large-sample studies with rigorous designs are needed to verify this conclusion.