Physical Activity: Community-Wide Campaigns

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.

Ten studies qualified for the review.

• Percentage of people who report being physically active: median net increase of 4.2 % (interquartile range: -2.9% to 9.4%; 6 study arms)
• Energy expenditure: median net increase of 16.3% (interquartile range: 7.6% to 21.4%; 3 study arms)
• Other measures of physical activity: all but one of five study arms showed increases in physical activity.
• This review also found evidence that community-wide campaigns are effective in increasing:
  
  • Knowledge about exercise and physical activity
  • The intention to be more physically active
• These campaigns can also reduce risk factors for cardiovascular disease. However, studies that measured body weight changes had mixed results. Some studies showed weight loss, but others showed no change or even slight weight gain.

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

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.

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 be institutionalized?
• What are the most effective and efficient delivery settings and channels (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 burdens of implementation?

General Research Issues

The following outlines evidence gaps for reviews of these interventions to increase physical activity: Individually-Adapted Health Behavior Change Programs; Social Support Interventions in Community Settings; Family-Based Social Support; Enhanced School-Based Physical Education (archived); College-Based Physical Education and Health Education; Classroom-Based Health Education to Reduce TV Viewing and Video Game Playing; Community-Wide Campaigns; Mass Media Campaigns (archived); Classroom-Based Health Education Focused on Providing Information; Creation of or Enhanced Access to Places for Physical Activity Combined with Informational Outreach Activities.

Effectiveness

Several crosscutting research issues about the effectiveness of all of the reviewed interventions remain.

• What behavioral changes that do not involve physical activity can be shown to be associated with changes in physical activity?
  
  • For example, does a decrease in time spent watching television mean an increase in physical activity or will another sedentary activity be substituted?
  • Does an increase in the use of public transportation mean an increase in physical activity or will users drive to the transit stop?
• Physical activity is difficult to measure consistently across studies and populations. Although several good measures have been developed, several issues remain to be addressed.
  
  • Reliable and valid measures are needed for the spectrum of physical activity. Rationale: Current measures are better for vigorous activity than for moderate or light activity.
  • Sedentary people are more likely to begin activity at a light level; this activity is often not captured by current measurement techniques.
  • Increased consensus about “best measures” for physical activity would help to increase comparability between studies and would facilitate assessment of effectiveness.
• Note: This is not intended to preclude researchers’ latitude in choosing what aspects of physical activity to measure and to decide which measures are most appropriate for a particular study population. Perhaps a useful middle ground position would be the establishment of selected core measures that most researchers should use which could then be supplemented by additional measures. The duration of an intervention’s effect was often difficult to determine.

Applicability

Each recommended and strongly recommended intervention should be applicable in most relevant target populations and settings, assuming that appropriate attention is paid to tailoring. However, possible differences in the effectiveness of each intervention for specific subgroups of the population often could not be determined. Several questions about the applicability of these interventions in settings and populations other than those studied remain.

• Are there significant differences in the effectiveness of these interventions, based on the level or scale of an intervention?
• What are the effects of each intervention in various sociodemographic subgroups, such as age, gender, race, or ethnicity?

Other Positive or Negative Effects

The studies included in this review did not report on other positive and negative effects of these interventions. Research on the following questions would be useful:

• 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 approaches to increasing physical activity increase awareness of opportunities for and benefits of physical activity?
• What are the most effective ways to maintain physical activity levels after the initial behavior change has occurred?
• Are there other benefits from an intervention that might enhance its acceptability? For example, does increasing social support for physical activity carry over into an overall greater sense of community?
• 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)?

Economic Evidence

The available economic data were limited. Therefore, considerable research is warranted on the following questions:

• What is the cost-effectiveness of each of these interventions?
• 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 each of these approaches contribute to economic efficiency?
• What combinations of components in multicomponent interventions are most cost-effective?

Barriers

Research questions generated in this review include the following:

• What are the physical or structural (environmental) barriers to implementing these interventions?
• What resource (time and money) constraints prevent or hinder the implementation of these interventions?

• In addition to addressing sedentary behavior, most of the included studies also addressed other cardiovascular disease risk factors, particularly 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 in the form of 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 studies evaluated interventions delivered over a period of several years, though a few were limited to between 6 weeks and 6 months.