Elsevier

The Lancet

Volume 380, Issue 9838, 21–27 July 2012, Pages 272-281
The Lancet

Series
Evidence-based intervention in physical activity: lessons from around the world

https://doi.org/10.1016/S0140-6736(12)60816-2Get rights and content

Summary

Promotion of physical activity is a priority for health agencies. We searched for reviews of physical activity interventions, published between 2000 and 2011, and identified effective, promising, or emerging interventions from around the world. The informational approaches of community-wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended. Behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school-based strategies that encompass physical education, classroom activities, after-school sports, and active transport. Recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community-scale and street-scale urban design and land use, active transport policy and practices, and community-wide policies and planning. Thus, many approaches lead to acceptable increases in physical activity among people of various ages, and from different social groups, countries, and communities.

Section snippets

Importance of physical activity promotion

Scientific guidelines issued by various international bodies, national centres and institutes, and professional organisations have documented that regular physical activity protects against coronary heart disease, type 2 diabetes, some cancers, hypertension, obesity, clinical depression, and other chronic disorders.1, 2, 3, 4, 5 These findings have been reiterated in Lee and colleagues' systematic review of the evidence.6 Therefore, the substantial potential benefits of promotion of physical

Search strategy and selection criteria

Here, we summarise representative evidence-based physical activity interventions from throughout the world that are linked to a broad understanding of health promotion and disease prevention at the national, state and regional, and local levels. We did a systematic review of reviews to assess the present evidence. We searched the Database of Abstracts of Reviews of Effects (DARE), the Cochrane library, TRIP, PubMed (Medline), the American Psychological Association, National Guidelines

Campaigns and informational approaches

A recommended strategy within this domain is use of community-wide campaigns (appendix),36 such as the Stanford heart disease prevention programme38 and the Wheeling Walks intervention.39 These campaigns represent large-scale, high-intensity, high-visibility programming and often use television, radio, newspapers, and other media to raise awareness, disseminate targeted health messages to specific segments of the population (ie, segmented messages), and reinforce behaviour change. This strategy

Behavioural and social approaches

Individually adapted programmes to change health behaviour are characterised by a multicomponent intervention approach, and aim to have participants incorporate physical activity into their daily routines.36 Goal setting, social support, and behavioural reinforcement through self-reward, structured problem solving, and relapse prevention are examples of this type of intervention.36 Such programmes can be delivered in group settings or by email, internet, mail, or telephone, or by all four

Policy and environmental approaches

Walking and biking trails and exercise facilities can be created or enhanced to promote physical activity, and access to existing facilities can be increased with a reduction in structural and environmental barriers (eg, increased safety, improved affordability; appendix).36 Environmental and policy initiatives are often supported by training of personnel or participants, or both, provision of social support, and further integration of these structures, facilities, and programmes into

Translation, adaptation, capacity building, and keys to success

On the basis of existing evidence, an interesting pattern seems to be emerging, which emphasises important regional and cultural differences in how physical activity promotion is being approached around the world. The best options for interventions aimed at communities and individuals are probably dictated by local region and culture for some populations and settings. For example, previous reviews of work from Latin America41 have identified a high prevalence of community-based interventions

Limitations and next steps

Several limitations are associated with our review of reviews. Although we attempted to identify reports from around the world irrespective of language, we have mainly drawn information from reports in English, Spanish, and Portuguese. Additionally, we did not attempt to complete a thorough search of the grey literature. Much of the published work did not include measures of external validity and hence restricted the generalisability of the findings to other settings and countries. Despite

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