Effectiveness of interventions based on health action process approach in promoting physical activity among rehabilitation patients: a systematic review and meta-analysis

Physical activity (PA) is essential for rehabilitation patients, enhancing physical function, reducing chronic disease risk, and improving overall quality of life. Interventions based on the Health Action Process Approach (HAPA) are widely used to promote PA among rehabilitation patients, yet their effectiveness remains controversial. This meta-analysis aims to evaluate the effectiveness of HAPA-based interventions in enhancing PA among rehabilitation patients. A comprehensive search was conducted across six electronic databases (including PubMed, Embase, Cochrane Library, Web of Science, SPORTDiscus, and PsycINFO), including twelve randomised controlled trials with a total of 1,773 participants. A fixed-effects model was utilised to combine the effect sizes of various PA interventions. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool. Publication bias was assessed using funnel plots and Egger's test, while sensitivity analyses ensured the robustness of the findings. The findings indicate that HAPA-based interventions yielded a significant moderate effect compared to control groups (SMD = 0.43, 95% CI: 0.34, 0.53, p < 0.001). Moderator analysis revealed that older participants, face-to-face interventions, and longer intervention duration demonstrated greater efficacy. The most frequently employed behaviour change techniques (BCTs) within HAPA-based interventions included goal setting, action planning, and social support. This study provides robust evidence supporting the role of HAPA in promoting PA among rehabilitation patients. Future research should tailor interventions to individual characteristics and further explore the underlying mechanisms of BCT elements to enhance the application of theory-based interventions.