Physical Activity: Community-Wide Campaigns

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Snapshot

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends community-wide campaigns to increase physical activity and improve fitness among adults and children.

Intervention

Many community sectors work together to implement community-wide campaigns to increase physical activity using highly visible, broad-based, multicomponent strategies (e.g., social support, risk factor screening, health education). Campaigns may focus on physical activity alone or include other cardiovascular disease risk factors such as nutrition and tobacco use

CPSTF Finding and Rationale Statement

Read the CPSTF finding pdf icon [PDF - 133 KB].

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 10 studies (search period 1980 – 2000).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 3.13 MB].

Ten studies were included in the review.

The percentage of people who reported being physically active increased by a median of 4.2 % (6 study arms)
Reported energy expenditure increased by a median of 16.3% (3 study arms)
All but 1 of 5 study arms that measured physical activity reported increases.
Community-wide campaigns increased knowledge about exercise and physical activity and self-reported intention to be more physically active
Studies that measured body weight changes showed mixed results. Some studies showed weight loss, but others showed no change or even slight weight gain.

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.

Applicability

The results of this review should be applicable to most communities in the United States if the campaign is adapted to specific needs and interests of the target population.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

What characteristics and components of community-wide campaigns are most effective?
How can community-wide efforts become permanent?
What are the most effective and efficient delivery settings and methods (e.g., media, work settings)?
Do coalitions enhance the delivery and effectiveness of interventions in community settings? If so, is the enhanced effect worth the potential added cost and burden of implementation?
How do interventions affect various population subgroups, such as age, gender, race, or ethnicity?
Does the level or scale affect whether interventions work?
After the initial behavior change, what are the most effective ways to maintain physical activity levels?
Do informational approaches to increasing physical activity help to increase health knowledge? Is it necessary to increase knowledge or improve attitudes toward physical activity to increase physical activity levels?
Do these interventions increase awareness of opportunities for, and benefits of, physical activity?
Are there any key harms?
Is anything known about whether or how approaches to physical activity could reduce potential harms (e.g., injuries or other problems associated with doing too much too fast)?
What time and money constraints slow or stop the implementation of these interventions?
Can reliable and valid measures be developed to address the entire spectrum of physical activity, including light or moderate activity?
Are these interventions cost effective?
How can effectiveness in terms of health outcomes or quality-adjusted health outcomes be better measured, estimated, or modeled?
How can the cost–benefit of these programs be estimated?
How do specific characteristics of these interventions contribute to economic efficiency?
What combinations of components in multicomponent interventions are most cost-effective?
What are the physical or environmental barriers to implementing these interventions?

Study Characteristics

In addition to sedentary behavior, most included studies also considered other cardiovascular disease risk factors, such as diet and smoking.
Communication techniques were a common element in all of the campaigns.
- Campaign messages were directed to large and relatively undifferentiated audiences through diverse media, including television, radio, newspaper columns and inserts, direct mailings, billboards, advertisements in transit outlets, and trailers in movie theaters.
- Messages were delivered as paid advertisements, donated public service announcements, press releases, the creation of feature items, or a combination of two or more of these approaches.
Multicomponent interventions were typically evaluated as a "combined package" because it was impossible to distinguish the relative contributions of each component. These interventions most often included some combination of the following.
- Social support, such as self-help groups
- Risk factor screening, counseling, and education about physical activity in a variety of settings, including worksites, schools, and community events
- Environmental or policy changes such as the creation of walking trails
Many of the evaluated interventions lasted several years, though a few were limited to 6 weeks to 6 months.

Publications

Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: a systematic review. American Journal of Preventive Medicine. 2002;22(4S):73-107.

Task Force on Community Services. Recommendations to increase physical activity in communities. American Journal of Preventive Medicine. 2002;22(4S):67-72.

Centers for Disease Control and Prevention. Increasing physical activity. A report on recommendations of the Task Force on Community Preventive Services. MMWR. 2001;50(RR-18):1-16. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5018a1.htm.

Wilcox S, Shephard D, Martin SL, et al. Informational approaches to promoting physical activity. In: Promoting Physical Activity: A Guide for Community Action. Promoting Physical Activity: A Guide for Community Action. Champaign (IL): Human Kinetics; 2010. Available at: http://www.humankinetics.com/products/all-products/the-promoting-physical-activity---2nd-edition.

Dunn AL, Blair SN. Translating evidence-based physical activity interventions into practice. American Journal of Preventive Medicine. 2002;22(4S):8-9.

Task Force on Community Services, Zaza S, Briss PA, Harris KW. Physical activity. In: The Guide to Community Preventive Services: What Works to Promote Health?. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press; 2005:80-113.

Supporting Materials

Analytic Framework

Effectiveness Review

Analytic Framework pdf icon [PDF – 3.1 MB] – see Figure 1 on page 76

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table - Effectiveness Review pdf icon [PDF - 133 KB]

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Goodman RM, Wheeler FC, Lee PR. Evaluation of the Heart To Heart Project: lessons from a community-based chronic disease prevention project. Am J Health Promot 1995;9:443–55.

