Exploring sedentary behaviour reduction interventions in the primary healthcare setting: a scoping review

Abstract

Background

Excessive sitting time is a risk factor for many non-communicable diseases and an increased risk of early mortality. Primary healthcare is a viable setting to target population health behaviour change. This scoping review investigated the scope, implementation, and effectiveness of interventions targeting sedentary behaviour outcomes in adults within primary healthcare settings.

Methods

Four databases (Medline Complete, CINAHL, APA PsycINFO and Embase) were systematically searched from inception to October 2025. Eligible studies included those involving adult populations (≥ 18 years), conducted solely in primary healthcare, and aimed at modifying sedentary behaviour outcomes (e.g., sitting time).

Results

From 4,941 records, 20 studies met the inclusion criteria. Twelve studies (60%) targeted physical activity exclusively; one study (5%) included an intervention solely targeting sedentary behaviour, and seven studies (35%) targeted both physical activity increases and sedentary behaviour reduction. Interventions commonly utilised individual counselling sessions, behaviour change techniques (i.e., goal setting and action planning), and digital technology feedback (i.e., via Fitbit devices) to support change in individual movement behaviour. Across studies, ‘Train and educate stakeholders’ emerged as the dominant implementation strategy category (n = 13, 65%). Eleven studies (55%) reported at least one significant improvement in a sedentary behaviour outcome.

Conclusions

Few interventions have primarily targeted sedentary behaviour reduction within primary healthcare settings. Some interventions targeting changes in physical activity also resulted in sedentary behaviour reduction. Further research is required to understand if primary healthcare-based sedentary behaviour interventions can achieve and sustain meaningful reductions in sedentary behaviour among adults. Future interventions and their supporting implementation strategies should be designed to be practical, acceptable, and aligned with primary healthcare processes.

Supplementary information

The online version contains supplementary material available at 10.1186/s12875-026-03371-w.

Introduction

Sedentary behaviour (SB), defined as “any waking behaviour characterised by an energy expenditure of 1.5 METS (metabolic equivalent of tasks) or lower while sitting, reclining, or lying” [1], is considered a unique risk factor for multiple chronic diseases. Excessive sitting time is associated with an increased risk of all-cause, cardiovascular, and cancer-related mortality, with risks heightened among those who are also physically inactive [2, 3]. Meta-analyses report that the acute effects of prolonged sitting include significant reductions in lower limb vascular function and increased systolic and mean arterial pressure [4, 5]. The World Health Organization’s (WHO’s) 2020 Physical Activity (PA) and SB guidelines recommend that adults limit their sedentary time and replace it with PA of any intensity and that individuals with high levels of SB exceed the minimum recommended level of moderate-to-vigorous PA to offset associated health risks [1].

The primary healthcare (PHC) setting is a pragmatic, widely accessible setting for embedding interventions that support health behaviour change [6]. A previous review reported that PHC PA referral schemes — where patients are referred to third-party PA interventions — had a small effect on increasing PA levels compared to usual care (ES: 0.18) [7, 8]. PHC settings have also been used to deliver PA interventions directly to patients, with a review of reviews (ten systematic reviews and meta-analyses) and a more recent meta-analysis of six RCTs reporting small to moderate effects (ES: 0.17–0.28 and ES: 0.19 at 12-month follow-up, respectively) compared to control or usual care [9–11]. The PA interventions were delivered by PHC physicians and/or nurses, and commonly comprised consultations supporting behaviour change with subsequent follow-up (i.e., phone calls) [11].

Despite the modest evidence regarding the effectiveness of PA interventions within PHC, there has been very little investigation into the impact of interventions in PHC on modifying SB outcomes. Previous reviews have explored the effectiveness of SB interventions across school and workplace settings [12, 13]. However, none have explored the effects of SB interventions delivered within PHC settings. Further investigation into the implementation of SB interventions within PHC is essential to understanding strategies that support healthcare professionals in facilitating SB change among patients. Effective implementation of interventions in real-world settings can assist in bridging the research-to-practice gap and may contribute to sustained changes within PHC systems, ultimately leading to more effective outcomes [14].

This review aimed to understand the scope, implementation, and effectiveness of interventions targeting SB outcomes in adults within PHC. Due to the broad nature of the research objectives, a scoping review methodology was chosen. The following research questions were posed:

1. What types of interventions targeting SB outcomes have been implemented within PHC?

2. What implementation strategies have been applied to interventions targeting SB outcomes within PHC?

3. What is the effectiveness of PHC-based interventions targeting SB outcomes?

Methods

This scoping review was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR) [15]. The protocol was registered a priori on Open Science Framework registries on May 29, 2024: 10.17605/OSF.IO/9VPJT.

Eligibility criteria

Studies were eligible if they involved adult populations (≥ 18 years) and evaluated interventions conducted exclusively within PHC settings that targeted changes in SB outcomes (e.g., sitting time), either directly or indirectly via the replacement of sedentary behaviours (e.g., sit-stand or PA interventions). Only peer-reviewed original research studies were eligible; protocol papers of planned interventions that met eligibility criteria were included to capture planned approaches to implementation.

To ensure the identification of interventions delivered exclusively within PHC, interventions based solely on referral to outside of PHC (i.e., where a PHC physician refers a patient to an external third party and this referral is the only form of intervention) were not considered. The scope was further limited to studies targeting movement behaviours exclusively; consequently, lifestyle interventions targeting additional health behaviours (e.g., eating, smoking, alcohol or sleep behaviours) were excluded.

Search strategy

The search strategy was developed in consultation with a university library liaison. Electronic databases that were searched from inception to October 2025 included Medline Complete, CINAHL, APA PsycINFO (all via EBSCO) and Embase. Specific search terms and subject headings were tailored to each database as required and encompassed concepts related to SB, interventions or programs, and PHC. The full search strategies for all databases are provided in Supplementary Table 1. English language was the only search limiter applied.

Study selection

All records identified via the database searches were imported into EndNote for duplicate removal and then imported into Covidence for screening and extraction. Title and abstract screening was completed independently by two reviewers using a standardised screening process. Full-text articles were subsequently assessed for eligibility by two reviewers. Any discrepancies between reviewers at either stage were resolved through discussion. Reasons for exclusion at the full-text screening stage were recorded. A backward citation search of included studies was also completed.

Data extraction

A single reviewer (AB) extracted data from included studies using a pre-defined template in Covidence. A second reviewer (SS) checked a sample of this extraction for accuracy, with discrepancies resolved via joint discussion. In line with the review aims, extracted information included study characteristics, intervention retention rates, intervention details and outcomes, implementation strategies and outcomes, and the nature of healthcare professional involvement within the interventions. A targeted search (i.e., author searches) was undertaken for each included study to identify associated publications (e.g., previously published trial protocols and process evaluations), which were used to supplement the extraction of implementation strategy and outcome data, and were not treated as separate studies.

