Community wide interventions for increasing physical activity

Abstract

The independent commentary was written by Virginia Fernandes Moça Trevisani aBstraCtBACKGROUND: Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown. OBJECTIVES: To evaluate the effects of community-wide, multi-strategic interventions upon population levels of physical activity. Cluster randomized controlled trials, randomized controlled trials (RCT), quasi-experimental designs which used a control population for comparison, interrupted time-series (ITS) studies, and prospective controlled cohort studies (PCCS) were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community-wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomized individuals from the same community were excluded. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted the data and assessed the risk of bias of each included study. Non-English language papers were reviewed with the assistance of an epidemiologist interpreter. Each study was assessed for the setting, the number of included components and their intensity. Outcome measures were grouped according to whether they were dichotomous (physically active, physically active during leisure time and sedentary or physically inactive) or continuous (leisure time physical activity, walking, energy expenditure). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated net percentage change from baseline, unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. MAIN RESULTS: After the selection process had been completed 25 studies were included in the review. Of the included studies, 19 were set in high income countries, using the World Bank economic classification, and the remaining six were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organizations (NGOs) (22 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity consideration. However of those included studies undertaken in high income countries, 11 studies were described by the authors as being provided to deprived, disadvantaged, or low socio-economic communities. Fifteen studies were identified as having a high risk of bias, 10 studies were unclear, and no studies had a low risk of bias. Selection bias was a major concern with these studies, with only one study using randomization to allocate communities (Simon 2008). No studies were judged as being at low risk of selection bias although 16 studies were considered to have an unclear risk of bias. Eleven studies had a hig...

Efficacy of population‐wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta‐analysis of impact on BMI

“…Nine reviews evaluated evidence regarding multicomponent community‐based or “whole of community” interventions . These interventions combined multiple elements to encourage healthy diet and increased physical activity across the entire population living within a geographically defined area, such as a city, village, or region.…”

“…Intervention components work at the personal, interpersonal, and community level and include communications (eg, media campaigns), social support (eg, self‐help groups), risk factor screening, counselling, and education about nutrition and physical activity in worksites, schools, and at community events as well as changes to the built environment (eg, cycle lanes) and local policy (eg, reduced prices on healthy foods, restaurant, and menu labelling). Of the nine reviews, three evaluated outcomes solely in terms of increases in physical activity, one in terms of increasing walking, and the remaining five weight‐related measures. One review incorporated a meta‐analysis but noted a high degree of heterogeneity between studies, two undertook quantitative synthesis, and the remainder were narrative syntheses.…”

“…Of the nine reviews, three evaluated outcomes solely in terms of increases in physical activity, one in terms of increasing walking, and the remaining five weight‐related measures. One review incorporated a meta‐analysis but noted a high degree of heterogeneity between studies, two undertook quantitative synthesis, and the remainder were narrative syntheses. Reviews incorporated 83 primary studies, many with multiple publications, including 34 with pre‐post design and comparison group, 24 cluster RCTs, eight repeat cross‐sectional studies, and the remainder employing a variety of study designs.…”

“…Multicomponent community interventions appear to be promising in reducing BMI within participating communities in a wide variety of countries, although their effect on physical activity and prevalence of overweight and obesity is uncertain. Of the four good‐quality reviews that reported effect on physical activity, the three most recent reviews did not find a positive effect in most included studies and one review, which included papers up to the year 2000, found a median net increase in the percentage of people being active of 4.2% (range, −2.9% to 9.4%). Five good‐quality reviews, which reported impact on BMI or weight, found positive findings in most included studies.…”

The effect of regulatory focus and time preference on the dual process of physical activity: A cross‐sectional study among nurses

“…Suboptimal physical activity is a common phenomenon and a key behavioural risk factor for non‐communicable diseases (Guthold, Stevens, Riley, & Bull, 2018) that imposes a significant burden on healthcare systems worldwide (Ding et al, 2016). There is no consistent evidence supporting the benefits of intervention strategies for increasing physical activity (Baker, Francis, Soares, Weightman, & Foster, 2015) and individuals' decision‐making mechanisms that underlie adoption of physical activity remain a conundrum. Nurses play a key role in promoting healthy lifestyle behaviours (Blake & Harrison, 2013).…”