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Interventions to increase physical activity among healthy adults: meta-analysis of outcomes
Authors:Conn Vicki S  Hafdahl Adam R  Mehr David R
Affiliation:University of Missouri School of Nursing, Columbia, MO, USA. conn@missouri.edu
Abstract:Objectives. We conducted a meta-analysis summarizing the effects of interventions designed to increase physical activity among healthy adults.Methods. Our comprehensive searches located 358 reports eligible for inclusion. We used random-effects analyses to synthesize data, and we used meta-analytic analogues of regression and analysis of variance to examine potential moderator variables. We also explored moderator variable robustness and publication bias.Results. We computed meta-analytic results from studies comprising 99 011 participants. The overall mean effect size for comparisons of treatment groups versus control groups was 0.19 (higher mean for treatment participants than for control participants). This effect size is consistent with a mean difference of 496 ambulatory steps per day between treatment and control participants. Exploratory moderator analyses suggested that the characteristics of the most effective interventions were behavioral interventions instead of cognitive interventions, face-to-face delivery versus mediated interventions (e.g., via telephone or mail), and targeting individuals instead of communities. Participant characteristics were unrelated to physical activity effect sizes. Substantial between-studies heterogeneity remained beyond individual moderators.Conclusions. Interventions designed to increase physical activity were modestly effective. Interventions to increase activity should emphasize behavioral strategies over cognitive strategies.Adequate physical activity is linked with important health outcomes, including reductions in cardiovascular disease,1 type 2 diabetes,2,3 some cancers,4,5 falls,6 osteoporotic fractures,7 and depression,8 and improvements in physical function,911 weight management,1215 cognitive function,16,17 and quality of life.18 Despite this compelling evidence for the benefits of physical activity, healthy adults commonly get an inadequate amount of physical activity.19Extensive primary research has tested interventions to increase physical activity. Although many meta-analyses have addressed health outcomes of physical activity, few have examined physical activity behavior outcomes. The seminal 1996 meta-analysis of interventions to increase physical activity behavior reported a moderate effect size across 127 studies of healthy and chronically ill adults and children.20 Their moderator analyses documented larger effect sizes when interventions used behavior modification, had face-to-face delivery versus mediated delivery (e.g., telephone), focused on healthy people, measured active leisure versus structured exercise, measured low-intensity activity, encouraged unsupervised physical activity versus supervised physical activity, targeted participants of diverse ages, and targeted groups versus individuals.A recent comprehensive meta-analysis of work site programs for healthy adults documented a d effect size (standardized mean difference) of 0.21 but did not conduct moderator analyses to determine the intervention characteristics linked with the largest physical activity increases.21 Other meta-analyses have integrated across chronically ill adults22 or focused on small, specific interventions or populations, such as primary care–based referrals to physical activity programs,23 older adults,24 computer-based interventions,25 or environmental interventions.26 Many meta-analyses have been plagued by small samples that hinder moderator analyses.27,28 For example, only 19 studies were included in the most recent Cochrane review that aggregated randomized, controlled trials with follow-up data gathered at least 6 months after interventions to increase physical activity among sedentary adults.27Because of the importance of physical activity and the proliferation of studies testing interventions to increase physical activity, we sought to move this area of science forward by conducting a comprehensive meta-analysis to estimate the overall effect of interventions and, more importantly, to conduct moderator analyses to identify intervention characteristics associated with the best outcomes. We addressed 2 questions: (1) What overall effects do interventions designed to increase physical activity have on physical activity behavior after completion of interventions? (2) Do interventions’ effects on physical activity behavior vary depending on intervention, methodology, or sample characteristics?
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