Interventions for promoting physical activity Foster, Charles; Hillsdon, Melvyn; Thorogood, Margaret ...
Cochrane database of systematic reviews,
01/2005, Volume:
2013, Issue:
1
Journal Article
Peer reviewed
Open access
Background
Little is known about the effectiveness of strategies to enable people to achieve and maintain recommended levels of physical activity.
Objectives
To assess the effectiveness of ...interventions designed to promote physical activity in adults aged 16 years and older, not living in an institution.
Search methods
We searched The Cochrane Library (issue 1 2005), MEDLINE, EMBASE, CINAHL, PsycLIT, BIDS ISI, SPORTDISCUS, SIGLE, SCISEARCH (from earliest dates available to December 2004). Reference lists of relevant articles were checked. No language restrictions were applied.
Selection criteria
Randomised controlled trials that compared different interventions to encourage sedentary adults not living in an institution to become physically active. Studies required a minimum of six months follow up from the start of the intervention to the collection of final data and either used an intention‐to‐treat analysis or, failing that, had no more than 20% loss to follow up.
Data collection and analysis
At least two reviewers independently assessed each study quality and extracted data. Study authors were contacted for additional information where necessary. Standardised mean differences and 95% confidence intervals were calculated for continuous measures of self‐reported physical activity and cardio‐respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% confidence intervals were calculated.
Main results
The effect of interventions on self‐reported physical activity (19 studies; 7598 participants) was positive and moderate (pooled SMD random effects model 0.28 95% CI 0.15 to 0.41) as was the effect of interventions (11 studies; 2195 participants) on cardio‐respiratory fitness (pooled SMD random effects model 0.52 95% CI 0.14 to 0.90). There was significant heterogeneity in the reported effects as well as heterogeneity in characteristics of the interventions. The heterogeneity in reported effects was reduced in higher quality studies, when physical activity was self‐directed with some professional guidance and when there was on‐going professional support.
Authors' conclusions
Our review suggests that physical activity interventions have a moderate effect on self‐reported physical activity, on achieving a predetermined level of physical activity and cardio‐respiratory fitness. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions.
Background:Sedentary behaviour (sitting) is detrimental to health, independently of participation in physical activity. Socioeconomic position (SEP) is known to relate strongly to physical activity ...participation but we know very little about how SEP relates to sedentary behaviour. This study aimed to assess the relationships between SEP, neighbourhood deprivation and an index of sedentary time.Methods:Cross-sectional study of a representative sample of 7940 Scottish adults who participated in the 2003 Scottish Health Survey, which collected information on SEP (household income, social class and education), neighbourhood deprivation (Scottish Index of Multiple Deprivation), television and other screen-based entertainment time, and physical activity.Results:The three indicators of SEP and deprivation index were independently of each other associated with daily times of television and other screen-based entertainment, even after adjustment for occupational and leisure-time physical activity, health status, smoking, alcohol drinking, car ownership and body mass index: income p = 0.002; social class p<0.001; education p<0.001, deprivation p<0.001. Also, there was a strong cumulative effect of SEP (a composite scale where 0 = lowest, 9 = highest SEP position) with those in the lowest SEP spending an additional 109 minutes each day on screen-based entertainment compared to those in the highest socioeconomic position (p<0.001 for linear trend).Conclusion:Adverse socioeconomic position is associated with a cumulative increase in the time spent on screen-based entertainment. Reducing inequalities would be expected to reduce exposure to sedentary behaviours, such as excessive screen-based entertainment times, and therefore reduce the risk of chronic disease.
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Objective To assess the impact of exercise referral schemes on physical activity and health outcomes.Design Systematic review and meta-analysis.Data sources Medline, Embase, PsycINFO, Cochrane ...Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references.Study selection Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. Population: sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes. Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings.Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.
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This study examined the association between access to quality urban green space and levels of physical activity.
A cross-sectional examination of the relationship between access to quality urban ...green space and level of recreational physical activity in 4950 middle-aged (40–70 years) respondents from the European Prospective Investigation into Cancer and Nutrition (EPIC), who resided in Norwich, UK.
