Principal Investigator Kathryn Hesketh
(Funding: NIHR School for Public Health Research)
This international systematic review examined factors affecting physical activity change in young children. It included 44 quantitative studies with children aged 0-6. Two thirds of interventional studies were ‘multi-level’, targeting individual children, parents and teachers, whole organisations and/or the home environment. All the studies measured children’s change in physical activity behaviour, either objectively or subjectively. Outcomes included light, moderate and/or vigorous physical activity. Of 44 determinants of change, 14 were assessed in at least four papers. Of these, parental monitoring, involving logbooks and pedometers, showed a consistently positive association with change in child physical activity across intensities (four of six studies). Provider training was positively associated with change in moderate to vigorous physical activity (six of nine studies), but showed no clear association with physical activity overall. Five determinants (sex, parental goal setting, social support, motor skill training and increased time for physical activity) showed no clear association. The remaining seven (child knowledge, parental knowledge, parental motivation, parenting skills, parental self-efficacy, curriculum materials and portable equipment) were consistently not associated with change in children’s physical activity. Three further studies showed a positive effect of mothers as role models. Positive effects were often small in scale. The wide range of determinants and outcome measures used within the studies limited the authors’ conclusions.
Hesketh KR, O’Malley C, Paes VM, Moore H, Summerbell C, Ong KK et al. Determinants of change in physical activity in children 0–6 years of age: a systematic review of quantitative literature. Sports Medicine 2017 July;47(7): 1349–1374.
Principal Investigator Debbie A Lawlor
(Funding: NIHR PHR - 09/3005/04)
This trial investigated the effectiveness of a school-based intervention to increase children’s levels of physical activity, reduce sitting time and increase fruit and vegetable consumption. Participants were children from 60 English primary schools, aged 8-9 at recruitment (n= 2221). Half the schools received the intervention, delivered in Year 5. It included teacher training, 16 lesson plans and materials, ten parent-child homework assignments, and written materials for school newsletters. Primary outcome measures included accelerometer-assessed levels of physical activity and sedentary behaviour, and child-reported consumption of fruit and vegetables, assessed at Year 5-end, and a year later. The study found no difference in primary outcomes between children in intervention and control schools. The intervention appeared effective on three of nine secondary outcomes; children reported reducing weekend screen time by an average of 21 minutes per day, eating fewer snacks, and drinking fewer high-energy drink. Effects appeared to persist a year later, but differences might not have resulted from the intervention. The intervention cost to providers was approximately £18 per child. The researchers concluded that school-based interventions are unlikely to have a major impact on promoting physical activity and healthy diets in primary school children. They recommended research into more intensive family and community interventions.
Lawlor DA, Kipping RR, Anderson EL, Howe LD, Chittleborough CR, Moure-Fernandez A et al. Active for Life Year 5: a cluster randomised controlled trial of a primary school-based intervention to increase levels of physical activity, decrease sedentary behaviour and improve diet. Public Health Research 2016;4(7).
Principal Investigator Rob Anderson
(Funding: NIHR School for Public Health Research)
This systematic review examined the factors that lead to successful implementation of health promotion programmes in schools. The authors reviewed a wide range of international theoretical papers, from policy documents to qualitative research and systematic reviews. Twenty-two of these sources informed the development of a framework of what helps or hinders implementation. Evidence from 41 UK evaluation studies of school health promotion programmes was used to test the framework. These evaluations used a range of comparative designs, including randomised controlled trials and ‘before and after’ studies. Primary and secondary schools were included. The interventions included family smoking, education, sexual health education, a healthy lifestyle programme and various physical activities. The review found some in-depth evidence about how to prepare for implementation, and about initial implementation. This included the need for negotiation about programme delivery with staff and parents, addressing its acceptability to those who will deliver it, and highlighting short-term gains to both teachers and pupils. Evidence about embedding programmes into routine practice and adapting them for specific needs was more limited.
Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB et al. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implementation Science 2015;10:149
Principal Investigator Katrina Wyatt
(Funding: PHR - 10/3010/01)
This randomised controlled trial tested the effectiveness of a school-based healthy lifestyles programme in preventing obesity in children. Participants were 1324 children in Year 5 (aged 9-10 years) at recruitment, from 32 Devon primary schools, 14 of which had more than 19% of pupils eligible for free school meals. The programme comprised engaging with schools, children and families in the spring term of Year 5, a healthy lifestyles week with drama and goal-setting in the summer term, and reinforcement activities, such as promoting self-monitoring, early in Year 6. Half the schools received the intervention, half continued as usual. The main outcome measure was body mass index at 24 months after baseline (12 months post-intervention). Secondary outcomes included waist circumference, percentage body fat, accelerometer-assessed physical activity and food intake. A very high follow-up of 94% after two years was achieved. Results showed no difference in body mass index between children in the intervention and control schools at 24 months. There was no difference in secondary outcomes, apart from intervention children reporting consuming fewer unhealthy snacks and less unhealthy food generally. The cost of implementing the intervention was approximately £210 per child. The intervention successfully engaged children, families and teachers across the socioeconomic spectrum, but did not prevent overweight or obesity. The authors concluded that school-based programmes targeting one age group are unlikely to affect weight.
