Efficacy, characteristics, behavioural models and behaviour change strategies, of non-workplace interventions specifically targeting sedentary behaviour; a systematic review and meta-analysis of randomised control trials in healthy ambulatory adults

Abstract

Background Sedentary behaviour (SB) research has grown exponentially but efficacy for interventions to reduce sedentary behaviour is often contaminated by interventions primarily or co-targeting other behaviours and outcomes. The primary aim of this research therefore, was to systematically review the efficacy of interventions specifically targeting sedentary behaviour reduction, as a sole primary outcome, from randomised control trials in healthy ambulatory adults. This research also sought to identify the successful interventions characteristics, behaviour change techniques (BCT’s) and underlying theories, and their relation to intervention effectiveness. Methods We followed PRISMA reporting guidelines for this systematic review. Six electronic databases were searched and a grey literature review conducted. Only randomised or cluster randomised controlled trials, from 2000 to 2020, in adult populations with a sole primary outcome of change in sedentary behaviour were included. Data codebooks were developed, data were extracted, and a narrative synthesis and meta-analysis was conducted using mixed methods random effects models. Results Of 5589 studies identified, 7 studies met the inclusion criteria. Six studies reported activPAL3 measures of mean daily sitting time, and four reported mean daily standing time, stepping time and number of sedentary breaks. Pooled analysis of weighted mean differences revealed a reduction in mean daily sitting time of -32.4mins CI (-50.3, -14.4), an increase in mean daily standing time of 31.75mins CI (13.7, 49.8), and mean daily stepping time of 9.5mins CI (2.8, 16.3), and an increase in rate of sedentary breaks per day of 3.6 (CI 1.6, 5.6). BCTs used exclusively in two of the three most effective interventions are ‘feedback on behaviour’ and ‘goal setting behaviour’ whilst all three most effective interventions included ‘instruction on how to perform the behaviour’ and ‘adding objects to the environment’, BCTs which were also used in less effective interventions. Conclusions Although limited by small sample sizes and short follow up periods, this review suggests that interventions specifically designed to change sedentary behaviour, reduce overall daily sitting time by half an hour, with an equivalent increase in standing time, in the short to medium term. Effective characteristics and behaviour change strategies are identified for future development of high quality interventions targeting change in sedentary behaviour. Prospero registration PROSPERO 2020 CRD42020172457 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172457.

A Standardised Core Outcome Set for Measurement and Reporting Sedentary Behaviour Interventional Research: The CROSBI Consensus Study

“…Despite these recommendations and recent SB research, pooled evidence from reviews on the effectiveness of interventions to reduce SB is limited by heterogeneity of outcomes [ 11 , 12 ]. This field of research spans many disciplines, interventions and populations, and the heterogeneity of outcomes, ‘what to measure and report’, is a fundamental stumbling block to the accumulation and aggregation of evidence [ 13 , 14 , 15 ]. Rapid growth in both laboratory and personal activity sensing devices now provide an abundance of data for potential analysis [ 16 , 17 , 18 , 19 ].…”

“…The development of a standardised COS for reporting SB outcomes will facilitate comparability and meta-analyses of data from intervention trials in this complex research field. This critical action research project was identified following a recent systematic literature review, led by members of the research team, of randomised controlled trials of interventions designed specifically to change SB across all domains of living, unpublished and published [ 15 ]. Consistent with a prior review [ 34 ], heterogeneity in measuring and reporting SB in interventions was a limitation noted in the review, preventing inclusion of all of the study data in meta-analyses.…”

Modelling decay in effectiveness for evaluation of behaviour change interventions: a tutorial for public health economists

“…To this respect, an individual level framework, such as microsimulation [ 23 ], can be more suitable, provided relevant data are available. Lack of long-term follow-up data is a common hurdle of public health evaluations, not least the information regarding the sustainability of intervention effects [ 5 ]. Nevertheless, this does not justify the use of implausible assumptions and lack of robustness checks.…”

“…In these evaluations, however, is estimating long term intervention effects (e.g., changes in physical activity (PA) habits) is often a challenge [ 4 ]. Effectiveness evidence tends to be short-term [ 5 ], whilst most health benefits accrue over the long term [ 6 ]. Acknowledging this issue, the National Institute for Health and Care Excellence (NICE) recommends the application of extrapolation methods and careful consideration in defining model assumptions that ought to be plausible and related uncertainties that need to be fully explored and systematically addressed [ 7 ].…”

The Validity of the Energy Expenditure Criteria Based on Open Source Code through two Inertial Sensors

“…The estimation of energy expenditure (EE) is fundamental to determine the level of physical activity of a person. The current society we live in has eminently sedentary behaviour, which can produce serious problems, and along with other unhealthy lifestyle habits, means a change in lifestyle is necessary [ 1 , 2 ]. Likewise, the use of behaviour modification techniques alone can produce an increase in physical activity [ 3 ].…”