Introduction: A vast majority of children and adolescents are physically inactive. As a result, high obesity rates and related diseases have made physical activity promotion a politically relevant topic. In order to form the basis for political decision making, evidence is required regarding the efficacy and effectiveness of interventions for physical activity promotion. In contrast to previous research, this systematic review of reviews targets three key settings (family and home, childcare, school), and is among the largest to have been conducted.Methods: A systematic review of reviews was conducted as part of a large-scale project to develop national recommendations for physical activity promotion in Germany. Six electronic databases were searched and inclusion criteria were defined. Two independent reviewers screened the titles and abstracts of potentially relevant literature. 213 reviews were identified and categorised by target group. A total of 74 reviews were identified dealing with children and adolescents. Each review underwent a quality assessment.Results: 39 reviews with the highest quality and relevance were analysed. Three reviews focused on the family and home setting, 4 on the childcare setting, 28 on the school setting and 4 on other settings. Evidence revealed the key role played by parents in promoting physical activity in children within each setting. Furthermore, evidence pointed toward the efficacy of multi-component interventions in the childcare and school setting. Several evidence-based intervention strategies were identified for childcare facilities and schools.Discussion: The review of reviews identified a number of promising strategies for PA promotion among children and adolescents. Among reviews, multi-component interventions in childcare facilities and schools stand out prominently. At the same time, the review of reviews indicated that there is still a lack of studies on the efficacy of interventions that go beyond the individual level. We recommend that future research should also target community and policy level interventions and interventions other than the school setting. In order to make more specific recommendations regarding the scale-up of promising intervention strategies, further knowledge about the effectiveness, health equity and cost effectiveness of interventions is needed.
BackgroundDespite growing recognition of the need to promote physical activity, the existing evidence base on the cost-effectiveness of relevant interventions appears scant and scattered. This systematic review of reviews set out to take stock of the evidence on the cost-effectiveness of physical activity interventions.MethodsTen literature databases were systematically searched for available reviews on the cost-effectiveness of physical activity interventions, complemented by a hand search. Out of the 515 articles identified, 18 reviews met the inclusion criteria. A quality appraisal of the 18 reviews was undertaken.ResultsOf the 18 reviews, 4 contained information on the target group of children and adolescents, 12 on adults, 3 on older adults, and 6 on the general population. Across the reviews some intervention strategies were identified as being particularly cost-effective, including certain school-based interventions (children and adolescents), interventions using pedometers (adults), fall prevention programs (older people), mass media campaigns and environmental approaches (general population). However, for some of these approaches (e.g. mass media campaigns), the underlying evidence of being able to change physical activity behavior remains inconsistent.ConclusionAvailable evidence for the cost-effectiveness of physical activity interventions is scattered, but points towards the cost-effectiveness of certain interventions. Until this moment, cost-effectiveness has more often been studied for individual-level interventions. This is potentially due to some methodological challenges in assessing the cost-effectiveness of population-based interventions.
Highlights
Policies that support physical activity (PA) in the school-setting have promise but their impact is poorly understood.
Nine policy action areas for which there was evidence of impact were identified. These were whole-school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks, physical environment, shared use agreements, active school transport and surveillance.
Evidence supports the effectiveness of PA policy actions within the school-setting but cautions a “one-size fits all” approach.
Further evaluation of policy implementation to maximize translation into practice is required.
Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed, and suggestions provided.
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