Data synthesis

Extracted data were synthesised narratively in relation to the stated research questions. The implementation strategies reported in each study were mapped to the nine implementation strategy categories of the Expert Recommendations for Implementing Change (ERIC) framework [16]. The implementation outcomes reported for each study were mapped according to the taxonomy of implementation outcomes (which include acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability), as described by Proctor and colleagues [17]. Mapping was completed by one reviewer (AB), with cross-checking completed by a second reviewer (AC) with expertise in implementation science.

Results

After duplicate removal, 2,894 records underwent title and abstract screening, of which 254 progressed to full-text review. Nineteen full texts met the inclusion criteria. The most common reasons for non-inclusion were interventions not conducted exclusively within PHC, unavailable full texts, and a lack of SB outcome measurement. One additional eligible study was identified through backward citation searching. Overall, 20 studies were included in the review, with 29 associated protocol or supplementary papers. The study selection process is summarised in Fig. 1.

Fig. 1.

PRISMA flowchart of the screening process

Year of publication for the included studies ranged from 2008–2025, with over half (n = 11, 55%) [18–28] published between 2020 and 2025. Studies were conducted across a range of countries, including Spain (n = 5, 25%), [21–23, 25, 28] the United Kingdom (n = 3, 15%) [19, 29, 30], the Netherlands (n = 2, 10%) [18, 31], Sweden (n = 2) [32, 33], and the United States (n = 2) [24, 34], with single studies conducted in the Czech Republic [26], China [35], Belgium [36], Brazil [20], India [27], and Oman [37]. Most studies (n = 15, 75%) employed RCT or cluster RCT designs [18–23, 25–30, 33, 34, 37]. He and colleagues [35] delivered a randomised pilot study, and Nyberg and colleagues [32] conducted a controlled parallel-group pragmatic pilot trial; neither was powered sufficiently to assess effectiveness. The studies by Stewart and colleagues [24] and Rodriguez Elias [34] used single-group pre-post designs, and the paper by Helmink and colleagues [31] was reported as a descriptive case series.

A range of health professionals were involved in intervention delivery. These included general practice nurses (n = 6, 30%) [18, 21, 25, 26, 29, 30]; other nursing staff (n = 4, 20%) [20, 31, 36, 37]; physiotherapists (n = 5, 25%) [19, 21, 22, 27, 37]; dietitians/nutritionists (n = 4) [19, 20, 37, 38]; and undefined health professionals/lifestyle advisors (n = 4) [19, 27, 33, 34]. In some studies, general practitioners (GPs) assisted with recruiting and screening participants for the intervention [28, 31, 36, 39]. The studies by Stewart and colleagues [24] and He and colleagues [35] did not report the involvement of any healthcare professionals in their interventions.

In total, 11 studies (55%) recorded SB objectively via accelerometers [18–21, 25, 26, 28–30, 35, 37]. The International Physical Activity Questionnaire was used to record sitting time in six studies (30%) [23, 27, 31, 33, 34, 36], while two studies (10%) used the Marshall Sitting Questionnaire [21, 22] and one (5%) used the Workforce Sitting Questionnaire [28]. The study by Nyberg and colleagues [32] reported measuring sitting time using a 5-point Likert scale (higher scores = lower sitting time) in response to the question ‘How much do you sit during a normal day not counting sleep?’ [32].

Types of interventions

The intervention characteristics are summarised in Table 1. Only one study exclusively focused on improving SB [22]. Seven studies (35%) targeted both increases in PA and reductions in SB [19, 21, 25, 26, 28, 31, 37]. The remaining 12 (60%) studies involved interventions primarily targeting increases in PA, but included SB as an outcome [18, 20, 23, 24, 27, 29, 30, 33–36, 38]. The intervention focusing solely on SB reduction involved researcher-led, individual 30-min appointments to assist women aged 25–65 with fibromyalgia in identifying opportunities to decrease daily sitting time [22]. Five studies (25%) utilised digital health feedback and support (for example, via wearable activity monitors such as Fitbit and associated mobile applications) to promote behaviour change [19, 24, 26, 28, 36]. Many interventions (n = 11, 55%) were guided by behaviour change theories and strategies (including action planning, goal setting, and feedback on behaviours) [18–20, 24, 25, 28–31, 36, 37]. Key intervention details for all studies are provided in Table 1.

Table 1.