Wyatt K, Lloyd J, Creanor S, Green C, Dean SG, Hillsdon M et al. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. Public Health Research 2018;6(1)
Principal Investigator Chris Bonell
(Funding: NIHR PHR - 09/3002/08)
This international review considered the effects of both primary and secondary school environments on student health, as distinct from curriculum-based health education. The main health topics included were violence, bullying, harassment, diet and physical activity. Three main aspects of the school environment were considered: management or school polices, catering services or vending machines, and sport or active transport. The researchers focused on schools’ organisation and management, teaching, pastoral care, discipline and physical environment, and analysed ten outcome evaluations in depth. Five examined interventions encouraging staff/students to build a stronger sense of community and/or better interpersonal relations. They generally reported benefits, such as to emotional health and aggression. Two evaluations assessed interventions modifying schools’ food/physical activity environments, and reported benefits for physical activity measures but not for diet. Three UK studies examined playground improvements and reported mixed findings on students’ physical activity. Process evaluations reported mainly positively on the feasibility and/or acceptability of interventions. Qualitative studies suggested that a lack of school safety, weak student/ staff relationships and lack of student participation in decisions may harm student health. The authors concluded that school environment interventions have the potential to promote student health, but the evidence is not clear-cut. They recommended conducting more trials that are welldesigned, and more research outside of the USA.
Bonell C, Jamal F, Harden A, Wells H, Parry W, Fletcher A. Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. Public Health Research 2013;1(1)
Principal Investigator Ben Barr
(Funding: NIHR School for Public Health Research Public Health Practice Evaluation Scheme)
This study investigated whether providing children with free swimming access during school holidays increased their participation in swimming, and considered associations with neighbourhood deprivation. Children were aged 5-15, living in Blackpool. Blackpool Borough Council had been providing free swimming for under 16s during summer holidays since the national free swimming scheme for children ended in 2010. The comparator was a similar local authority which had ended its free swimming offer to children in 2010. The outcome was the number of children swimming, and the number of swim attendances, per 100 population in 2014. The study found similar rates of swimming for those aged 16 and over in Blackpool and in the comparison local authority. It found that free summer holiday swimming was associated with an extra 6% of children swimming, and an additional 33 swims per 100 children per year. The effects were greatest in areas of moderate deprivation, and smaller in the least and most deprived areas. Even so, an additional 4% of children from the most deprived areas participated in swimming. Study limitations included using areabased rather than individual indicators of socioeconomic status. The authors concluded that providing free access to swimming facilities to children living in a deprived local authority can increase their swimming participation and may help promote physical activity.
Higgerson J, Halliday E, Ortiz-Nunez A, Barr B. The impact of free access to swimming pools on children’s participation in swimming. A comparative regression discontinuity study. Journal of Public Health 2018; fdy079.
Lead Author Maureen Dobbins
(Funding: Cochrane Health Promotion and Public Health Field, Australia & City of Hamilton Public Health Services, Canada)
This international systematic review explored the effectiveness of school-based interventions in promoting physical activity and fitness in children and teenagers. It included 44 randomised controlled trials involving children aged 6-18 (n= 36,593). Interventions varied, and lasted from 12 weeks to six years. All focused on health promotion, were implemented mainly in a school-setting (sometimes also in the community and home), and included all pupils. Primary outcomes included rates of, and time engaged in, moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes included physical health measures. The authors found some evidence of positive effects of school curriculum changes, often with printed educational material. Time spent in physical activity increased by between five and 45 minutes per day across studies (mainly self-reported). Television time reduced by between five and 60 minutes per day (self/parentreported), and there were improvements in one physical health measure (maximal oxygen uptake). There was limited evidence of a positive effect on physical activity rates in children, but not in adolescents. The authors’ conclusions were limited by the studies’ risk of bias, and the generally small size of effects.
Dobbins M, Husson H, DeCorby K, LaRocca RL. Schoolbased physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database of Systematic Reviews 2013;2:CD007651.
