Behavior Change Techniques Improve Adherence to Physical Activity Recommendations for Adults with Metabolic Syndrome: A Systematic Review

Figures & data

Figure 1 PRISMA flow of trials through the review.

Table 1 Trial Characteristics

Study and Setting	Participants	Intervention	Control	Outcomes
Fappa (2012)^Citation31 Out-patient lipid clinic, Greece	n = 87 M:F = 49:38 Mean Age: 49	Duration: 6 months Type: Diet and physical activity goal setting and counselling. Frequency: Group 1: face to face, 1-hour, 1:1 sessions, fortnightly × 4, then monthly × 3 Group 2: telephone, 20-minute 1:1 sessions, fortnightly × 4, then monthly × 3 Delivered by: Dietitian	Duration: 6 months Type: Guidance and education for diet and physical activity goal setting during one baseline session. Frequency: Once. Delivered by: Dietitian	Harokopio Physical Activity Questionnaire (HAPAQ)
Luley (2014)^Citation32 Community/home-based, Germany	n = 178 M:F= 105:73 Mean age: 52	Duration: 12 months Type: Health education and telemonitoring. Frequency: One 2-hour session followed by feedback via weekly letters or monthly phone calls Delivered by: specialist doctors and nurses	Duration: 12 months Type: Health education only. Frequency: one 2-hour session Delivered by: specialist doctors and nurses	Objectively assessed physical activity (accelerometer)
Suwankruhasn (2013)^Citation33 Unknown setting, Thailand	n = 86 M:F= 15:71 Mean age: 61	Duration: 3 months Type: Small-group education, counselling and goal-setting Frequency: Weekly × 4, then monthly × 2 Delivered by: Dietitian	Duration: 3 months Type: Usual care Frequency: unclear Delivered by: Registered Nurses	Self-reported physical activity using a logbook
Wong (2021)^Citation34 Community centre and Research centre, Hong Kong	n = 77 M:F= 34:43 Mean age: 57	Duration: 3 months Type: Health education plus mobile application for monitoring and goal setting Frequency: one 30-minute session on how to use application. Delivered by: researchers	Duration: 3 months Type: Health education only Frequency: one 30-minute session Delivered by: Registered Nurse	Godin-Shephard Leisure time physical activity questionnaire (GSLTPA)

Figure 2 Risk of bias.

Table 2 Summary of Findings

Intervention	Effect	Number of Participants (Trials)	Certainty of Evidence
Goal setting	One trial found increased adherence to physical activity recommendations at 3 and 6 months but the other reported no difference between groups.	n = 173 (2 trials)	VERY LOW*^^a ⨁⨁⨁◯
Self-monitoring and feedback	Both trials reported small to moderate improvements in adherence to physical activity recommendations.	n = 255 (2 trials)	LOW*^ ⨁⨁◯◯

Notes: *Downgraded one place as studies were all considered to have at least some concern regarding risk of bias; ^Downgraded one place due to low sample sizes; ^aDowngraded one place due to inconsistency.

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