A scoping review of behavior change techniques used to promote physical activity among women in midlife

Abstract

Women in midlife experience health risks that could be mitigated by regular physical activity and reduced sedentary time, but this population rarely achieves physical activity levels that would protect their health. As a result, many behavioral interventions are designed to promote physical activity in this population, which are purportedly guided by theoretical models of health behavior (change) and activate an associated set of behavior change techniques (BCTs). The efficacy and effectiveness of these interventions appear to be limited, however, raising questions about their design and adaptation for women in midlife. Several aspects of these interventions are currently unclear. Specifically, which women they target (i.e., how “midlife” and “sedentary” or “inactive” are defined), which theoretical models or behavior BCTs are used, and how BCTs are activated in such interventions. A synthesis of this information would be useful as an initial step toward improving physical activity interventions for this at-risk group, and thus, represented the goal of the present scoping review. Eligibility required publication in a peer-reviewed journal in English between 2000 and 2021, inclusion of only women in midlife who did not have any medical or other restrictions on their physical activity (e.g., cancer diagnosis), and free-living physical activity or sedentary behavior as the target outcome (with associated assessment). Of the 4,410 initial results, 51 articles met inclusion criteria, and these described 36 unique interventions. More than half of the articles (59%) named an underlying theoretical model and interventions included an average of 3.76 identifiable BCTs (range 1–11). However, descriptions of many interventions were limited and did not provide enough detail to determine whether or how specific BCTs were activated. Interventions also used a wide range of inclusion criteria for age range and starting activity level, which has implications for targeting/tailoring and effectiveness, and many interventions focused on marginalized populations (e.g., women from racial/ethnic minority backgrounds, those un- or under-insured). The present review identifies some strengths and highlights important limitations of existing literature, as well as key opportunities for advancing the design and potential utility of physical activity interventions for women in midlife.Systematic review registrationhttps://osf.io/g8tuc.

Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review

“…In addition, this method runs the risk of including BCTs that do not add to effectiveness but happened to be included in the effective interventions [ 89 ]. Furthermore, although other evaluation methods such as meta-analyses can provide generalizable conclusions [ 89 ], poor quality in intervention description and high heterogeneity in the designs may not allow for statistical analysis of the effectiveness of individual BCTs or a combination of BCTs on the intervention outcomes [ 21 , 44 , 78 , 91 , 92 ]. Making confident estimates of the effectiveness of BCTs and BCT combinations for a given behavior delivered in a particular way in a given setting to a given target population requires synthesis of information from diverse sources [ 89 ].…”

“…BCIs are typically complex and involve many interacting components and, therefore, a theoretical understanding of how the intervention causes behavior change is needed to strengthen the effects of BCI on clinical outcomes [ 20 ]. A recent scoping review [ 21 ] identified limitations in describing PA interventions in midlife women, with only 59% of the 51 studies specifying an underlying theoretical model. Many studies provided a limited description of how behavior change techniques (BCTs) were activated to achieve desired outcomes and provided limited insight into how the BCTs were received by midlife women [ 21 ].…”

“…A recent scoping review [ 21 ] identified limitations in describing PA interventions in midlife women, with only 59% of the 51 studies specifying an underlying theoretical model. Many studies provided a limited description of how behavior change techniques (BCTs) were activated to achieve desired outcomes and provided limited insight into how the BCTs were received by midlife women [ 21 ]. As a result, interpreting designs and evaluations of complex interventions can be challenging without sufficient description of key intervention content [ 22 ] and, therefore, characterizing interventions by BCTs can be insightful in understanding the effectiveness of interventions [ 23 ].…”

Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review

“…Consuming healthy dietary patterns—with adequate amounts of key nutrients such as protein, calcium, vitamin D, fiber, and fluid intake—might aid in diminishing the degenerative alterations that occur during aging, such as cognitive decline or loss of skeletal muscle [ 21 , 22 ]. Increased physical activity (PA) and reduced sedentary time also contribute to the prevention of chronic diseases throughout the lifespan [ 23 ].…”

“…Many multi-component lifestyle interventions have been developed to promote healthy aging behaviors for older adults or to reduce the risk of developing complications from existing health conditions, such as stroke [ 23 , 24 , 25 , 26 ]. This is particularly relevant for community-dwelling adults who face the changes associated with aging and who aim to live independently for as long as possible [ 27 ].…”