From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

Abstract

Background: Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Methods: Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002–2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.

Comparing and assessing physical activity guidelines for children and adolescents: a systematic literature review and analysis

“…Alternatively, there may be countries who adopt the WHO guidelines without specifically stating it. Guidelines are designed to provide recent evidence-based information that aligns with the recommendation to encourage healthy behaviour [55]. With the increasing burden of the noncommunicable disease impacting low, middle and high income countries, reducing risk factors by improving healthy lifestyles is key in the management of this global challenge.…”

“…The WHO advocates for multi-sectoral approaches to address declining levels of physical activity, urging governments to develop policies which support interventions to increase physical activity and reduce sedentary behaviour [55,56]. The current WHO physical activity and sedentary behaviour guidelines are 9 years old, with current plans to update these guidelines in place [18].…”

“…Notably, this review has disclosed considerable betweencountry variability in guideline quality and development. Scientific legitimation is one of the key factors for guideline implementation [55,65]. In instances where guidelines provide advice without current research to support the recommendation, it should be acknowledged.…”

Translating the international scientific spinal cord injury exercise guidelines into community and clinical practice guidelines: a Canadian evidence-informed resource

“…The steps taken in our KT project are built upon the general literature on developing, updating, and adapting guidelines [10,13,25,26], KT literature [9,12,27,28], PAG messaging literature [7,8,11], and SCI-specific PAG literature [5]. Table 3 summarizes our 10-step KT approach by providing a general description of each step, an example from our KT project, and the supporting evidence.…”

“…Such resources are unlikely to be implemented and used, however, unless they are tailored to local audiences and settings (i.e., presented in a manner that aligns with users' needs and preferences) [7]. By engaging stakeholders throughout the guideline and resource development and adaptation processes [9][10][11], we can ensure that we address the preferences, concerns, and feedback from people living with SCI in a specific community. Adopting such a communityengaged approach will result in products that are meaningful for potential end-users [10,12].…”