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Physical Activity: Individually Adapted Health Behavior Change Programs

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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.

Context

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Summary of Results

More details about study results are available in the published evidence review pdf icon [PDF - 3.13 MB].

Eighteen studies were included in the review.

  • In all included studies, individually adapted health behavior change programs were effective in increasing physical activity.
    • Time spent in physical activity: median net increase of 35.4% (20 study arms)
    • Aerobic capacity (VO2 max): median increase of 6.3% (13 study arms)
    • Energy expenditure: median increase of 64.3% (15 study arms)
  • Programs also increased the following:
    • Proportion of people who started exercise programs
    • Frequency that people reported engaging in physical activity

Summary of Economic Evidence

More details about study results are available in the published evidence review pdf icon [PDF - 3.13 MB].

One study was included in the economic review.

  • This two-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 used behavioral skills training to fit 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 was between $0.05 and $3.94 and $0.07 to $5.39 per average unit (as defined in the outcomes measured above), respectively, of improvement for the lifestyle and structured interventions.

Applicability

Results should be applicable to diverse settings and populations provided interventions are adapted to target populations.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

  • Which intervention characteristics and components are most effective?
  • What method of delivery is most effective?
  • Does the effectiveness of behavioral change methods vary by type of physical activity?
  • Do these interventions promote positive or negative attitudes toward physical activity?
  • Does the level or scale affect whether interventions work?
  • What are the effects of each intervention in various sociodemographic subgroups, such as age, gender, race, or ethnicity?
  • Do informational approaches to increasing physical activity increase health knowledge? To increase physical activity levels, is increased knowledge or improved attitudes toward physical activity needed?
  • Do these approaches to increasing physical activity increase awareness of opportunities for and benefits of physical activity?
  • After the initial behavior change, what are the most effective ways to maintain physical activity levels? 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 reliable and valid measures can be developed to address the entire spectrum of physical activity, including light or moderate activity?
  • Are these interventions cost effective?
  • How can we better measure, estimate, or model effectiveness in terms of health outcomes or quality-adjusted health outcomes?
  • How can we estimate the cost–benefit of these programs?
  • 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 structural (environmental) barriers to implementing these interventions?
  • What resource (time and money) constraints slow or stop the implementation of these interventions?

Study Characteristics

  • Most included studies used concepts from one or more health behavior change models.
  • All interventions were delivered to people in group settings or by mail, telephone, or direct media.
  • Most interventions included volunteer samples.
  • In the typical intervention, volunteers were grouped to provide companionship and support to help each other reach self-selected activity goals. Participants received phone calls from each other and from study staff to monitor progress and encourage continued activity.
  • Some studies had 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), and a telecommunications company (1 study).
  • Study populations for most studies were middle-aged; four studies focused on people aged 50 years or older.

Publications