Workplace Interventions to Improve Physical Activity, Reduce Sedentary Behavior, and Promote Healthy Diet Among Employees in Low- and Middle- Income Countries: A Systematic Review.

Background: Cardiovascular diseases (CVD) are the leading cause of mortality globally, with a disproportionate burden in low- and middle-income countries (LMIC). The workplace presents a strategic setting for preventive interventions targeting modifiable risk factors like physical inactivity, sedentary behavior, and poor diet among adults. This systematic review aimed to synthesize evidence on the effectiveness and implementation of workplace interventions targeting physical activity, sedentary behavior, or diet among employees in LMICs. Methods: We conducted a systematic review following PRISMA guidelines. Five databases (PubMed, Scopus, Cochrane CENTRAL, OATD, Google Scholar) were searched for studies published between January 2000 and May 2025. Eligible studies included working adults in LMIC workplaces, assessed interventions targeting at least one CVD-related behavior (physical activity, sedentary behavior, diet), and reported behavioral or cardiometabolic outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Given the heterogeneity in study designs, interventions, and outcomes, findings were synthesized narratively. Results: Sixteen studies (11 randomized controlled trials (RCTs)) from six countries (South Africa, Malaysia, Iran, India, Thailand, Mexico) were included. Interventions were heterogeneous: seven (43%) focused on physical activity (PA), five (31%) on reducing sitting time, four (25%) included dietary interventions, embedded within larger multicomponent programs.Technology-supported interventions (e.g., Stepathlon pedometer programme) increased step counts by +3,519 steps/day. Environmental interventions (sit-stand desks, text prompts) reduced sitting time by 6-66 minutes/day (largest effect: -66 min/day with frequent prompts). Multicomponent programmes that included dietary counselling or canteen modifications improved fruit and vegetable intake (27% to 64%) and reduced fat/calorie consumption (-553 ± 339 kcal). A standalone nutrition education programme also improved dietary knowledge and reduced sweet/snack intake.Multi-component, theory-informed programmes showed the most consistent improvements: systolic blood pressure reductions up to -10.2 mmHg, weight loss up to -1.8 kg, and total cholesterol reductions up to -0.45 mmol/L (≈17.4 mg/dL). Single-component environmental or technology-only interventions rarely improved biomarkers.Common implementation challenges included high attrition (15-30%) and declining digital engagement (app use fell from 77% to 31% by month 6). Overall risk of bias was moderate to high, driven by lack of blinding, reliance on self-reported outcomes (60% of studies), and attrition bias. Conclusion: Workplace interventions in LMICs show promise for improving CVD risk profiles, particularly multicomponent programs, although the number of studies remains limited. Simple modifications in physical activity, sedentary behavior and diet provide a feasible entry point but should be augmented with components designed to increase MVPA.