Intervention details and sedentary outcomes of included interventions

Study	Population Description	Behaviours Targeted	Intervention Details	Intervention Period	Sedentary Outcome Type(s)	Effect of Intervention(s) on Sedentary Outcomes	Retention Rate (%)
Rodriguez-Roca et al. 2021 (ESP) [22]	Females aged 25—65 years, diagnosed with fibromyalgia, BMI of 25–34.9 (kg/m2), spending more than 6 h/day sitting	SB	Intervention Group: Six-month health education intervention included 30-min appointments with the researcher (face-to-face or via phone). The appointments aimed to identify opportunities to decrease sitting time and SB and to integrate these into patient routines (e.g., using the stairs, getting off the bus one stop earlier, walking after finishing a book chapter) Control Group: Continued usual daily activities	6 months (3-month follow-up)	Sitting Time (hrs/day)	A significant reduction in sitting time at the 3-month follow-up in the intervention group, compared with the control group (p < 0.05). No significant differences between the control and intervention groups post-intervention	Intervention: 67% Control: 55%
Alghafri et al. 2018 (OMN) [37]	Adults ≥ 18 years with T2DM. Attending health centres for at least six months for diabetes care	SB + PA	Intervention Group: Advice on weight and diet management as part of routine care. Three personalised face-to-face consultations (maximum 20 min) by a dietitian aimed to encourage participants to achieve the PA guidelines. The content of the consultations was based on multiple behaviour change techniques and included: PA planning and educational content, PA follow-up and motivational content, and PA maintenance and behavioural content. Psycho-social content was delivered throughout. Also received a pedometer, separate monthly messages and feedback on step counts via WhatsApp message Control Group: Advice on weight and diet management as routine care	12 months	Sitting Time (hrs/day)	A significant reduction in sitting time between the intervention group compared to the control group at 3 months −1.3 h/day (95% CI −2.2 to −0.6) and at 12 months −1.5 h/day (95% CI −2.4 to—0.7) (p < 0.001)	Intervention: 90% (after 3 months) & 67% (after 12 months) Control: 96% (after 3 months) & 84% (after 12 months)
Alonso-Dominguez et al. 2021 (ESP) [21]	Women aged 45–70 years, postmenopausal and classified as inactive via a brief questionnaire	SB + PA	Intervention Group: Given brief advice on the benefits of PA and the current recommendations for PA by the practice nurse. A combined aerobic and resistance exercise program with progressive loading over 12 weeks was delivered by a nurse and physiotherapist. Sessions per week increased from 3 to 6 over the 12 weeks. Received a Xiaomi Mi Band 3 Smartband, a daily goal to achieve 10,000 steps, and notified when sitting for over an hour and encouraged to stand up Control Group: Given brief advice on the benefits of PA and the current recommendations for PA by the practice nurse	3 months (6- and 9-month follow-up)	Daily Sedentary Time (undefined) Sitting Time (undefined)	N/A – Protocol	N/A – Protocol
Alos et al. 2025 (ESP) [28]	Adults 18–65 years with T2DM	SB + PA	Participants used an mHealth Walk@Work mobile application, which included automated strategies to promote sitting less and moving more. The App was installed during a primary care consultation and provided self-monitoring features and targets included steps, sitting and standing time. It used behaviour change techniques including feedback on behaviour, self-monitoring, information about health consequences, goal setting, action planning, social support and instructions on how to perform the behaviour and prompts	12 weeks (6- & 12-month follow-up)	Total sedentary breaks (number/day), Number of sedentary breaks with four different lengths (< 20 min, 20–40 min, 40–60 min and > 60 min), Time spent in sedentary bouts, and Time spent on four different lengths of sedentary bouts (< 20 min, 20–40 min, 40–60 min and > 60 min) (min/day) Sitting Time (min/day)	The intervention group saw a significant reduction in time spent in sedentary bouts < 20 min (−33.45 min/day (SD: 34.72)) compared to the control group (−1.16 min/day (SD: 25.43)) (p < 0.05) The intervention group significantly reduced reported sitting time while at work by 45.63 min/day (SD: 49.90) and 26.25 min/day (SD: 51.90) at the six (p < 0.01) and 12-month follow-ups (p < 0.05) respectively. The intervention group also saw a significant reduction in reported sedentary time while using a computer, tablet or smartphone at home on non-workdays by 27.83 min/day (SD: 64.27) (p < 0.01) after 12 months, and while doing other sedentary leisure activities on workdays by 10.00 min/day (SD: 50.99) (p < 0.05) and 22.08 min/day (SD: 45.59) (p < 0.05) at the six and 12-month follow-ups respectively	Intervention: 97% Control: 83%
Helmink et al. 2013 (NLD) [31]	Adults with pre-diabetes or T2DM, not combined with three or more complications, serious polypharmacy or stage 3 hypertension	SB + PA	Coaching based on motivational interviewing principles and an individualised exercise program with collaboration from the participant. Frequent appointments with the lifestyle advisor in the first three months and a final appointment 12 months post-intervention start	12 months (2-year follow-up)	Total Sitting Time (min/day)	No significant change between baseline and follow-up	Intervention: 33%
Jabardo-Camprubi et al. 2023 (ESP) [25]	Adults aged 60–80 years with T2DM for two or more years. BMI > 34.9 (kg/m2)	SB + PA	Intervention: Social-Ecological model driven psychological and social support (included education on problem-solving, action planning and increasing social support) + Nordic-walking intervention (as described below) Nordic-Walking Comparator Group: Nordic Walking 2 × per week for 30–40 min on green areas surrounding the primary care centre Control Group: Usual advice to increase PA and break up long periods of SB	3 months	Absolute Time in SB (min/day) Number of SB bouts (number)	No significant pre-post changes for any outcomes across all groups	Intervention: 50% Active Comparator: 82% Control: 66%
Peacock et al. 2020 (UK) [19]	Adults 40–70 years old treated in primary care and with medium or high risk of CVD and/or T2DM	SB + PA	Control group: A 20-min meeting with a health trainer and print-based materials with links to internet-based resources regarding the risks of T2DM and CVD, benefits of PA on risk reduction, current PA guidelines, ideas for increasing PA and info on local opportunities Intervention group: The same as the control plus a wearable PA monitor for 3 months, personalised PA and SB feedback via the app and offered four health trainer sessions at 2,4,8 and 12 weeks. The sessions included behaviour change strategies such as feedback on behaviour, self-monitoring of PA behaviour, setting and reviewing goals, and visualising the discrepancy between one behaviour and the health target	3 months (3- and 12-month follow-up)	Sedentary Time (min/day) (< 1.8 METS)	No significant difference between the intervention and control groups at any time point	Intervention: 90% (after 3 & 12 months) Control: 96% (after 3 months) & 94% (after 12 months)
Vetrovsky et al. 2023 (CZE) [26]	Patients ≥ 18 years old with a diagnosis of pre-diabetes or T2DM living independently	SB + PA	Intervention group: Receive brief PA advice from GPs, an educational leaflet, a receipt with a PA prescription, a Fitbit tracker, and advised to achieve the recommended goal of an extra 3000 daily steps. Plus, the mHealth intervention including the just-in-time adaptive intervention supported by monthly phone counselling sessions of 10–20 min duration for six months, followed by automated messages for six months. Example prompts include messages to increase walking pace, prompts to interrupt sitting and review of weekly step goals Active Control Group: Receive brief PA advice from GPs, an educational leaflet, a receipt with a PA prescription, a Fitbit tracker, and advised to achieve the recommended goal of an extra 3000 daily steps	12 months	Daily Sedentary Time (undefined) Daily Sedentary Bouts > 30 min (undefined)	N/A- Protocol	N/A – Protocol
Benedetti et al. 2020 (BRA) [20]	Adults ≥ 60 years with no severe physical and/or mental health impairments and had not participated in PA programs in the past 6 months	PA	Behaviour Change Group: 12 weekly meetings of 1.5–2 h conducted by nutrition or exercise science professionals on topics relating to behaviour change, with a goal of becoming more active Traditional Exercise Group: 12-week exercise class led by an exercise professional (3 × per week for 60 min). Included a 5–10 min warm up, 25 min aerobic exercise, 20 min resistance training and 5 min cool-down	3 months (6- and 12-month follow-up)	Sedentary Time (min/week)	Intention to treat analysis: The behaviour change group had a significant mean change in sedentary time of −14.3 min/week (SE: 56.3) at 3 months (p < 0.05), −16.6 min/week (SE: 46.0) at 6 months (p < 0.01) and −10.9 min/week (SE: 59.9) at 12 months (p < 0.01). The traditional exercise group had a significant mean change in sedentary time of −16.4 min/week (SE: 97.9) at 6 months (p < 0.01). The behaviour change group had a significantly greater reduction in sedentary time compared to the traditional exercise group at 6 months (p = 0.01), but not at 3 or 12 months	Behaviour Change Group: 50% Traditional Exercise Group: 63% Control: 88%