Using geographic information systems (GIS), three measures of access to open green space were calculated based on distance only, distance and size of green space and distance, size and quality of green space. Multiple regression models were used to determine the relationship between the three indicators of access to open green space and level of recreational physical activity.
There was no evidence of clear relationships between recreational activity and access to green spaces. Non-significant associations were apparent for all variables, and there was no evidence of a clear trend in regression coefficients across quartiles of access for either the distance, size adjusted, and quality and size-adjusted models. Furthermore, the neighbourhood measures of access to green spaces showed non-significant associations with recreational physical activity.
Access to urban green spaces does not appear to be associated with population levels of recreational physical activity in our sample of middle-aged adults.
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Study objective: To examine the relation between adults’ perceptions of the social and physical environment and their self reported walking behaviour. Design: Cross sectional survey. Setting: ...England. Participants: A national sample of 4265 adults aged 16–74 years. Main outcome measures: Self reported walking behaviour was categorised into two dichotomous variables: (a) any reported walking in past four weeks, (b) reported walking ⩾150 minutes per week in the past four weeks. Perceptions of the social environment covered safety of walking alone and social support for walking. Perceptions of the physical environment covered attractiveness of local area for walking, access to shops, leisure centres, parks, cycle paths, and traffic density. Main results: In women, perceived safety of walking during the day (OR = 0.53; 95% CI: 0.31 to 0.88), and no shop within walking distance (OR = 0.72; 95% CI: 0.52 to 0.99) were associated with any reported walking occasions. Perceptions of the environment were not related to women walking ⩾150 min/week. In men, having a park within walking distance was associated with walking ⩾150 min/week (OR = 2.22; 95% CI: 1.18 to 4.35). No other significant associations were found. Conclusions: Women seem to be more concerned about walking for utility and in safety. Men are more likely to walk ⩾150 min/week if they have access to a local park but their walking is not influenced by concerns about safety. Future research should focus on the relation between objective measures rather than perceptions of the environment and physical activity.
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Exercise referral schemes (ERS) aim to identify inactive adults in the primary-care setting. The GP or health-care professional then refers the patient to a third-party service, with this service ...taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the individual.
To assess the clinical effectiveness and cost-effectiveness of ERS for people with a diagnosed medical condition known to benefit from physical activity (PA). The scope of this report was broadened to consider individuals without a diagnosed condition who are sedentary.
MEDLINE; EMBASE; PsycINFO; The Cochrane Library, ISI Web of Science; SPORTDiscus and ongoing trial registries were searched (from 1990 to October 2009) and included study references were checked.
Systematic reviews: the effectiveness of ERS, predictors of ERS uptake and adherence, and the cost-effectiveness of ERS; and the development of a decision-analytic economic model to assess cost-effectiveness of ERS.
Seven randomised controlled trials (UK, n = 5; non-UK, n = 2) met the effectiveness inclusion criteria, five comparing ERS with usual care, two compared ERS with an alternative PA intervention, and one to an ERS plus a self-determination theory (SDT) intervention. In intention-to-treat analysis, compared with usual care, there was weak evidence of an increase in the number of ERS participants who achieved a self-reported 90-150 minutes of at least moderate-intensity PA per week at 6-12 months' follow-up pooled relative risk (RR) 1.11, 95% confidence interval 0.99 to 1.25. There was no consistent evidence of a difference between ERS and usual care in the duration of moderate/vigorous intensity and total PA or other outcomes, for example physical fitness, serum lipids, health-related quality of life (HRQoL). There was no between-group difference in outcomes between ERS and alternative PA interventions or ERS plus a SDT intervention. None of the included trials separately reported outcomes in individuals with medical diagnoses. Fourteen observational studies and five randomised controlled trials provided a numerical assessment of ERS uptake and adherence (UK, n = 16; non-UK, n = 3). Women and older people were more likely to take up ERS but women, when compared with men, were less likely to adhere. The four previous economic evaluations identified suggest ERS to be a cost-effective intervention. Indicative incremental cost per quality-adjusted life-year (QALY) estimates for ERS for various scenarios were based on a de novo model-based economic evaluation. Compared with usual care, the mean incremental cost for ERS was £169 and the mean incremental QALY was 0.008, with the base-case incremental cost-effectiveness ratio at £20,876 per QALY in sedentary people without a medical condition and a cost per QALY of £14,618 in sedentary obese individuals, £12,834 in sedentary hypertensive patients, and £8414 for sedentary individuals with depression. Estimates of cost-effectiveness were highly sensitive to plausible variations in the RR for change in PA and cost of ERS.
