Exercise Interventions for Adults With Chronic Conditions Living in Rural Areas-A Systematic Review.

Abstract

Background: Exercise is essential for chronic disease management, but intervention implementation in rural populations remains unclear. This review aimed to synthesize the characteristics and impact of exercise interventions delivered to adults living with chronic conditions in rural areas.

Methods: Six databases (MEDLINE, Embase, Emcare, Scopus, CINAHL, and SPORTDiscus) were searched from inception to September 2025 for interventional studies evaluating exercise training interventions of ≥2 weeks among adults with chronic conditions living in rural areas across all countries. Data were extracted on study characteristics, exercise prescription, delivery methods, engagement strategies, and effectiveness outcomes related to physical activity and physical function.

Results: Twenty-seven studies (n = 2846 participants; 13 randomized controlled trials [RCT], 14 non-RCT) were included. The most common condition groups were musculoskeletal, cancer (acute or survivorship), respiratory, and metabolic/endocrine. Interventions were predominantly supervised and delivered in person (37%) or via telehealth (33%), most often by exercise professionals (37%). Combined aerobic and resistance (48%), aerobic only (22%), and resistance only (15%) training were commonly prescribed. Most studies prescribed 2 to 3 weekly sessions (57%), lasting 30 to 60 minutes (67%). Rural adaptations included telehealth delivery, upskilling nonexercise professionals, minimal or no equipment use, and delivery in existing healthcare settings. Evidence for intervention effectiveness was mixed; positive effects were observed for physical function outcomes (2 RCT and 5 non-RCT), while evidence for improvements in physical activity behavior (4 RCT and 1 non-RCT) and aerobic fitness (2 RCT and 6 non-RCT) were inconsistent.

Conclusions: Interventions were generally supervised and incorporated rural adaptations. While physical function outcomes showed promising improvements, evidence for increasing physical activity and aerobic fitness remains inconclusive.