De Cocker et al. 2012 (BEL) [36]	Adults 18–65 years with internet access at home or work and a personal email address	PA	Pedometer-only Group: Received a pedometer, and generic information booklets on how to increase their steps Pedometer + computer-tailored step advice group: Received a pedometer, and generic information booklets on how to increase their steps. Computer-tailored step advice (based on the theory of planned behaviour and the transtheoretical model) which involved personalised feedback/tips and suggestions on how they could increase take steps. Reminders to accept/receive the computer-tailored step advice	3 months	Sitting Time (hrs/day)	The pedometer-only group (−0.7 h/day; 95%CI: −1.9 to 0.5) and the pedometer + advice group (−0.5 h/day; 95%CI: −1.5 to 0.4) reported changes in sitting time after the intervention period	Intervention: 74% Control: 84%
Garcia-Ortun et al. 2022 (ESP) [23]	Adults between 35–70 years old at risk of suffering cardiovascular events (i.e., T2DM, metabolic syndrome, hypertension, and smoking, dyslipidaemia or overweight/obesity)	PA	Intervention group: Received a 2-h educational talk on healthy cardiovascular habits. Completed a physiotherapist supervised physical training program in groups of six at the rehabilitation area of the primary care centre (3 × per week for 2 months). Sessions lasted 60 min and included 30 min of aerobic exercise with cycle ergometer and 15 min of strength exercises with weights and machines Control Group: Received a 2-h educational talk on healthy CV habits	2 months	Sitting Time (min/week)	A reduction in sitting time was found in both the control group: −270 min/week (95%CI: −516 to −23) and the intervention group: −284 min/week (95%CI: −605 to 36). No significant difference between groups reported	Intervention: 84% Control: 96%
Harris et al. 2017 (UK) [29]	Adults 45–75 years old living independently. Not reporting ≥ 150 min/week of MVPA	PA	Pedometer-based walking intervention (by post or with nurse support) compared to usual care. Aiming to increase step counts and achieve the PA guidelines Postal Pedometer Group: Received a pedometer, PACE-UP Handbook (included behaviour change techniques such as goal setting, planning and self-monitoring), and PA Diary (includes an individualised 12-week walking program) Nurse-supported Group: Received a pedometer, PACE-UP Handbook, PA Diary. Two 10–20-min nurse appointments at one- and two-months post-baseline Control Group: Not provided any feedback on PA levels or materials on PA for the trial duration	3 months (12-month follow-up)	Sedentary Time (min/day)	No significant differences between groups at any time point	Nurse Intervention: 92% (after 3 months) & 93% (after 12 months) Postal Intervention: 94% (after 3 months) & 92% (after 12 months) Control: 94% (after 3 months) & 96% (after 12 months)
He et al. 2018 (CHN) [35]	Women aged 55–60 years, postmenopausal with essential, resistant and/or secondary hypertension. Not accompanied by any other metabolic or CVD	PA	Intervention Group: 12-week exercise intervention of brisk walking training 3–5 times per week, plus 60 min of exercise training Control Group: No intervention Negative Control Group (normal blood pressure): 12-week exercise intervention of brisk walking training 3–5 times per week, plus 60 min of exercise training	3 months	Sedentary Time (min/day)	No changes in sedentary time from pre- to post-intervention in either control group. The intervention group reported a significant reduction in sedentary time (Pre: 833 min/day (SD: ± 86) vs. Post: 773 min/day (SD: ± 96) (p < 0.05))	Intervention: 87% Active Control: 87% Control: 96%
Kallings et al. 2008 (SWE) [33]	Elderly adults, healthy but insufficiently active, BMI of 25–40 (kg/m2) and waist circumference ≥ 88 cm for women and ≥ 102 cm for men	PA	Intervention Group: A group-based session on PA and health. A page of general information about the importance of PA for health. Patient-centred counselling and individualised PA prescription (via a 30-min individual counselling session), patients were encouraged to complete30 min or more of MPA on most, if not all, days and to include aerobic, strength, flexibility and balance training Control Group: Usual care, one page of general information on the importance of PA for health	6 months	Sitting Time (hrs/day)	The intervention group reduced sitting time by a median 2 h/day (p < 0.01). The control group reduced sitting time by a median of 1 h/day (p < 0.01). No between-group analysis was reported	Intervention: 87% Control: 93%
Mutrie et al. 2012 (Scotland, UK) [30]	Adults ≥ 65 years, living independently, not meeting current PA recommendations	PA	Intervention Group: Two individual 30-min PA consultations delivered by the practice nurse (involved following recommended guidelines and using the social cognitive model of behaviour change to increase PA). The initial consultation aimed to increase walking, and participants were given a booklet (12-week graduated walking programme), a pedometer and example walking routes. Walking groups led by a researcher 2 × per week were offered. The second consultation was completed after 12 weeks and aimed to maintain walking behaviour Control Group: Asked to continue normal PA for 12 weeks and then received the same intervention	3 months (6-month follow-up)	Sedentary Time (min/day)	After 3 months, the intervention group decreased sedentary time by 47.9 min/day (95% CI −70.2 to −25.6). There was also a significant difference in sedentary time between the intervention and control groups −67.5 min/day (95% CI-100.1 to −34.9) (p < 0.001). No significant difference was reported between groups during the follow-up period	Intervention: 100% Control: 81%
Nyberg et al. 2019 (SWE) [32]	Persons with a diagnosis of COPD visiting primary care	PA	Intervention Group: Received an introduction to the COPD-web (interactive website to support and assist self-management activities for COPD which include PA, physical training, breathing techniques and symptom knowledge, exacerbation prevention and management), a pedometer, and an information leaflet on the importance of PA Control group: Received usual care, a pedometer and an information leaflet on the importance of PA	3- and 12-month follow-up	Daily Sitting Time (5-point Likert scale)	No significant difference in sitting time between the intervention and control group at any time point	Intervention: 100% (after 3 months) & 95% (after 12 months) Control:100% (after 3 months) & 85% (after 12 months)
Rodriguez Elias 2016 (USA) [34]	Physically inactive adults 18–65 years of age	PA	An education intervention was presented through online modules which included information on how much PA adults need for important health benefits, the importance of aerobic activity, the significance of muscle-strengthening activities, and recommendations for PA in disabled persons	2 months	Sitting Time (min/week)	Did not include a comparison of pre-and post-test results	Not Reported
Samal & Manchana 2025 (IND) [27]	Adults 40–90 years	PA	Multi-component exercise program of 11 exercises including group walking, breathing exercises, strength, flexibility & endurance training, balance, coordination, mobility activities and meditation. A group-based activity and home-based program for 30 min/day, 5 × per week over 16 weeks. All exercises were supervised when conducted in the group setting	4 months	Sitting Time (hrs/day)	Significant reduction (p < 0.05) in mean sitting time for the intervention group (pre-intervention: 3.7 h/day (SD: ± 1.0) to post-intervention: 3.5 h/day (SD: ± 1.2)) compared to the control group (pre-intervention 3.4 h/day (SD: ± 1.19) to post-intervention 3.3 h/day (SD: ± 1.19))	Intervention & Control: 100%
Stewart et al. 2022 (USA) [24]	Pre-diabetic patients with access to a smartphone	PA	Utilises core concepts of a diabetes prevention program that included goals of weight loss and completing 150 min of PA/week. The intervention provided this content via SMS/MMS messages delivered daily to participants. Participants received daily text messages over sixteen weeks. Utilised technology-based methods to substitute for the behavioural strategies delivered by lifestyle coaches (e.g., reinforcement of performance accomplishment). Participants also received a 16-week technology-based intervention using a Fitbit and the accompanying app to monitor daily PA behaviours, receive instant feedback, improve self-efficacy etc	4 months	Sitting Time (min/day)	Sedentary time decreased significantly from 509.5 min/day (SE: 48.7) at baseline, to 389.9 min/day (SE: 39.0) at mean 6-month follow-up (p = 0.007)	Not Reported
Westland et al. 2020 (NLD) [18]	Adult patients from general practices aged 40–75 years, at risk of CVD and completing less than 30 min of MVPA ≥ 5 days/week	PA	Intervention group: Four structured and standardised nurse-led 20–30 min consultations (at week 1, 3, 7 & 12) to enhance the patient's level of PA. Received activity logs, action planning forms, trial information, tips and tricks, discussed the motivation for increasing PA and set goals at the first consultation. Received an accelerometer to monitor PA behaviour and kept an activity log Control Group: Usual care in accordance with the Dutch guidelines for CVD risk management	3 months (6-month follow-up)	Daily Sedentary Time (% of accelerometer wear spent in < 1.8 METS)	No change in the control or intervention groups after 3 or 6 months	Intervention & Control: 100%