Principal Investigator Russ Jago
(Funding: NIHR PHR - 11/3050/01)
This cluster randomised controlled trial investigated the effectiveness of a dance-based intervention in increasing girls’ physical activity levels. Participants were girls aged 11-12 (n= 571), in Year 7, in Bristol secondary schools. Girls opted to sign up following a ‘taster’ dance session offered to all. Experienced instructors delivered two free 75-minute dance sessions after school each week, for 20 weeks. Nine schools received the intervention; nine control schools continued as normal. The main outcome was accelerometer-assessed average minutes of weekday moderate to physical activity, one year after study start. Secondary outcomes included physical activity levels immediately after the intervention, and psychosocial outcomes. Results showed no differences between the intervention and control groups for physical activity at either time point. Only one third of girls in the intervention group attended at least two thirds of available dance sessions, although girls reported enjoying them. Attendance declined over time. The intervention cost an average of £73 per girl. Physical activity levels at baseline were high, suggesting the intervention appealed to already active girls. The authors noted the difficulty in maintaining attendance in secondary-school physical activity programmes, and the need for new ways to encourage adolescent girls to be physically active.
Jago R, Edwards MJ, Sebire SJ, Bird EL, Tomkinson K, Kesten JM, et al. Bristol Girls Dance Project: a cluster randomised controlled trial of an after-school dance programme to increase physical activity among 11- to 12-year-old girls. Public Health Research 2016;4(6)
Principal Investigator Judith Green
(Funding: NIHR PHR - 09/3001/13)
This study evaluated the health impacts of London’s free bus and tram travel policy for young people. It included secondary analysis of routine travel survey data and road accident records, interviews and focus groups, and literature reviews. Participants were young people aged 12-17 and older people aged at least 60, from two outer and two inner London boroughs. Changes in outcomes before and after the intervention were compared for young people, and adults aged 25-59 years (i.e. a population ineligible for the free travel policy). Results showed an increase in bus travel of almost a third over the period, for both adults and young people, especially for short journeys. Qualitative data suggested the policy had contributed to bus travel becoming the ‘default’ mode for many journeys. There was no significant overall reduction in walking, but no evidence of a beneficial effect on physical exercise. There was a reduction in road traffic injuries for car occupants and cyclists, consistent with the reduction in car occupancy and cycling, but which may have been due to other interventions over the period. There was no evidence of an adverse impact on travel for older people. Interviews suggested a positive effect on young people’s well-being, including on sociability and feelings of belonging.
Green J, Steinbach R, Jones A, Edwards P, Kelly C, Nellthorp J et al. On the Buses: A mixed method evaluation of the impact of free bus travel for young people on the public health. Public Health Research 2014;2(1)
Principal Investigator Melanie J Davies
(Funding: NIHR PHR - 13/90/30)
This trial explored the effectiveness of the Girls Active intervention. It was a two-arm cluster randomised controlled trial, with interviews and focus groups alongside. Participants (n=1752) were girls aged between 11 and 14 years attending 20 state secondary schools in the Midlands, UK. At least 80 girls were randomly selected to take part from each school (around 30 from each year group). The intervention provides a support framework for schools to review and change their physical activity, physical education and school sport culture and practices. Lead teachers attend training, review their schools and create action plans. They identify and work with girls to become peer leaders, encouraging other girls to be more active. Half the schools received the intervention, half carried on with usual practice. The main outcome was change in accelerometer-measured moderate to vigorous physical activity level at 14 months, (available for 69% of participants). Results showed no overall impact of the intervention on physical activity levels at 14 months. Teachers and girls who became peer leaders viewed the intervention positively, but some pupils reported they had not fully understood it. Workload meant teachers did not implement everything they wanted to. The per pupil intervention cost ranged by school from £23 to £95.
Harrington DM, Davies MJ, Bodicoat D, Charles JM, Chudasama YV, Gorely T et al. A school-based intervention (‘Girls Active’) to increase physical activity levels among 11- to 14-year-old girls: cluster RCT. Public Health Research 2019;7(5)
Principal Investigator Chris Power
(Funding: Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.)
This study analysed influences from early adulthood on patterns of midlife leisure-time inactivity. It used information from participants of the 1958 British Birth Cohort who were living in Britain aged 50. Early adult factors, recorded at 23 and 33 years, included physical status, depression, education level, social, family and neighbourhood circumstances. The outcome was selfreported inactivity at 33 or 50 years (n=12,271). Leisuretime inactivity was defined as participating less than once a week in regular activity of mostly moderate or vigorous intensity, such as swimming or going for walks. The study found that between the ages 33-50 years, 51% of respondents were never inactive, 14% were persistently inactive and 35% changed their inactivity status (17% deteriorated to inactivity and 18% improved from inactivity). Two factors from young adulthood – obesity and neighbourhood lived in – had long-lasting associations with midlife inactivity patterns. Compared to those who were not obese at either 23 or 33 years, those who were obese at both ages had higher odds of persistent inactivity (74%) and inactivity deterioration (56%), and 38% lower odds of improvement. Compared to those living in suburbs, service centres, rural areas or seaside resorts, living in industrial / local authority housing areas was associated with higher odds of inactivity persistence (59%) and deterioration (30%), and 25% lower odds of improvement. The authors noted these findings can help identify groups likely to benefit from inactivity interventions, and highlight how, via inactivity, neighbourhood can potentially influence future health.
