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Community-wide Interventions for

Increasing Physical Activity:

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What’s the evidence? Baker, P.R.A., Francis, D.P., Soares, J.,

Weightman, A.L. & Foster, C. (2011). Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews, Issue 4. Art. No.:CD008366. DOI: 10.1002/14651858.CD008366.pub2.

http://www.health-evidence.ca/articles/show/21588

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Welcome! This webinar has been made possible with support from the

Canadian Institutes of Health Research

Community-wide Interventions for

Increasing Physical Activity:

What’s the evidence?

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Philip Baker

Professor of Epidemiology, School of Public Health and Social Work, Queensland University of Technology, Brisbane Australia

Review Baker, P.R.A., Francis, D.P., Soares, J., Weightman, A.L.

& Foster, C. (2011). Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews, Issue 4. Art. No.:CD008366. DOI: 10.1002/14651858.CD008366.pub2.

Authors and affiliations Professor Dr Philip Baker – QUT Daniel Francis – Queensland Health /

QUT Prof Alison Weightman – Cardiff

University, Wales Dr Charlie Foster – Oxford University,

UK Dr Jesus Soares – CDC, USA

Questions?

Summary Statement: Baker(2011) P General population, i.e. communities. I Community wide, multi-strategic interventions

with at least two strategies aimed at promoting physical activity.

C Usual practice. O Population levels of physical activity. Quality Rating: 9 (strong)

Included intervention s: Multi-strategic interventions that aim to reach the whole

community, which must have included at least 2 of a possible 6 components:

social marketing; other communication strategies; individual counselling by health practitioners; partnerships with government or non-government

groups; working in specific settings; and environmental change strategies.

Overall Considerations

Insufficient evidence, most included studies at high risk of bias. Serious issues in the design affecting their trustworthiness

There may be efficacious approaches

Different interventions seemed to reach different segments of the population.

Some studies showed positive effect, others decreased or no effect

High intensity interventions did not necessary result in more effective interventions

General Implications Public health should promote/support/implement: Can not assume combining interventions will yield a

measurable health outcome.

Should not group label “evidence-based”.

There is a need for more robust studies to investigate community wide interventions. Need to measure PA accurately, continuous measures best.

New studies should be rigorously designed and analysed and should include process evaluations

Consider individual components e.g. School-based

General implications Robust, continuous measurement

better Might be promise in the environmental

strategies long term perspective Reaching whole community difficult

Public health should consider that…

Interpretation limited by the included studies

many at high risk of bias

Selection bias- e.g. “purposely” different communities, “head start”

Detection –poor outcome measurement, low response rate

Reporting bias – outcomes measured – but missing

What’s the evidence? Outcomes reported in the review

Dichotomous outcomes % Physical activity % Not sedentary % Leisure time physical activity

Continuous outcomes Time physically active Walking METs (energy expenditure)

What the review found There was much variation in interventions, population and

outcomes. The results of the studies themselves were inconsistent,

making it especially difficult to identify the key, reliable findings.

Few studies reported a substantial or sustained increase in

physical activity There was no evidence that more intense interventions

worked better then others.

Countries of origin

USA 8 Demark 1

China 4 Finland 1

Australia 2 France 1

Netherlands 2 Iran 1

Norway 2 Pakistan 1

Canada 1

Belgium 1

What the review found

What the review found included strategies

Building partnership (22 studies) Some form of counselling (18) Mass media (15) Other communication (18) Specific settings (11) Environmental change strategies (10)

Dichotomous outcomes – Physical activity

0

0.5

1

1.5

2

2.5

Wendel-Vos2009

Reger-Nash2005

Brown 2006 Lupton 2003 Sarrafzadegan2009

Kloek 2006 NSW Health2002

Jiang 2008

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urs

co

ntr

ol

F

avo

urs

inte

rve

nti

on

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

Nishtar 2007 Kumpusalo 1996 Luepker 1994a Luepker 1994b

Favo

urs

cont

rol

F

avou

rs in

terv

enti

onDichotomous outcomes – Physical activity during leisure time

0

1

2

3

Jenum 2006 Nafziger 2001 Osler 1993 GoodmanFavo

urs

inte

rven

tion

F

avou

rs c

ontr

olDichotomous outcomes – Sedentary or physically inactive

Continuous outcomes 7 included studies 3 showing some evidence (DeCocker

2007 (women), Simon 2008, Wendel-Vos 2009 Measured a against background

decreasing PA levels Continuous measures more useful

Continuous measures – Leisure time spent in PA

Study Measure (labelled)

Subgroups Post-mean difference

Adjusted mean difference

Adjusted % change relative to the control mean

Wendel-Vos 2009

Leisure time PA (hours/wk)

Men -0.2 -0.4 -2.06

Women -0.7 2.2 14.01 (P<0.5)

DeCocker 2008 Leisure time PA (min/week)

Leisure time PA

0 32 25.60 (P<0.05)

Simon 2008 Supervised leisure time PA (hours/week)

Children only measured

0.9 1.1 43.14 (P<0.0001)

Continuous outcomes walking

Study Measure (labelled)

Sub-groups Post mean difference

Adjusted mean difference

Adjusted % change relative to the control mean

Wendel-Vos 2009

Walking (hours/week)

Men 1.8 1.1 15.94 NS

Women 1.8 2.0 29.41 NS

DeCocker 2007

Walking (min/week)

Walking 34 47 17.34 (P<0.05)

Brownson 2005

Walking (mean min/week)

N/A -0.8 5.2 4.75 NS

Brownson 2004

7 day total walking (mean

N/A -5.3 -1.4 -1.38 NS

Continuous outcomes – Energy expenditure METs

Study Measure (labelled)

Post mean difference

Adjusted mean difference

Adjusted % change relative to the control mean

Sarrafzegan 2009

Total daily PA (MET –m/week +SD)

32 46 9.09 (P<0.05)

Leisure time PA (MET- m/week)

14 13 12.26 (P<0.01)

Kloek 2006 METs/week 81 -241 -3.54 (P=0.95)

Intensity of the Intervention 9 high intensity 10 medium intensity 6 low intensity

Interventions by Gu 2006, Jiang 2008,

and Zhang 2003 reached every individual in their target communities

High intensity studies Of the 9 studies assessed of high intensity 5 of these reported some improved PA

outcomes 3 of these found no effects Some high intensity interventions not

appropriate for western settings

Environmental – possible? Brown -2006 (wide range) women Brownson 2004 (walking trails) De Cocker 2007 (signage) Eaton 1999 (trails, paths) Goodman 1995 (walking trails) Jenum 2006 (approaches) maybe Leupker 1994 (change) NSW Health 2002 (parks) maybe O’Loughlin 1999 (minimal) Simon 2008 (various)

General Implications Review is a foundation of relevant evidence

Reviews of specific components

Environmental change strategies and settings based approaches may provide a promising direction for future interventions

Incorporation of strong evaluation designs

Take home messages

Many of the included studies had significant methodological issues

The effects reported from the 25 studies included in the review were inconsistent across both studies and measurements.

This review has established a foundation of the relevant evidence

Improved evaluation design is required to better understand what strategies work for whom, what components are essential and what measures are reliable

Environmental change strategies and/or settings based approach may be the place to start for further research

Questions?

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