Abbreviations: 95% CI 95% Confidence Interval, BEL Belgium, BRA Brazil, CHN China, COPD Chronic Obstructive Pulmonary Disease, CVD Cardiovascular Disease, CZE Czech Republic, ESP Spain, IND India, MPA Moderate Physical Activity, MVPA Moderate -Vigorous Physical Activity, NLD Netherlands, OMN Oman, PA Physical Activity, SWE Sweden, T2DM Type 2 Diabetes Mellitus, UK United Kingdom, USA United States of America

Legend: Objective MeasurementSubjective Measurement

Implementation strategies applied

The implementation strategy details, mapped according to the nine ERIC implementation categories, are presented in Table 2. Seven studies (35%) did not report any implementation strategies [21–24, 34–36]. Among the 13 studies (65%) reporting the use of implementation strategies, nine (45%) used more than one strategy [18–20, 26, 27, 29–31, 37]. All such studies included at least one strategy within the ‘Train and educate stakeholders’ category to support stakeholders in implementing interventions [18–20, 25–31, 33, 37, 38]. Discrete strategies within this category most commonly involved individual or group-based training sessions for health professionals, aimed at building capacity to facilitate the intervention or deliver specific program components (i.e., utilising motivational interviewing or other behaviour change techniques) [18–20, 25, 29–31, 33, 37, 38]. The next most frequently reported category was ‘Use evaluative and iterative strategies’ (e.g., fidelity monitoring and formative feedback to intervention deliverers), reported in four studies (20%) [19, 29, 31, 37] followed by ‘Provide interactive assistance’, reported in three studies (15%) [18, 30, 37]. ‘Develop stakeholder interrelationships’ was reported in two studies (10%) [20, 27], with ‘Utilize financial strategies’ and ‘Engage Consumers’ each utilised in one study [26, 28].

Table 2.

Healthcare professional involvement and implementation strategy details of included studies

