35. Community wide interventions for increasing physical activity.
Commentary by Rona Macniven, Cluster for Physical Activity and Health (CPAH), University of Sydney
Cochrane Reviews are systematic reviews of primary research in human health care and health policy. They investigate the effects of interventions (literally meaning to intervene to modify an outcome) for prevention, treatment and rehabilitation. This review focussed on the effects of community wide interventions for increasing physical activity, concluding inconsistency in the findings from studies included in the review.
Cochrane reviews are conducted around strict criteria for inclusion of studies. This review included only studies whose designs were cluster randomised controlled, randomised controlled, quasi-experimental using a control population, interrupted time-series studies, and prospective controlled cohort studies (PCCS) were included. Studies also needed to have at least six-months follow up period and incorporate at least two broad physical activity intervention strategies for the whole population.
Twenty-five studies met the inclusion criteria for the review; 19 in high income countries, 6 in low income countries, nearly all of which included a component of building partnerships with local governments or non-governmental organisations (NGOs). Of the 19 studies in high income countries 11 studies were described as targeting deprived, disadvantaged, or low socio-economic communities but none compared findings across groups. The reviewers considered all 25 studies either to have a high or unclear risk of bias. Detection bias was also examined through an assessment of the validity of measurement tools and quality of outcome measures with only four studies considered to have no risk of bias. In terms of intervention effectiveness, findings were inconsistent across studies and measures and some of the higher quality studies showed no increase in physical activity.
Interventions with a whole-of-population approach are popular in physical activity and health promotion due to their broad reach and convenience to participants. Whilst this review highlights current concerns regarding the effectiveness and measurement of such programs, the stringent selection criteria adopted by the review may not reflect real life challenges and measurement issues in health promotion practice. Collaboration among researchers, policy makers and practitioners is strongly advised to progress the evidence base in this area and establish rigorous yet achievable and meaningful ways to measure the effects of complex, multi-strategy community programs and to plan future intervention strategies.