Remote and web 2.0 interventions for promoting physical activity

Abstract

Background: Remote and web 2.0 interventions for promoting physical activity (PA) are becoming increasingly popular but their ability to achieve long term changes are unknown.

Objectives: To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control group exposed to placebo or no or minimal intervention.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied.

Selection criteria: Randomised controlled trials (RCTs) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies (for example the internet, smart phones) or more traditional methods (for example telephone, mail-outs), or both. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis.

Data collection and analysis: At least two authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% CIs were calculated.

Main results: A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of the interventions on cardiovascular fitness at one year (two studies; 444 participants) was positive and moderate with significant heterogeneity of the observed effects (SMD 0.40; 95% CI 0.04 to 0.76; high quality evidence). The effect of the interventions on self-reported PA at one year (nine studies; 4547 participants) was positive and moderate (SMD 0.20; 95% CI 0.11 to 0.28; moderate quality evidence) with heterogeneity (I2 = 37%) in the observed effects. One study reported positive results at two years (SMD 0.20; 95% CI 0.08 to 0.32; moderate quality evidence). When studies were stratified by risk of bias, the studies at low risk of bias (eight studies; 3403 participants) had an increased effect (SMD 0.28; 95% CI 0.16 to 0.40; moderate quality evidence). The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels. There was no evidence of an increased risk of adverse events (seven studies; 2892 participants). Risk of bias was assessed as low (eight studies; 3060 participants) or moderate (three studies; 2677 participants). There were no differences in effectiveness between studies using different types of professionals delivering the intervention (for example health professional, exercise specialist). There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human, nor between studies that used pedometers as part of their intervention compared to studies that did not.

Authors' conclusions: We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA. These interventions have positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at 12 months. The effectiveness of these interventions was supported by moderate and high quality studies. However, there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups. To better understand the independent effect of individual programme components, longer term studies, with at least one year follow-up, are required.

Conflict of interest statement

Melvyn Hillsdon has received a research council grant to investigate the feasibility of a primary care PA intervention. This was not a study of outcomes and therefore had no bearing on this review. He has been a member of a NICE programme development group on walking and cycling and was paid for travel expenses.

No other authors have any known conflict of interest.

Figures

1

Delivery of PA interventions described according to interaction with implementer and other participants.

2

Study flow diagram.

3

Funnel plot of comparison: 1 Remote and web 2.0 interventions versus control, outcome: 1.4 Self‐reported physical activity: 12 months.

1.1. Analysis

Comparison 1 Remote and web 2.0 interventions versus control, Outcome 1 Cardiorespiratory fitness: 12 months.

1.2. Analysis

Comparison 1 Remote and web 2.0 interventions versus control, Outcome 2 Dichotomous outcomes: 12 months.

1.3. Analysis

Comparison 1 Remote and web 2.0 interventions versus control, Outcome 3 Dichotomous outcomes: 24 months.

1.4. Analysis

Comparison 1 Remote and web 2.0 interventions versus control, Outcome 4 Self reported physical activity: 12 months.

1.5. Analysis

Comparison 1 Remote and web 2.0 interventions versus control, Outcome 5 Self reported physical activity: 24 months.

2.1. Analysis

Comparison 2 Remote and web 2.0 interventions versus control with low risk of bias (risk of bias score ≥ 50%), Outcome 1 Cardiorespiratory fitness: 12 months.

2.2. Analysis

Comparison 2 Remote and web 2.0 interventions versus control with low risk of bias (risk of bias score ≥ 50%), Outcome 2 Dichotomous outcomes: 12 months.

2.3. Analysis

Comparison 2 Remote and web 2.0 interventions versus control with low risk of bias (risk of bias score ≥ 50%), Outcome 3 Dichotomous outcomes: 24 months.

2.4. Analysis

Comparison 2 Remote and web 2.0 interventions versus control with low risk of bias (risk of bias score ≥ 50%), Outcome 4 Self reported physical activity: 12 months.

3.1. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 1 Delivery: individual.

3.2. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 2 Implementer: health professional.

3.3. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 3 Implementer: non‐health professional.

3.4. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 4 Physical activity type: specified.

3.5. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 5 Physical activity type: not specified.

3.6. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 6 Prescribed physical activity: human generated.

3.7. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 7 Prescribed physical activity: computer generated.

3.8. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 8 Intervention: includes pedometer.

3.9. Analysis

Comparison 3 Remote and web 2.0 interventions versus control (subgroup analysis ‐ self‐reported physical activity: 12 months), Outcome 9 Intervention: does not include pedometer.