Study (associated papers)	Healthcare Professional Involvement (if any)	Implementation Strategy Details (as reported)	Mapping to ERIC Implementation Strategies
Alghafri et al. 2018 (OMN) [37, 40–43]	Dietitians (delivered consultations). Project officers (were existing diabetes healthcare providers i.e., doctors/nurses/dietitians/health educators)	1) Project officers received a 5-day bespoke training program facilitated by a health psychologist and public health specialist—content included recruitment procedures, outcome measurements and delivering the ‘MOVEdiabetes’ intervention. 2) Project group held monthly meetings to discuss issues regarding attendance, PA consultations and measurements. 3) A telephone application (WhatsApp) was used throughout the study period by project officers and the primary investigator to manage the daily logistics and administrative queries	1) Train and educate stakeholders; 2) Use evaluative and iterative strategies; 3) Provide interactive assistance
Alos et al. 2025 (ESP) [28, 44]	Physicians and Nurses (recruitment and monitoring)	1) 1 × 2-h training course with medical staff (GPs and Nurses) that covered a) the benefits of physical activity and reduction of sedentary behaviour in T2DM, b) information and objectives of the study and c) schedule of the visits and tasks in each follow-up visit	1) Train and educate stakeholders
Benedetti et al. 2020 (BRA) [20]	Nutrition or exercise professionals (delivered intervention)	1) Initial meeting where the study was presented to all five health district coordinators. 2) Nutrition or exercise science professionals received specific training to facilitate the program	1) Develop stakeholder interrelationships; 2) Train and educate stakeholders
Harris et al. 2017 (UK) [29, 45–50]	Practice nurse (delivered consultations)	1) A 1-day training session in specific behaviour change techniques and the use of intervention handbooks, provided by trainers experienced in behaviour change technique training in primary care and practice nurses. 2) Three additional half-day training sessions over a 12-month period to provide support in behaviour change techniques, communication skills, and to troubleshoot problems. 3) A sample of the audio-recordings of each nurse's consultations was reviewed by the behaviour change technique trainers, with individual feedback provided	1) Train and educate stakeholders; 2) Train and educate stakeholders; 3) Use evaluative and iterative strategies
Helmink et al. 2013 (NLD) [31, 51–54]	GP (recruitment). Lifestyle Advisor- usually a practice nurse or physiotherapist (delivered intervention)	1) Development of a professional development and support manual. 2) Use of regular peer feedback meetings for healthcare providers. 3) All medical specialists involved in the program were trained in motivational interviewing—four eight-hour sessions, with the final session after one year	1) Train and educate stakeholders; 2) Use evaluative and iterative strategies; 3) Train and educate stakeholders
Jabardo-Camprubi et al. 2023 (ESP) [25, 55]	Physiotherapists (delivered intervention)	1) Instructors were trained (by the principal investigator) and advised to use a SEM approach to guide increases in PA (in the SEM group). All instructors in charge of conducting the socio-ecological Nordic walking intervention and active comparator group were trained by the research team to apply a standardised protocol. Instructors also informed about hypoglycaemia and how to manage such an event	1) Train and educate stakeholders
Kallings et al. 2008 (SWE) [33, 56]	Health professional trained in PA counselling	1) A health care professional trained in motivational counselling for physical activity delivered the intervention; unclear if training was delivered as part of the study	1) Train and educate stakeholders
Mutrie et al. 2012 (Scotland, UK) [30, 57]	Practice nurse (delivered consultations). Walking group leaders	1) Nurses received a one-to-one training session (1 day) by a trainer from NHS Health Scotland. The trainer was also available to nurses for clarification and guidance prior to intervention delivery. 2) Walking group leaders received standardised training through a 1-day workshop delivered by the national charity Paths for All	1) Train and educate stakeholders, provide interactive assistance; 2) Train and educate stakeholders
Nyberg et al. 2019 (SWE) [32, 38]	Four asthma/COPD-nurses, one district nurse, one dietician and one physiotherapist (Recruitment and delivery)	1) Two training sessions: a. Session 1 (2 h) introduced the intervention (COPD-web), the study procedures, and attendees were provided with a reflection task; b. Session 2 (1 h) some repeat of initial information, followed by a reflection task. 2) Healthcare professionals provided with written information on study procedures and the COPD-web	1) Train and educate stakeholders; 2) Train and educate stakeholders
Peacock et al. 2020 (UK) [19, 58, 59]	Health trainers—Dietitians (n = 5) and non-registered health professionals, i.e., PA or lifestyle advisors (Delivered intervention)	1) Provision of written materials (i.e., on facilitating behaviour change). 2) 2-day training on the intervention (included familiarisation with the platform and self-monitoring technology, understanding the multidimensional nature of PA, using the integrated PA profiles, provision of information as part of the intervention). 3) Recorded a selection of consultations, implemented fidelity checklists, and provided formative feedback to health trainers	1) Train and educate stakeholders; 2) Train and educate stakeholders; 3) Use evaluative and iterative strategies
Samal & Manchana 2025 (IND) [27]	Healthcare workers (delivered intervention)	1) Healthcare workers were given intervention-related education and orientation as well as guidance on recruitment and referral. 2) Understandable local language announcements and posters, handouts were used for information dissemination and to encourage participation. 3) The intervention involved planned meetings with the district medical officer and the community level health care workers, community leaders, political representatives, mahila samiti (women groups) members, head of the family etc., to assist implementation	1) Train and educate stakeholders; 2) Engage Consumers; 3) Develop stakeholder interrelationships
Vetrovsky et al. 2023 (CZE) [26, 60, 61]	GP's (screening/recruitment of participants)	1) GPs trained remotely via 3 × 1 h Zoom sessions covering the electronic data capture tool, initialising and downloading data, and provision of brief PA advice in primary care. 2) GPs received remuneration of 100 EUR per patient completing the study	1) Train and educate stakeholders; 2) Utilise financial strategies
Westland et al. 2020 (NLD) [62–65]	Practice nurse (delivered individual consultations)	1) Standardised training program; 1-day knowledge and skills training in behaviour change theories and counselling. 2) Instructional videos on applying the behaviour change theories in consultations. 3) Provision of a scripted handbook and checklists outlining what to do and when. 4) Two individual coaching sessions from a health psychologist to reinforce the trained skills in applying the behaviour change theories	1) Train and educate stakeholders; 2) Train and educate stakeholders; 3) Train and educate stakeholders; 4) Provide interactive assistance
Alonso-Dominguez et al. 2021 (ESP) [21]	Practice nurse and physiotherapist (delivered intervention)	No implementation strategy details reported	-
De Cocker et al. 2012 (BEL) [36]	GPs (recruitment). Intervention was online/computerised	No implementation strategy details reported	-
Garcia-Ortun et al. 2022 (ESP) [23]	Physiotherapist (supervised physical training program)	No implementation strategy details reported	-
He et al. 2018 (CHN) [35]	None reported	No implementation strategy details reported	-
Rodriguez Elias 2016 (USA) [34]	Nursing staff (recruitment)	No implementation strategy details reported	-
Rodríguez-Roca et al. 2021 (ESP) [22, 66]	Research nurse (recruitment and data collection)	No implementation strategy details reported	-
Stewart et al. 2022 (USA) [24]	None. Remotely Implemented	No implementation strategy details reported	-

Abbreviations: BEL Belgium, BRA Brazil, CHN China, COPD Chronic Obstructive Pulmonary Disease, CZE Czech Republic, ESP Spain, GP General Practitioners, IND India, NLD Netherlands, OMN Oman, PA Physical Activity, SEM Socio-Ecological Model, SWE Sweden, T2DM Type 2 Diabetes Mellitus, UK United Kingdom, USA United States of America

Implementation outcomes

Implementation outcomes for all included studies mapped to Proctor and colleagues framework [17] are presented in Table 3. The reporting of outcomes varied extensively. The most frequently reported implementation outcome was adoption, reported in 14 studies (70%) [18–20, 22, 23, 25, 27–32, 36, 37]. The reported adoption rates of interventions ranged widely across studies from 6.2% [36] up to 81% [27]. The next most frequently reported implementation outcome, reported in eight studies (40%) [18–20, 23, 25, 29, 30, 33], was fidelity, with adherence rates ranging from 53% [33] to 91%. [23] Two studies (10%) did not include any details on implementation outcomes [21, 35].

Table 3.