Pinto Pereira SM and Power C. Early adulthood determinants of mid-life leisure-time physical inactivity stability and change: Findings from a prospective birth cohort. Journal of Science and Medicine in Sport 2018 July;21(7):720-726. Published online 22 November 2017.
Principal Investigator Cindy M Gray
(Funding: NIHR PHR - 13/99/32)
This study investigated long-term outcomes of the Football Fans in Training programme. Participants were overweight or obese men aged 35-65, who had taken part in a 2011/12 trial (n=665), or later participated in a routinely delivered programme (n=511). The intervention comprised 12 free weekly group-based advice and physical activity sessions, delivered by coaches at professional Scottish football clubs. Sessions include dietary advice, self-monitoring, goal-setting and feedback, and coach-led physical activity. Mutual learning and support are encouraged. The trial group were compared with the routine delivery group. The primary outcome was long-term weight loss after 3.5 years.Trial intervention participants still weighed an average of 2.9kg less. Almost a third had kept off at least 5% of their starting weight, but around two thirds had not. Participants showed long-term improvements in body mass index, waist circumference, percentage body fat, blood pressure, selfreported physical activity, diet, self-esteem and well-being. At 3.5 years, men reported walking an extra 90 minutes per week more than at baseline. Routine programme participants showed similar long-term benefits, suggesting its effectiveness beyond research conditions. Men continued to self-monitor weight, physical activity and diet, and to engage with other participants and coaches. The authors recommended further research into achieving greater weight loss outcomes through the programme.
Gray CM, Wyke S, Zhang R, Anderson AS, Barry S, Brennan G, et al. Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study. Public Health Research 2018;6(9)
Principal Investigator Tom Yates
(Funding: NIHR CLAHRC for Leicestershire, Northamptonshire and Rutland & NIHR CLAHRC – East Midlands)
This trial investigated an intervention to promote and sustain increased walking activity. Participants (n=808) were from 10 general practices, scored highly on a Type 2 diabetes risk score, aged 18-74, and 36% female. Half the practices received the intervention, comprising a threehour group-based education session, goal setting, selfmonitoring via pedometer, annual refresher sessions, and brief telephone support. Control participants received an information booklet. The main outcome was accelerometerassessed steps/day at 12 months, and also at 24 and 36 months. Results found an increase of 411 steps/day at 12 months in the intervention group, compared with the control. Differences were not maintained at 36 months. The authors noted their pilot study had found a much larger effect of 2000 steps/day over 12 months, illustrating the difficulties of implementing physical activity interventions in routine primary care settings. They concluded that, since those with raised glucose levels at baseline appeared more successful in changing their behaviour at 12 months, testing glucose levels at the outset may help motivate people and improve success. Furthermore, 23% of intervention participants did not attend the initial group session, and tended to have worse health status indicators than those who did attend, suggesting more personalised approaches may help. A follow-on study will investigate further.
Yates T, Edwardson CL, Henson J, Gray LJ, Ashra NB, Troughton J et al. Walking Away from Type 2 diabetes: a cluster randomized controlled trial. Diabetic Medicine 2017;34(5):698-707. First published 02 September 2016.
Principal Investigator Fiona Campbell
(Funding: NIHR HTA - 13/45/01)
This review analysed the effectiveness of exercise referral schemes, in which health professionals refer patients to external exercise providers to increase their physical activity levels. It combined data from eight randomised controlled trials (n= 5190 adult participants) and from linked qualitative studies. Interventions involved in-person or telephone counselling, written materials, or supervised exercise training, for varying lengths of time. Comparators were: no intervention or brief advice (n=5), motivational counselling (n=1) or alternative schemes (n=2). The most common outcome was self-reported physical activity. The authors concluded that exercise referral schemes result in a small increase in self-reported physical activity. Referral did not lead to changes in objective measures of health such as weight or blood pressure. People without their own transport, or living in more deprived neighbourhoods, were less likely to take up a referral. People with a history of being more physically active, who received a referral due to their risk of coronary heart disease, or who were older, were more likely to increase their physical activity levels. The authors’ recommendations for future research included investigating which groups benefit more from the schemes, which aspects are most effective, and comparisons with a non-exercise intervention with a potential social benefit (such as choirs).
Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Woods H, Anokye N, et al. A systematic review and economic evaluation of exercise referral schemes in primary care: A short report. Health Technology Assessment 2015;19(60)
Principal Investigator Tess Harris
(Funding: NIHR HTA - 10/32/02)
This randomised controlled trial assessed the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention. The intervention used behaviour change techniques. The trial included 1,023 inactive adults (10% of those approached), aged 45 to 75, from London general practices. They were assigned, by household, to usual care, postal intervention, or nurse-support intervention. The postal group received a pedometer, diary and 12-week walking programme, advising them to gradually add ‘3000 steps in 30 minutes’ at least five days weekly. The nurse-support group received the same materials with three practice nurse consultations. The main outcomes, measured with accelerometers, were changes over 12 months in average daily step counts, and time in moderate to vigorous physical activity levels. Ninety three percent of participants provided outcome data at 12 months. On average, both interventions increased 12-month step counts by around one-tenth (660 extra steps per day), and time in moderate to vigorous physical activity by around one-third (34 extra minutes per week). The benefits persisted for at least three years. There were no differences in physical activity outcomes between the postal and nurse-supported groups, but the postal route was more cost-effective in both the short and long-term. Qualitative evaluations indicated that participants and nurses found the interventions acceptable and enjoyable. The authors suggested adopting ‘3000 steps in 30 minutes’ as a public health goal, and researching the integration of the 12-week programme into commonly used wearable devices.
Harris T, Kerry S, Victor C, Iliffe S, Ussher M, Fox-Rushby J, et al. A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT. Health Technology Assessment 2018;22(37)
Principal Investigator Louise Lafortune
(Funding: National Institute for Health and Care Excellence (NICE) & NIHR School for Public Health Research)
This systematic review examined barriers and facilitators to people at mid-life undertaking and maintaining healthy behaviours. It reviewed international evidence from 46 systematic reviews (19 focused on physical activity), 28 qualitative studies and 11 longitudinal cohort studies. The review included studies targeting adults in mid-life (40 to 64 years) and younger adults in disadvantaged or minority groups who are at higher risk of health inequalities. It identified evidence relating to the uptake and maintenance of physical activity, diet and nutrition, weight loss, smoking, alcohol, eye care and other health promoting behaviours. It excluded studies about participation in, or effectiveness of, specific interventions. Evidence quality ranged from low to high. Barriers to physical activity participation included existing physical ill-health, lack of time, neighbourhood safety, financial cost, lack of availability/access, lack of motivation, low self-belief and low socioeconomic status. Facilitators included focusing on improved wellbeing and self-esteem, health benefits in general, promoting healthy ageing, enjoyment of the activity, integrating physical activity into everyday life, focusing on short-term benefits, being a good role model and being supported by others. The authors concluded that this information could help tailor health interventions for people in mid-life.
Kelly S, Martin S, Kuhn I, Cowan A, Brayne C, Lafortune L. Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review. PLoS ONE 2016;11(1): e0145074.
Principal Investigator Emma Solomon-Moore
(Funding: NIHR CLAHRC & South West Peninsula and Economic and Social Research Council)
This trial evaluated whether a community-level physical activity intervention increased the activity levels of rural communities. 128 rural villages were randomly allocated to receive the intervention in one of four time periods from April 2011-December 2012, until all had received it. A postal survey was sent to samples of adults within the villages before study start, and following each intervention period; 10,412 adults completed the survey in total across these five data collection phases (response rate 32%). The intervention comprised 12 weeks of physical activity for all ages, with at least three subsidised activities and 12 months’ follow-up support. Before the intervention, delivery partners (including district authorities and charities) surveyed local people about their preferred activities. Activities were then tailored to each village and included children’s basketball, multi-sports sessions for adolescents and adult fitness classes. The main outcome was adults’ self-reported physical activity levels. Minutes spent in moderate-and-vigorous activity per week was a secondary outcome. Only 16% of participants reported awareness of the intervention programme, and just 4% participated in the activities. The intervention did not increase the chances of adults meeting the physical activity guideline, but there was weak evidence of an increase in minutes of moderate-and-vigorous activity. The authors concluded that the intervention’s ineffectiveness might have been due to its low uptake, and that future research could investigate achieving greater community engagement.
