Comparative efficacy of interventions for promoting physical activity in people with type 2 diabetes: A systematic review and network meta-analysis

Background: Increasing physical activity is recommended as a cornerstone of self-management strategies for diabetes prevention and management. While evidence supporting the effectiveness of various interventions to enhance physical activity in individuals with type 2 diabetes is expanding, there remains a lack of consensus regarding the most effective intervention. Objective: To compare and rank the efficacy of different interventions in improving physical activity among individuals with type 2 diabetes. Design: Systematic review and network meta-analysis. Methods: PubMed, Cochrane Library, EMBASE, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database were systematically searched for relevant studies published from the inception of databases until August 4, 2023. Randomized controlled trials evaluating any interventions aimed at improving physical activity (moderate-to-vigorous physical activity or steps per day measured objectively) in individuals with type 2 diabetes were included. The risk of bias was assessed according to the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). A random-effects network meta-analysis model was employed to synthesize all available evidence. The registration number of this study is CRD42023432185. Results: 33 studies involving 6304 participants were included in the quantitative synthesis. In total, the studies assessed 12 different interventions. Sixteen of the 33 studies (48.5 %) met the adapted Cochrane ROB2 for low risk of bias, while five studies were considered to be at high overall risk of bias. Compared to minimal intervention, multi-component interventions (MD 6.43 min/day, 95 % CI 1.85-11.01) had statistically significant effects on improving moderate-to-vigorous physical activity. Additionally, physical activity programme, counselling plus self-help materials, counselling plus Biofeedback, self-help materials plus biofeedback, physical activity programme plus biofeedback, and multi-component interventions had statistically significant effects on improving daily step counts, with MDs ranging from 1672 to 2504 steps per day in individuals with type 2 diabetes. Conclusions: A combination of more than two intervention components appears required to increase physical activity. Counselling, physical activity programme, and biofeedback may be effective ingredients of such combinations, especially to increase the daily step count, among individuals with type 2 diabetes. However, the findings should be interpreted cautiously due to the limited number of studies, small sample sizes, and inconsistencies between outcome measures and comparison types. Further research is needed to strengthen the evidence base for clinical decision-making and to identify the most effective intervention combinations.