Implementation outcome details of included studies

Study (associated papers)	Acceptability	Adoption	Appropriateness	Costs	Feasibility	Fidelity	Penetration	Sustainability
Rodríguez-Roca et al. 2021 (ESP) [22, 66]	Not reported	Reported a high rejection rate with 282 (57.1%) potential participants refusing to take part	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Alghafri et al. 2018 (OMN) [37, 40–43]	The majority of participants and all project officers were either 'very satisfied' or 'quite satisfied' with the project	232 (53%) participants screened consented to participation	Participants perceived the program as appropriate for use in local diabetes primary care. Project officers perceived the program as suitable	Not reported	Not reported	Not reported	Not reported	Not reported
Alonso-Dominguez et al. 2021 (ESP) [21]	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Alos et al. 2025 (ESP) [28, 44]	Not reported	54/75 (72%) agreed to participate	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Helmink et al. 2013 (NLD) [31, 51–54]	Not reported	Reported low uptake of patients	Not reported	Not reported	Not reported	Not reported	Reported lack of major partners (i.e. municipalities, welfare organizations, GPs and local sports facilities) which impacted intervention delivery	Not reported
Jabardo-Camprubi et al. 2023 (ESP) [25, 55]	All participants expressed enjoyment with the intervention. Healthcare professionals reported wanting greater variability	47 participants invited, 33 (70%) agreed to participate	Not reported	Not reported	Differences in physical activity capacity of individuals affected intervention delivery	Intervention groups adherence was 71% (n = 22)	Not reported	Participants reported not continuing post intervention period. Reported a lack of institutional support affecting sustainability
Peacock et al. 2020 (UK) [19, 58, 59]	Not reported	951/1484 (64%) of those invited either declined to participate or did not respond	Not reported	Not reported	Not reported	High dose and coverage of intervention delivery; 105 (78%) intervention participants attended all 5 health trainer sessions	Not reported	Not reported
Vetrovsky et al. 2023 (CZE) [26, 60, 61]	Not reported	Not reported	Not reported	GPs received ~ 100EUR per patient completing the intervention	Not reported	Not reported	Not reported	Not reported
Benedetti et al. 2020 (BRA) [20]	Overall, participants perceived positive changes and reported satisfaction with the program	6 (14%) of public health centres adopted the program. Lack of adoption linked to lack of interest, insufficient space, individual health reasons or heavy workloads	Not reported	The estimated cost per participant was U$10/month for the behaviour change group and U$23/month for the traditional exercise group	Not reported	Reported a 98% fidelity via analysis. 49% of intervention participants attended ≥ 75% of sessions	The study reached 11.5% (114/985) of the eligible community population. System-level instabilities affected program reach. Distribution of flyers and personal invitations improved reach	Not reported
De Cocker et al. 2012 (BEL) [36]	Participants found the advice credible (94%, 17/18) and understandable (100%, 18/18)	Initial response rate was 6.2% (107/1737)	The majority of participants found the advice relevant (83%, 15/18)	Not reported	The majority of participants perceived it was useful for GPs to promote and assist patients to complete sufficient physical activity and offer pedometers	Not reported	Not reported	Not reported
Garcia-Ortun et al. 2022 (ESP) [23]	Not reported	Initial response rate was 61% (152/250)	Not reported	Not reported	Not reported	Reported intervention adherence of 91%	Not reported	Not reported
Harris et al. 2017 (UK) [29, 45–50]	Nurses reported satisfaction with intervention training and research team support. Nurses were highly satisfied with involvement in the intervention and behaviour change sessions	4572/10927 (42%) participants responded to the initial invitation letter, and 1150 (11%) completed baseline assessments	Nurses adjusted handbook material as needed to improve fit. Reported usefulness of pedometers as part of the intervention	Average cost per participant after 12 months was £461 for the control, £375 for the postal and £603 for the nurse support group. At 3 months, the cost per additional minute of MVPA in a bout of ≥ 10 min was £0.35 for the postal and control groups and £2.21 for the nurse support group	Use of handouts became optional to improve feasibility	255/346 (74%) of nurse support participants attended all three sessions. 549/685 (80%) of all participants returned PA diaries, and 85% of all participants reported high pedometer use	Not reported	Enhancement of nurses' knowledge and skills in behaviour change techniques was deemed useful for future practice and routine consultations. However, time constraints of routine practice (outside of the intervention) were perceived to reduce sustainability
He et al. 2018 (CHN) [35]	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Kallings et al. 2008 (SWE) [33, 56]	Not reported	Not reported	Not reported	Not reported	Not reported	Reported 53% (128/240) fully adhered to the prescription. 16% (38/240) reported total non-adherence. Reasons for non-adherence included illness, lack of time or motivation, and no suitable physical activity	Not reported	Not reported
Mutrie et al. 2012 (Scotland, UK) [30, 57]	Not reported	Invitations were sent to 284 eligible participants; 41 (14%) participated in the study	The pedometer was reportedly easy to use and aided motivation	Cost-utility analysis suggested the intervention would cost 100 pounds per patient	The nurse-led intervention was deemed feasible	Reported the walking group was poorly attended (9/20 participants irregularly attended)	Not reported	Concerns were raised regarding time-consuming PA screening, which may threaten sustainability in routine care
Nyberg et al. 2019 (SWE) [32, 38]	Not reported	Of the 43 participants, 95% created an account and visited at least once, while 33 (77%) were considered users spending time on different pages	Not reported	Not reported	Not reported	Not reported	Not reported	The vast majority of time spent on the resource was during the first month (82% of total time), reducing to 8% by the third month
Rodriguez Elias 2016 (USA) [34]	Participants reported satisfaction with educational modules	Not reported	Participants reported that the content of the educational modules was appropriate	Not reported	Not reported	Not reported	Not reported	Not reported
Samal & Manchana 2025 (IND) [27]	Not reported	270/335 (81%) of those eligible participated in the study	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Stewart et al. 2022 (USA) [24]	Not reported	Not reported	Not reported	The messaging platform's total cost was $2.26 per participant. Fitbit costs ranged between $69.65 -$179.95 per participant	Not reported	Not reported	Not reported	Not reported
Westland et al. 2020 (NLD) [18, 62–65]	Patients reported being satisfied with results, the nurse-led consultations, accelerometer wear and the use of self-monitoring tools	31/478 (6.5%) of general practices agreed to participate	Participants reported that having nurse support and the use of self-monitoring tools were helpful and valuable	Not reported	Nurses reported high confidence and capability in delivering the intervention from early to late stages. Nurses perceived the feasibility and effectiveness of the intervention linked to patient engagement	73/93 (78.5%) participants attended all four consultations. Nurses' self-reported fidelity was 88.1%, and observed fidelity was 85.4%	Not reported	The ceasing of incentives, nurse support and self-monitoring tools post the intervention was perceived to challenge patients' own ability to maintain PA levels

Abbreviations: BEL Belgium, BRA Brazil, CHN China, CZE Czech Republic, ESP Spain, GP General Practitioners, IND India, NLD Netherlands, OMN Oman, PA Physical Activity, SWE Sweden, UK United Kingdom, USA United States of America

Effectiveness of interventions

The relevant SB outcomes are presented in Table 1. Of the included studies, two were protocol papers that have yet to publish outcomes [21, 24]. The study by Rodriguez Elias [34] only reported individual pre- and post-intervention outcomes on sitting time, with a comparison only completed on PA outcomes. Six studies (30%) [18, 19, 25, 29, 31, 32] reported no significant changes in SB outcomes. In contrast, eleven studies (55%) reported at least one significant reduction in a SB outcome [20, 22–24, 27, 28, 30, 33, 35–37]. The studies that saw the greatest change in a SB outcome included Stewart and colleagues [24] single group, pre-post pilot study in patients with pre-diabetes, which reported a decrease in self-reported sitting time of 119.6 min/day at six-month follow-up (p = 0.007) after a 16-week intervention [24]. Alghafri and colleagues [37] reported that their 12-month intervention involving adults diagnosed with type 2 diabetes resulted in a significant between-group difference in sitting time at three months (−1.3 h/day, 95% CI: −2.2 to −0.6), and at 12 months (−1.5 h/day, 95% CI: −2.4 to—0.7) when compared to the usual care control group (p < 0.001) [37]. Similarly, Mutrie and colleagues [30] reported that their three-month intervention on adults > 65 years reduced sedentary time by 67.5 min/day (95% CI: −100.1 to −34.9) (p < 0.001) when compared to the control [30]. However, no significant difference between groups was reported at 6-months [30]. Retention rates for included studies ranged from 33% [31] up to 100% [18, 27, 30, 32]. The retention rates for all studies are detailed in Table 1.