Solomon E, Rees T, Ukoumunne OC, Metcalf B and Hillsdon M. The Devon Active Villages Evaluation (DAVE) trial of a community-level physical activity intervention in rural south-west England: a stepped wedge cluster randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2014;11:94
Principal Investigator Ben Barr
(Funding: NIHR School for Public Health Research Public Health Practice Evaluation Scheme)
This study investigated the effect of removing charges from gyms and leisure centres on overall levels of physical activity. It analysed attendance data from nine leisure centres in Blackburn with Darwen, from 2005-2014, and used the Active People Survey to compare changes in physical activity in Blackburn with Darwen after the intervention, to change in national comparator areas. The re:fresh intervention,introduced in 2008, provided free access to swimming pools and gyms for people aged 16 and over. Free leisure was available to the whole population for 90% of the facilities’ opening hours overall. It included marketing, community engagement sessions, and individual and group behaviour change sessions for around 700 inactive people per year, delivered by five health trainers. Outcomes included attendance at swimming and gym sessions, and self-reported participation in gym, swim and any physical activity. Results found free leisure was associated with a 64% increase in attendances at swimming and gym sessions, and an extra 4% of local people participating in at least 30 minutes of moderate-intensity gym or swim sessions during the previous four weeks. An extra 2% of the population participated in any sport or active recreation of at least moderate intensity for at least 30 minutes on at least 12 days out of the last four weeks. These effects were significantly greater for the more disadvantaged socioeconomic group. The authors concluded with outreach and marketing activities, can increase overall population levels of physical activity while reducing inequalities.
Higgerson J, Halliday E, Ortiz-Nunez A, Brown R, Barr B. Impact of free access to leisure facilities and community outreach on inequalities in physical activity: a quasie-xperimental study. Journal of Epidemiology & Community Health 2018;72:252-258.
Principal Investigator Ruth Garside
(Funding: NIHR School for Public Health Research)
This study assessed the health and well-being impacts on adults who participated in environment and conservation activities. It systematically reviewed international quantitative and qualitative evidence. Participants were adult volunteers, or referred by a healthcare professional. The researchers identified 211 grey literature records and included 19 studies in their synthesis (n=3648 total participants): seven quantitative, nine qualitative, and three mixed methods. Most studies were internal programme evaluations, and most had fewer than 100 participants. There was no randomised controlled evidence. Activities included tree planting, making pathways and woodland management. Most of the quantitative studies found no effect on health and well-being. There was limited and mixed evidence of positive impacts on self-reported health and physical activity, and negative impacts including increased anxiety. Qualitative evidence suggested that participants enjoyed the social contact, especially if they were isolated or experiencing mental ill-health, and other positive experiences included feeling a sense of achievement, being outside and having a structured day. The researchers noted that the research was mainly of low quality, both in design and reporting, so they could not draw definitive conclusions. Future, more robust, research should investigate the effects of these activities, and their potential role in health promotion.
Husk K, Lovell R, Cooper C, Stahl-Timmins W, Garside R. Participation in environmental enhancement and conservation activities for health and well-being in adults: a review of quantitative and qualitative evidence. Cochrane Database of Systematic Reviews 2016; 5:CD010351.
Principal Investigator Aziz Sheikh
(Funding: NIHR HTA - 07/63/03)
This study considered the appropriateness and effectiveness of health promotion interventions for smoking cessation, increasing physical activity and improving healthy eating, for African-, Chinese- and South Asian-origin populations. It comprised launch and end-of-study conferences, analysis of guidelines and systematic reviews, a systematic review of adapted interventions, and interviews with researchers and health promoters. The authors identified 15 relevant UK guidelines and 111 international systematic reviews. Their search extended to community and wider interventions, but most research focused on individual-centred behavioural approaches. Overall evidence for physical activity and healthy-eating interventions in the general population was limited. The most consistent evidence of effectiveness was for medication for smoking cessation, but there was little evidence about ethnic minority populations. The authors reviewed 173 reports of adapted health promotion interventions, which informed their practical adaptation framework. Most studies focused on US-based African Americans. Only nine studies directly compared the effectiveness of culturally adapted with standard interventions, and evidence was inconsistent. Twenty-six interviews with researchers, and those delivering adapted health promotions, emphasised the need to consider contextual issues. The authors concluded that adapting interventions for ethnic minority communities should be considered. More research is required comparing standard and culturally adapted interventions, including UK-based studies.
Liu JJ, Davidson E, Bhopal R, White M, Johnson MRD, Netto G, Deverill M, Sheikh A. Adapting health promotion interventions to meet the needs of ethnic minority groups: mixed-methods evidence synthesis. Health Technology Assessment 2012;16(44)
Lead Author Nipin Shrestha
(Funding: Cochrane Work Review Group, NIHR CLAHRC West & Victoria university, Australia)
This systematic review explored the effectiveness of workplace interventions to reduce sitting at work. It included 34 studies, of which 26 were randomised controlled trials, and eight were controlled before-and-after studies. Participants (n= 3,397 in total) were employees from highincome countries. Interventions included physical workplace changes, workplace policy changes, information and counselling and multi-part interventions. Interventions were compared to no intervention or alternative interventions. The primary outcome was self-reported or objectively-measured time spent sitting at work per day. The authors found low quality evidence that sit-stand desks, either alone or combined with information and counselling, reduced sitting time at work compared to sit-desks. The average reduction was by 100 minutes per workday at up to three months follow-up, and by 57 minutes per day at 3-12 months follow-up. The effects of other interventions such as ‘active workstations’ (treadmill or cycling desks), walking during breaks, and information and counselling, were mostly inconsistent or there was insufficient evidence to draw conclusions. The authors found the quality of evidence was low to very low for most interventions. They concluded that larger trials with longer-term follow-up were needed.
Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Pedisic Z. Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews 2018;12:CD010912.
Principal Investigators Fehmidah Munir and Charlotte L Edwardson
(Funding: Loughborough University, Department of Health Policy Research Programme & NIHR Leicester Biomedical Research Centre)
This randomised controlled trial tested an intervention to reduce sitting time at work, building on an earlier Cochrane review (Shrestha, 2018). Participants (n=146) worked in 37 office groups within three NHS hospitals. The intervention included a group education session about the health consequences of sitting; a personalised action plan; provision of a sit-stand workstation; a sitting self-monitoring and prompt device; feedback on sitting and physical activity three times; and one-to-one brief coaching every three months. Intervention groups were compared with usual practice groups. The main outcome was accelerometer-measured sitting time at work. Secondary outcomes included daily sitting, standing time, physical activity, musculoskeletal problems and self-reported work-related and psychological health. Outcomes were assessed at three, six and twelve months. The intervention group showed reduced sitting at each time-point in comparison to the control group. The largest difference was at 12 months, when intervention participants were sitting at work for an average of 83 minutes less each day and standing more than the control group. There was no difference between groups in daily moderateto- vigorous activity or daily stepping time. The intervention group showed some improvement in work related and psychological health. A larger, longer-term trial is now testing the intervention further.
Edwardson CL, Yates T, Biddle SJH, Davies MJ, Dunstan DW, Esliger DW et al. Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial. BMJ 2018;363:k3870.
Principal Investigator Frank Kee
(Funding: NIHR PHR-12/211/82)
This trial evaluated the effectiveness of a loyalty scheme for increasing physical activity. Participants (n= 853) were healthy employees, aged 18-65, in nine public sector organisations in Northern Ireland. The loyalty card scheme enabled participants to earn points for minutes of physical activity, which converted into local retail vouchers. Sensors were placed within a 2 km radius of workplaces, and logged participants’ physical activity via keyfobs. Participants set goals and monitored themselves, and received personalised motivational emails, feedback and information. A waiting-list control group were able to participate following trial completion. The main outcome was pedometer-measured average steps per day after six months, also collected at 12 months. (54% of intervention and 60% of control participants provided data.) Secondary outcomes included self-reported workplace physical activity, health and wellbeing. Results found a significant reduction in average steps/day in the intervention group at 6 months, and no difference between groups at 12 months. Secondary outcomes were inconsistent; higher mental wellbeing scores for intervention participants were not matched by findings from the quality of life and mental health measures. The authors noted that early technological problems caused frustration, and significant organisational re-structuring may have limited the intervention. The trial highlighted implementation challenges.
Hunter RF, Murray JM, Gough A, Tang J, Patterson CC, French DP et al. Effectiveness and cost-effectiveness of a loyalty scheme for physical activity behaviour change maintenance: results from a cluster randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2018;15:127.
Principal Investigator Susan Baxter
(Funding: NIHR PHR – 12/133/20)
This systematic review assessed international evidence about the types, effectiveness and acceptability of interventions to increase physical activity in people around retirement age. Only one study specifically examined the transition to retirement, highlighting a clear evidence gap. The researchers broadened the search and examined 103 effectiveness studies in adults (mainly women) aged 49-75, alongside 55 qualitative papers. Interventions included training of healthcare professionals; counselling and advice giving; group and individual sessions; in-home programmes; and communitywide initiatives. Most studies compared several interventions. They measured a range of outcomes, reflecting inconsistency in the aims of physical activity interventions. Outcomes were mostly self-reported and included activity levels, fitness levels and psychosocial elements. Only two studies assessed sedentary behaviour. Most studies reported positive outcomes. Although older adults felt that enjoyment and socialising were important aspects of activity programmes, few interventions focused on this. Given the lack of evidence, the authors could not recommend specific interventions for people of retirement age, but concluded that a range of interventions may be effective, including group and individual sessions. Including a social element, being free or low cost, and meeting individual preferences, may increase the effectiveness of interventions. Future studies should evaluate effectiveness using robust, objective measures.
