Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis

Abstract

Physical inactivity and sedentary behavior relate to poor health outcomes independently. Healthy inactive adults are a key target population for prevention. This systematic review and meta-analysis aimed to evaluate the effectiveness of physical activity and/or sedentary behavior interventions, measured postintervention (behavior change) and at follow-up (behavior change maintenance), to identify behavior change techniques (BCT) within, and report on fidelity. Included studies were randomized controlled trials, targeting healthy inactive adults, aiming to change physical activity and/or sedentary behavior, with a minimum postintervention follow-up of 6 months, using 16 databases from 1990. Two reviewers independently coded risk of bias, the "Template for Intervention Description and Replication" (TIDieR) checklist, and BCTs. Twenty-six studies were included; 16 pooled for meta-analysis. Physical activity interventions were effective at changing behavior (d = 0.32, 95% confidence intervals = 0.16-0.48, n = 2,346) and maintaining behavior change after 6 months or more (d = 0.21, 95% confidence intervals = 0.12-0.30, n = 2,190). Sedentary behavior interventions (n = 2) were not effective. At postintervention, physical activity intervention effectiveness was associated with the BCTs "Biofeedback," "Demonstration of the behavior," "Behavior practice/rehearsal," and "Graded tasks." At follow-up, effectiveness was associated with using "Action planning," "Instruction on how to perform the behavior," "Prompts/cues," "Behavior practice/rehearsal," "Graded tasks," and "Self-reward." Fidelity was only documented in one study. Good evidence was found for behavior change maintenance effects in healthy inactive adults, and underlying BCTs. This review provides translational evidence to improve research, intervention design, and service delivery in physical activity interventions, while highlighting the lack of fidelity measurement.

Choice architecture interventions to change physical activity and sedentary behavior: a systematic review of effects on intention, behavior and health outcomes during and after intervention

“…Moreover, there is still a lack of insight regarding the extent to which choice architecture interventions can effectuate durable behavior change after removal of the intervention [15]. It is important to make a distinction between initial behavior change and maintenance of behavior change [32], especially since interventions that effectuate behavior change during the intervention often fail to maintain this change in the long term after removal of the intervention [8,9]. Finally, a more extensive insight into the effectiveness of choice architecture interventions could be obtained by looking at changes in behavioral intentions and health outcomes related to physical activity and sedentary behavior.…”

Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

“…Finally, we searched the literature to determine if a 12 week nature walks intervention would promote behaviour change and maintenance. We could not find research evidence specially in people with severe mental ill-health; however, there is evidence from a systematic review and meta-analysis that physical activity interventions lead to behaviour change that is sustained after 6 months or more [62]. In meetings, practitioners identified the active ingredients of the current "nature walks for wellbeing" programme being delivered in the Scottish Highlands to hospital in-patients that they believed improved physical and mental health outcomes in people with severe mental illness.…”

A scoping review of ontologies related to human behaviour change

“…Similar taxonomies to represent the mode of delivery 11 and mechanisms of action 12 of interventions are under development. Such classification systems allow similarities and differences between interventions to be made explicit; these have been very useful for evidence syntheses 13,14 .…”