Community-based efforts to promote physical activity: A systematic review of interventions considering mode of delivery, study quality and population subgroups

Abstract

Objectives

Despite the known benefits of physical activity, the majority of adults in developed countries lead sedentary lifestyles. The community setting is a promising venue for physical activity-promoting interventions. Our objectives were to investigate the effectiveness of community-based physical activity interventions by mode of delivery, study quality and to analyse intervention effectiveness in different subgroups in the population.

Design

We conducted a systematic literature review in Medline and other databases to identify controlled, community-based physical activity interventions published between 2001 and 2012.

Methods

We performed several post hoc subgroup comparisons for mode of delivery, study quality and selected population characteristics, using net per cent change in physical activity outcomes between baseline and follow-up as an effect measure.

Results

We identified 55 studies on exercise/walking sessions, face-to-face counselling, public campaigns and interventions by mail, the Internet and telephone presenting data on 20,532 participants. Overall, half of the studies reported positive physical activity outcomes (total net per cent change: 16.4%; p = 0.159; net per cent change for high-quality studies, i.e. studies meeting more than 5 out of 7 quality criteria: 16.2%; p = 0.010). Interventions using face-to-face counselling or group sessions were most effective (net per cent change: 35.0%; p = 0.014). Net per cent change was also higher in studies exclusively tailored to women (27.7%; p = 0.005) or specific ethnic groups (38.9%; p = 0.034).

Conclusions

This systematic review supports the effectiveness of community-based physical activity interventions in high-quality studies. Our results suggest that interventions using personal contact as well as tailored interventions are most promising.

Introduction

Regular physical activity (PA) is a key factor in the prevention and treatment of many chronic diseases. It is associated with increased physical and psychological well-being and reduced risk of all-cause mortality.1, 2 Acknowledging the health benefits of PA in the general population, it is recommended that all healthy adults engage in moderate-intensity PA for a minimum of 30 min on five days per week or in vigorous PA for a minimum of 20 min on three days per week.³ Population-based data world-wide suggest, however, that at most half of adults in developed countries engage in sufficient PA.4, 5, 6

Given significant gaps between recommendations and self-reported levels of activity, increasing the population level of PA has become a leading area of focus in contemporary public health policy. Earlier reviews have demonstrated the effectiveness of community-based PA interventions using face-to-face interaction in small groups, mail or telephone contact and community-wide campaigns in increasing PA.7, 8 Since the beginning of the new century, newer approaches using technologies like e-mail and the Internet have been used increasingly to disseminate public health information. Previous studies suggest the promise of incorporating new technology in the delivery of PA interventions.9, 10, 11 However, traditional approaches for promoting PA may still be more appropriate in some community settings. Previous work documents, for example, that Internet use among subgroups at higher risk for cardiovascular morbidity and mortality (e.g., older or less educated persons and those living in rural areas) is lower.¹² To date, little is known about the comparative effectiveness of community-based PA interventions using different modes of delivery. Additionally, there is a relative lack of data on the effectiveness of such interventions in deprived subgroups of the population in whom PA interventions may prove most valuable. Furthermore, previous work suggests significant variability in study quality and this may affect the conclusions that can be drawn. In this paper, we provide an overview on the effectiveness of community-based PA interventions through a systematic review of recent literature. Our objectives were to investigate the effectiveness of PA interventions by mode of delivery, study quality and in different subgroups in the population.