Discussion

This is the first review of PHC-based interventions reporting on changes to SB. Overall, the findings are diverse. Most interventions promoted or measured changes to both PA and SB, with only one exclusively targeting SB. The majority of interventions included the use of behaviour change theories and techniques, including goal setting, action planning and self-monitoring [20, 24, 28, 29, 36]. A variety of health professionals were involved in intervention delivery, with the strategies used to support implementation predominantly mapped to the ‘Train and educate stakeholders’ category.

Many interventions appeared to focus solely on targeting changes to PA, yet measured SB as a secondary outcome. As a result, it is possible that these interventions did not place equal emphasis on targeting PA and SB as distinct behaviours. This may partly be explained by the publication date of included studies, with approximately half published before 2020, and by the relatively recent recognition of SB as an independent risk factor for chronic disease and mortality [67, 68]. For example, the WHO first added recommendations on SB into its guidelines in 2020 [69].

Several interventions were effective in changing SB outcomes, with many of these utilising common behaviour change theories and techniques, including action planning, goal setting and self-monitoring [20, 28, 30, 33, 37]. While reducing total sedentary time is important [70], breaking up prolonged sitting is an additional consideration, particularly for managing chronic conditions such as type 2 diabetes [71, 72]. Despite strong evidence supporting effective interventions that target sedentary ‘bouts’ (i.e., extended uninterrupted periods of SB) [73, 74], only three interventions in this review measured this outcome [25, 26, 28]. Large-scale RCTs have shown that multicomponent workplace interventions that include behaviour change techniques can decrease sedentary ‘bouts’ and prolonged sitting time, while increasing standing time [73, 74]. Incorporating aspects of these interventions into PHC-based interventions may be an effective way to embed these habits into daily life. Previous systematic reviews have also reported the use of behaviour change strategies in reducing SB in other settings, and found self-monitoring, provision of feedback, social support, goal-setting, and making changes to the environment, as common techniques [13, 75]. While this review was unable to determine the effectiveness of specific behaviour change techniques, factorial randomised trial and meta-analytic evidence support the inclusion of self-monitoring as an effective technique to elicit reductions in SB [76, 77]. However, the effectiveness of using goal setting and action planning in reducing SB appears less understood.

The use of digital health approaches was also prevalent, and although the intervention by Stewart and colleagues [24] did not focus solely on SB reduction and had no control group, it did report the largest reduction in SB via implementing remote delivery of daily SMS/MMS messages. Multiple other studies that integrated behaviour change techniques with digital health approaches also reported significant change in SB outcomes [24, 28, 36]. This accentuates that combining these approaches may be beneficial for future interventions.

The limited reported use of implementation strategies identified by our review is consistent with findings from systematic reviews that have mapped implementation strategies using the ERIC framework [16, 78, 79]. Reviews by Appleton and colleagues [79] investigating the implementation of remote delivery of mental health care, and Chapman and colleagues [80] exploring the implementation of healthcare interventions in rural and remote contexts, similarly identified ‘Train and educate stakeholders’ as the most commonly used implementation strategy category. Regarding the reporting of implementation outcomes, existing literature has also shown adoption to be the most frequently reported outcome, with others (e.g. penetration, sustainability) less frequently reported [80, 81]. Although GPs are one of the most prevalent professions in PHC [82], they were not involved in conducting the intervention in most studies. When involved, GPs assisted with participant screening and recruitment, but not with intervention delivery [26, 28, 29, 36, 51]. This is potentially a missed opportunity, as although it is well documented that time constraints reportedly limit GPs' capacity to promote PA [83, 84], they are still considered a highly trustworthy and reliable source of advice, with evidence showing that patients are likely to take up their GPs advice regarding PA [85]. Regardless, these findings support the feasibility of involving other healthcare professionals, such as primary care nurses, physiotherapists and dietitians, in delivering intervention components (i.e., individual behaviour change counselling sessions or group PA programs) [18, 29, 37].

Overall, the lack of reported use of implementation strategies and subsequent implementation outcomes is unsurprising, given that the interventions included in this review primarily focused on establishing clinical effectiveness, rather than implementation effectiveness. The findings suggest that reported implementation strategies were predominantly provider-focused and lacked system- or organisational-level approaches, indicating a need for further exploration to enhance the feasibility and sustainability of implementation within PHC. Incorporating stakeholder input and co-design approaches may support the development and effective implementation of these interventions in real-world settings [86]. Future studies should also prioritise clear reporting of implementation strategies and outcomes, and evaluate their impact on supporting PHC professionals to achieve and sustain reductions in SB among patients.

In discussing the limitations of this review, only studies published in English were included, reflecting the practical constraints of the review process. Consequently, relevant studies published in other languages were not captured. Data extraction was primarily conducted by a single reviewer (AB), increasing the risk of bias or inaccuracy; however, this approach ensured a consistent and efficient process, with cross-checking undertaken for a subset of studies (SS), and the implementation strategy and outcome mapping reviewed by an experienced implementation scientist (AC) to enhance accuracy. As is common in scoping reviews, a formal risk of bias or quality assessment was not conducted, in line with the methodological aim to broadly map the available evidence rather than evaluate study quality.

Conclusion

This review identified that, although many PHC-based interventions influence SB outcomes, few explicitly target SB, and SB is rarely treated as a distinct outcome when PA is the primary intervention focus. Considering the distinct risks associated with excessive SB and prolonged sitting, independent of PA participation, further research may consider prioritising interventions that target SB more directly. Due to a lack of PHC interventions targeting ‘interruptions’ in bouts of SB, future research could investigate the effectiveness and implementation of interventions designed to break up periods of prolonged SB. Such interventions should use and clearly report contextually appropriate implementation strategies and outcomes to support healthcare professionals in delivering feasible and sustainable SB reduction interventions.

Abbreviations

ERIC

Expert Recommendations for Implementing Change

GP

General Practitioner

PA

Physical Activity

PHC

Primary Healthcare

RCT

Randomised Controlled Trial

SB

Sedentary Behaviour

WHO

World Health Organization

Authors’ contributions

AB, SS, AC and DD conceptualised the review and contributed to the methodology and search strategy development. AB and LB conducted the screening. AB led data extraction with assistance from SS and AC. AB led the preparation of the manuscript with contributions from SS, AC, LB and DD. All authors approved the final manuscript.

Funding

Author AB is supported by the Commonwealth through an Australian Government Research Training Program Scholarship [DOI: https://doi.org/10.82133/C42F-K220]. No funding was sourced for the completion or publication of this scoping review.

Data availability

The datasets extracted and analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

No ethical approval was required for the completion of this scoping review.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.