We found very limited evidence of the effectiveness of ERS. The estimates of the cost-effectiveness of ERS are based on a simple analytical framework. The economic evaluation reports small differences in costs and effects, and findings highlight the wide range of uncertainty associated with the estimates of effectiveness and the impact of effectiveness on HRQoL. No data were identified as part of the effectiveness review to allow for adjustment of the effect of ERS in different populations.
There remains considerable uncertainty as to the effectiveness of ERS for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. We failed to identify any trial-based evidence of the effectiveness of ERS in those with a medical diagnosis. Future work should include randomised controlled trials assessing the cinical effectiveness and cost-effectivenesss of ERS in disease groups that may benefit from PA.
The National Institute for Health Research Health Technology Assessment programme.
In the elderly, higher levels of physical function have consistently been associated with higher levels of physical activity. In this study, we test the hypothesis that physical activity earlier in ...the life course preserves high physical function over an extended period of time, before the onset of major age-related declines in physical function.
A cohort study with an average of 8.8 years of follow-up (1991–1993 to 2001). Logistic regression analyses were conducted adjusting for long-standing illness, baseline physical function, smoking, body mass index, and employment grade. Participants were 6398 London-based civil servants aged 39 to 63 years at baseline, 90% of whom were working. The main outcome measure was physical function measured by the Short Form (SF-36) General Health Survey.
Relatively fit and healthy, mainly working, middle-aged men and women who were physically active at recommended levels, were more likely to report high physical function at follow-up, compared to their sedentary counterparts (odds ratio 1.63, 95% confidence interval 1.32–2.00). The association between initial level of physical activity and high physical function at follow-up remained after adjustment for baseline level of physical function and the presence of long-standing illness.
Participation in a physically active lifestyle during mid-life appears to be critical to the maintenance of high physical function in those who are fit and well enough to work and do or do not report any long-standing illness.
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Objective:To assess the association between residential area-level deprivation, individual life-course socioeconomic position and adult levels of physical activity in older British women.Methods:A ...cross-sectional study of 4286 British women aged 60–79 years at baseline, who were randomly selected from general practitioner lists in 23 British towns between April 1999 and March 2001 (the British Women’s Heart and Health Study).Results:All three of childhood socioeconomic position, adult socioeconomic position and area of residence (in adulthood) deprivation were independently (of each other and potential confounders) associated with physical activity. There was a cumulative effect of life-course socioeconomic position on physical activity, with the proportion who undertook no moderate or vigorous activity per week increasing linearly with each additional indicator of life-course socioeconomic position (p<0.001 for linear trend).Conclusion:Adverse socioeconomic position across the life-course is associated with an increased cumulative risk of low physical activity in older women. Reducing socioeconomic inequalities across the life course would thus be expected to improve levels of physical activity and the associated health benefits in later life.
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This study examines the association between objectively measured access to green space, frequency of green space use, physical activity, and the probability of being overweight or obese in the city ...of Bristol, England. Data from the 2005 Bristol Quality of Life in your Neighbourhood survey for 6821 adults were combined with a comprehensive GIS database of neighbourhood and green space characteristics. A range of green space accessibility measures were computed. Associations between accessibility and the odds of respondents achieving a recommended 30min or more of moderate activity five times a week, or being overweight or obese, were examined using logistic regression. Results showed that the reported frequency of green space use declined with increasing distance. The study also found that respondents living closest to the type of green space classified as a Formal park were more likely to achieve the physical activity recommendation and less likely to be overweight or obese. The association with physical activity, but not with overweight or obesity, remained after adjustment for respondent characteristics, area deprivation, and a range of characteristics of the neighbourhood environment. The findings suggest that the provision of good access to green spaces in urban areas may help promote population physical activity.
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