ArticleThe effectiveness of interventions to increase physical activity: A systematic review1, 2
Introduction
Regular physical activity is associated with enhanced health and reduced risk of all-cause mortality.1, 2, 3, 4 Beyond the effects on mortality, physical activity has many health benefits, including reduced risk of cardiovascular disease,5, 6 ischemic stroke,7, 8, 9 non-insulin-dependent (type 2) diabetes,10, 11, 12, 13, 14, 15, 16 colon cancers,17, 18, 19, 20 osteoporosis, 21, 22, 23 depression,24, 25, 26, 27 and fall-related injuries.28, 29, 30, 31 Despite the benefits of regular physical activity, only 25% of adults in the United States report engaging in the recommended amounts of physical activity (i.e., 30 minutes of moderate-intensity activity on 5 or more days per week, or 20 minutes of vigorous-intensity activity on 3 or more days per week)32; 29% report no leisure-time regular physical activity33; and only 27% of students (grades 9 through 12) engage in moderate-intensity physical activity (30 minutes, 5 or more days per week).32
In Healthy People 2010,32 physical activity is ranked as a leading health indicator. Healthy People 2010 has developed goals to improve levels of physical activity among adults, adolescents, and children and to reduce sedentary behavior among adolescents (Table 1).
Recommendations to increase physical activity have been made for individuals and clinical settings but not for community settings. Increased physical activity has been linked not only to behavioral and social correlates but also to physical and social environmental correlates. Therefore, the role of community-based interventions to promote physical activity has emerged as a critical piece of an overall strategy to increase physical activity behaviors among the people of the United States. In 1996, the American College of Sports Medicine and the Centers for Disease Control and Prevention (CDC) recommended that every adult in the United States accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.34 That same year, the U.S. Preventive Services Task Force recommended that healthcare providers counsel all patients on the importance of incorporating physical activity into their daily routines.35 To date, community-based interventions to increase physical activity have not been summarized in an evidence-based process.
Section snippets
The guide to community preventive services
The systematic reviews in this report represent the work of the independent, nonfederal Task Force on Community Preventive Services (the Task Force). The Task Force is developing the Guide to Community Preventive Services (the Community Guide) with the support of the U.S. Department of Health and Human Services (DHHS) in collaboration with public and private partners. The Centers for Disease Control and Prevention (CDC) provides staff support to the Task Force for development of the Community
Healthy People 2010 goals and objectives for increasing physical activity
The interventions reviewed in this article should be useful in reaching the objectives set in Healthy People 2010.32 The two main foci of the Healthy People prevention objectives are to increase (1) the amount of moderate or vigorous physical activity performed by people in all population subgroups and (2) opportunities for physical activity through creating and enhancing access to places and facilities where people can be physically active. This article provides information on interventions
The U.S. Preventive Services Task Force
In 1996, in the Guide to Clinical Preventive Services,35 the U.S. Preventive Services Task Force (USPSTF) recommended that healthcare providers counsel their patients to incorporate regular physical activity into their daily routines. This recommendation was based on the accepted health benefits of such activity rather than the proven effectiveness of clinician counseling. The USPSTF found that problems associated with establishing the effectiveness of counseling included lack of information
Methods for conducting the review
The general methods used to conduct systematic reviews for the Community Guide have been described in detail elsewhere.39, 40 The specific methods for conducting this review, including intervention selection, outcome determination, and search strategy for interventions to increase physical activity, are presented in Appendix A. The conceptual approach to the review, critical both for describing the methods and for understanding the results of the review, is described below.
Results. Part I. Informational approaches to increasing physical activity
Informational approaches are designed to increase physical activity by providing information necessary to motivate and enable people to change their behavior, as well as to maintain that change over time. The focus is mainly on the cognitive skills thought to precede behavior. The interventions use primarily educational approaches to present both general health information, including information about cardiovascular disease prevention and risk reduction, as well as specific information about
Results. Part II. Behavioral and social approaches to increasing physical activity
Behavioral and social approaches focus on increasing physical activity by teaching widely applicable behavioral management skills and by structuring the social environment to provide support for people trying to initiate or maintain behavior change. Interventions often involve individual or group behavioral counseling and typically include the friends or family members that constitute an individual’s social environment. Skills focus on recognizing cues and opportunities for physical activity,
Results. Part III. Environmental and policy approaches to increasing physical activity
Environmental and policy approaches are designed to provide environmental opportunities, support, and cues to help people develop healthier behaviors. The creation of healthful physical and organizational environments is attempted through development of policy that lends itself to creating supportive environments and strengthening community action. Correlational studies have shown that physical activity levels are associated with factors such as the availability of exercise equipment in the
Effectiveness
The effectiveness of recommended and strongly recommended interventions in this section (i.e., community-wide campaigns and point-of-decision prompts) is established. However, important research issues about the effectiveness of these interventions remain.
Point-of-decision prompts
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What is the sustained effect of placing signs near the elevator or escalator?
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What effect does varying the message or format of the sign have on providing a “booster” to stair climbing among the targeted population?
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What type of sign is most
Summary
The Community Guide’s physical activity recommendations identify intervention tools that practitioners can use to achieve the Healthy People 2010 Objectives for Physical Activity and Fitness.32 The Task Force strongly recommends community-wide health education campaigns, school-based PE, and social support in community settings, highlighting the role of multisite, multicomponent interventions in successfully increasing physical activity behaviors. Two strongly recommended
Acknowledgements
We thank the following individuals for their contributions to this review: William Callaghan, Preventive Medicine Resident; Jonathan Stevens, Research Assistant; Benedict I. Truman, Stephanie Zaza, Maureen McGuire, and David R. Brown for their early help in developing the review; Reba A. Norman and Delle B. Kelley, Research Librarians; Kate W. Harris, Editor; and for their ongoing technical support and expertise, David Buchner, William H. Dietz, Jeffrey R. Harris, and Peter Briss. We are also
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- 1
The names and affiliations of the Task Force members are listed in the front of this supplement and at www.thecommunityguide.org.
- 2
Address correspondence and reprint requests to: Peter A. Briss, MD, Community Guide Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS-K73, Atlanta, GA 30341. E-mail: [email protected]
- 3
Dr. Stone is currently affiliated with the Department of Physical Performance and Development, University of New Mexico, Albuquerque, New Mexico.