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Physical Activity: Individually-Adapted Health Behavior Change Programs


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 18 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

Eighteen studies qualified for review.

  • In all 18 studies reviewed, individually-adapted health behavior change programs were effective in increasing physical activity as measured by various indicators.
    • Time spent in physical activity: median net increase of 35.4% (interquartile interval: 16.7% to 83.3%; 20 study arms)
    • Aerobic capacity (VO2 max): median increase of 6.3% (interquartile interval: 5.1% to 9.8%; 13 study arms)
    • Energy expenditure: median increase of 64.3% (interquartile interval: 31.2% to 85.5%; 15 study arms)
  • Other measures of physical activity, such as the percentage of people starting exercise programs and the frequency of physical activity, also increased as a result of these programs.

Summary of Economic Evidence

One study was included in the economic review.

  • This 2-year study evaluated the cost-effectiveness of two physical activity interventions (lifestyle and structured interventions) provided to adults aged 35 to 60 years.
    • The lifestyle intervention consisted of behavioral skills training to integrate moderate-to-intense physical activity into the lives of participants.
    • The structured exercise intervention consisted of supervised center-based exercise.
  • Program costs included personnel, capital equipment, facilities, and general supplies. Research costs, recruitment costs, and value of participants’ time were not included.
  • The adjusted cost-effectiveness ratio for each intervention arm ranged between $0.05 to $3.94 and $0.07 to $5.39 per average unit (as defined in the outcomes measured above) of improvement for lifestyle and structured intervention, respectively.


Given the diversity of settings and populations included in this body of evidence, these results should be applicable to diverse settings and populations, provided appropriate attention is paid to adapting the interventions to the target populations.

Evidence Gaps

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 are most effective?
  • What mode of delivery is most effective?
  • Does the effectiveness of behavioral change method vary by type of physical activity?
  • Are these interventions effective in increasing physical activity?
  • Do these interventions promote positive or negative attitudes toward physical activity?

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.


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.

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?

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?

Study Characteristics

  • All programs incorporated the following behavioral approaches:
    • Setting goals for physical activity and self-monitoring of progress toward goals
    • Building social support for new behavioral patterns
    • Behavioral reinforcement through self-reward and positive self-talk
    • Structured problem-solving geared to maintenance of the behavior change, and
    • Prevention of relapse into sedentary behaviors.
  • Many or most of the included studies used constructs from one or more established health behavior change models.
  • All of the interventions evaluated were delivered to people either in group settings or by mail, telephone, or directed media.
  • In the typical intervention, volunteers were grouped to provide companionship and support to help each other reach self-selected activity goals. Study participants received phone calls from other participants and from study staff members to monitor progress and encourage them to continue their activities.
  • Some studies involved formal discussion groups to address barriers to exercise and negative perceptions about activity.
  • Studies were conducted in the United States (17 studies), and Australia (1 study).
  • Interventions were offered in community settings (14 studies), worksites (4 studies), schools or universities (2 studies), or a telecommunications company (1 study).
  • Studies typically included volunteer samples, which limit generalizing to the entire population.
  • Most studies reported results for men and women, though three studies reported results only for women.
  • Study populations for most studies were middle-aged; four studies focused on people ages 50 years or older.