Community-based physical activity interventions for prevention and management of non-communicable diseases in high-income countries vs. low- and middle-income countries: a narrative review

Background Non-communicable diseases (NCDs) represent a major global health challenge, accounting for approximately 74% of global deaths and nearly 43 million deaths annually in 2025. Cardiovascular disease mortality has generally declined in many high-income countries, while many low- and middle-income countries (LMICs) continue to experience a substantial burden. Physical inactivity remains an important behavioural risk factor contributing to this burden. Objective This narrative review evaluates the effectiveness, feasibility, and sustainability of community-based physical activity (PA) interventions, comparing high-income countries (HICs) and LMICs to identify context-sensitive strategies and transferable lessons for global NCD prevention. Methods A structured literature search and narrative synthesis, guided by Popay et al., were conducted on English-language research and relevant institutional reports published from January 2006 to 18 March 2026. Searches covered PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. The narrative synthesis drew on 46 cited sources; eight representative evidence sources are summarised in Table 3. The review was designed as a narrative review rather than a systematic review, and therefore no PRISMA-style study-selection flow was undertaken. Results The synthesis indicates that community-based PA interventions are implemented through combinations of infrastructure, professional or peer delivery, behavioural support, and community adaptation. The representative evidence includes quantitative findings from controlled studies and meta-analyses as well as implementation and contextual evidence. Effects are shaped by implementation capacity, contextual barriers, and the fit between programme design and local needs; the available LMIC evidence is less extensive than the broader HIC evidence base. Conclusion Community-based PA interventions can support NCD prevention and management across diverse settings, but implementation should be adapted to available resources, health-system capacity, cultural context, safety, and community preferences. The Layered Socio-Ecological Comparison Framework is presented as an author-developed synthesis tool informed by established ecological and health-promotion frameworks, rather than as a validated standalone theory.