Jason LA, Greiner BJ, Naylor K, Johnson SP, Van Egeren L. A large-scale, short-term, media-based weight loss program. Am J Health Promot 1991;5:432–7.

Luepker RV, Murray DM, Jacobs DJ, et al. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. Am J Public Health 1994;84:1383–93.

Malmgren S, Andersson G. Who were reached by and participated in a one year newspaper health information campaign? Scand J Soc Med 1986;14:133–40.

Meyer AJ. Skills training in a cardiovascular health education campaign. J Consult Clin Psychol 1980;48:129–42.

Osler M, Jespersen NB. The effect of a community-based cardiovascular disease prevention project in a Danish municipality. Dan Med Bull 1993;40:485–9.

Owen N, Lee C, Naccarella L, Haag K. Exercise by mail: a mediated behavior-change program for aerobic exercise. J Sport Psychol 1987;9:346–57.

Tudor-Smith C, Nutbeam D, Moore L, Catford J. Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasi-experimental comparison of results from Wales and a matched reference area. BMJ 1998;316(7134):818–22.

Wimbush E, MacGregor A, Fraser E. Impacts of a national mass media campaign on walking in Scotland. Health Promot Internation 1998;13:45–53.

Young DR, Haskell WL, Taylor CB, Fortmann SP. Effect of community health education on physical activity knowledge, attitudes, and behavior. The Stanford Five-City Project. Am J Epidemiol 1996;144:264–74.

Search Strategies

Effectiveness Review

The search for evidence started with seven computerized databases (MEDLINE, Sportdiscus, Psychlnfo, Transportation Research Information Services [TRIS], Enviroline, Sociological Abstracts, and Social SciSearch) and included reviews of reference lists and consultations with experts in the field. Studies were eligible for inclusion if they:

Were published in English during 1980-2000
Were conducted in an Established Market Economy*
Assessed a behavioral intervention primarily focused on physical activity
Were primary investigations of interventions selected for evaluation rather than, for example, guidelines or reviews
Evaluated outcomes selected for review; and
Compared outcomes among groups of persons exposed to the intervention with outcomes among groups of persons not exposed or less exposed to the intervention (whether the study design included a concurrent or before-and-after comparison)

* Established Market Economies as defined by the World Bank are Andorra, Australia, Austria, Belgium, Bermuda, Canada, Channel Islands, Denmark, Faeroe Islands, Finland, France, Germany, Gibraltar, Greece, Greenland, Holy See, Iceland, Ireland, Isle of Man, Italy, Japan, Liechtenstein, Luxembourg, Monaco, the Netherlands, New Zealand, Norway, Portugal, San Marino, Spain, St. Pierre and Miquelon, Sweden, Switzerland, the United Kingdom, and the United States.

Economic Review

The databases MEDLINE, Transportation Research Information Services (TRIS), Combined Health Information Database (CHID), ECONLIT, PsychInfo, Sociological Abstracts, Sociofile, Social SciSearch, and Enviroline were searched for the period 1980–2000. In addition, the references listed in all retrieved articles were reviewed and experts were consulted. Most of the included studies were either government reports or were published in journals. To be included in the review a study had to:

Be a primary study rather than, for example, a guideline or review
Take place in an Established Market Economy
Be written in English
Meet the team’s definitions of the recommended and strongly recommended interventions
Use economic analytical methods such as cost analysis, cost-effectiveness analysis, cost-utility, or cost-benefit analysis; and
Itemize program costs and costs of illness or injury averted

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

Community-wide campaigns may produce additional benefits.
- Through working together, community members may develop a greater sense of unity and confidence in the community.
- Social networks may be developed or strengthened to achieve intervention goals, and community members may become involved in local government and civic organizations, thereby increasing social capital.
Community-wide campaigns require careful planning and coordination, well-trained staff, and sufficient resources to carry them out as planned.
Success is greatly enhanced by community buy-in, which can take a great deal of time and effort to achieve.
Without enough resources, community exposure to messages and other planned campaign interventions may be too limited to achieve changes in knowledge, attitudes, or behavior over time.

Crosswalks

Cancer P.L.A.N.E.T. RTIPs

Find a Research-tested Intervention Program (RTIP) about the use of community-wide campaigns to increase physical activity (What is an RTIP?).

Healthy People 2020

Healthy People 2020 includes the following objectives related to this CPSTF recommendation.

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Physical Activity: Community-Wide Campaigns

Tabs

Summary of CPSTF Finding

Intervention

CPSTF Finding and Rationale Statement

Promotional Materials

Users who viewed this also viewed

About The Systematic Review

Summary of Results

Summary of Economic Evidence

Applicability

Evidence Gaps

Study Characteristics

Publications

Analytic Framework

Effectiveness Review

Summary Evidence Table

Effectiveness Review

Included Studies

Effectiveness Review

Search Strategies

Effectiveness Review

Economic Review

Considerations for Implementation

Crosswalks

Cancer P.L.A.N.E.T. RTIPs

Healthy People 2020

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