Baxter S, Blank L, Johnson M, Everson-Hock E, Woods HB, Goyder E, et al. Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis. Public Health Research 2016;4(4)
Principal Investigator Louise Lafortune
(Funding: NIHR School for Public Health Research & CLAHRC - East of England)
This review of 40 international systematic reviews explored the effectiveness of physical activity for prevention of cognitive decline (n=14 reviews), interventions to increase and maintain physical activity levels (n=17 reviews), and barriers and facilitators to physical activity (n=9 reviews), for people aged over 55. The quality of evidence ranged from low to high. Interventions varied widely; details of intensity or duration were missing in half the reviews. No reviews reported outcomes of reduced incidence of dementia; outcomes related to short-term improvement in cognitive function. The authors found small positive effects of physical exercise on cognition amongst older people with normal cognition or mild cognitive impairment, but no conclusive evidence about the best type of exercise. A variety of interventions were effective for increasing older people’s short-term uptake of physical activity, including behavioural (walking and exercise) and cognitive (education and motivational interviewing). Few studies included long-term follow-up. Barriers to older people’s uptake and maintenance of physical activity included: health status, previous habits and experiences, low self-belief, time, access, cost, and environmental safety. Facilitators included: enjoyment, personal challenge, support, communication, information, access and convenience. Recommendations for future research included exploring the duration and intensity of physical activity required to produce effects, and long-term maintenance of physical activity.
Olanrewaju O, Kelly S, Cowan A, Brayne C, Lafortune L. Physical Activity in Community Dwelling Older People: A Systematic Review of Reviews of Interventions and Context. PLoS ONE 2016;11(12):e0168614.
Principal Investigator Steve Iliffe
(Funding: NIHR HTA - 06/36/04)
This trial compared a class-based and a home-based exercise programme with usual care. Participants were aged 65 or over (n=1256), from 43 general practices. The home-based programme involved 30 minutes of leg strengthening and balance exercises at least three times weekly, and encouraged two 30-minute walks per week. Peer mentors, where available, provided up to five home visits and 12 telephone contacts. The community class-based programme comprised weekly hour-long classes with a postural stability instructor, plus two 30-minute home exercise sessions, and encouraged two 30-minute walks per week. Both interventions lasted for 24 weeks. The primary outcome was self-reported physical activity 12 months after programme-end. Secondary outcomes included balance confidence, number of falls, and quality of life. Results showed an absolute increase of 14% more participants in the class-based exercise group reached the recommended level of 150 minutes of moderate to vigorous physical activity per week, compared to those receiving usual care. Participants added 13-15 minutes per day to their baseline physical activity level. The classbased group also experienced a reduction in falls. Both intervention groups showed improved balance confidence, but otherwise the home-based exercise group showed no significant difference to those experiencing usual care. Neither intervention made a significant difference to quality of life. The class-based programme cost £269 per participant in London (£218 in Nottingham).
Iliffe S, Kendrick D, Morris R, Masud T, Gage H, Skelton D et al. Multi-centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care. Health Technology Assessment 2014;18(49)
Principal Investigator Denise Kendrick
(Funding: NIHR School for Primary Care Research)
This cohort study examined factors associated with maintaining physical activity after completing an exercise programme within the trial described in Study 26. Participants were aged 65 or over, had received the classbased intervention, home-based intervention or usual care, and provided follow-up physical activity data at least once (n=731). Participants were mainly female, white, with a high level of education and higher socio-economic status, limiting the generalisability of the findings. After the interventions, participants received information about local exercise opportunities. Self-reported moderate to vigorous physical activity levels, and factors potentially associated with physical activity, were recorded at recruitment, 6, 12, 18 and 24 months after the exercise programme. The authors found that older people and women were less likely to achieve target physical activity levels. Those already physically active when recruited, with greater lower limb strength, and with wider social networks, were more likely to achieve the target. These effects persisted across the follow-up period. The strongest association with physical activity maintenance was physical activity at recruitment. The authors recommended that maintenance programmes should target those least likely to maintain physical activity, including older women, those with narrower social networks and those with poorer lower limb strength.
Kendrick D, Orton E, Lafond N, Audsley S, Maula A, Morris R et al. Keeping active: maintenance of physical activity after exercise programmes for older adults. Public Health 2018 Nov;164:118-127.
Principal Investigator David Ogilvie
(Funding: NIHR PHR - 09/3001/06)
This study assessed how a new bus network and pedestrian/cycle path affected people’s travel to work, and associated impacts on health. Researchers analysed a cohort of users from 2009 (n=1143) to 2012 (n=470), conducting annual surveys and detailed quantitative studies of activity patterns using travel diaries, accelerometers, body sensors and global positioning system receivers. They surveyed busway users (n= 1710), and conducted over 120 semi-structured interviews with cohort and survey participants. Cohort participants were adults living within 30km of Cambridge city centre and working in the city. The busway opened in 2011, comprising 22km of dedicated bus lane plus an off-road path for pedestrians and cyclists. Researchers compared participants by distance lived from the busway. The main outcome was time spent in active commuting (self-reported and objectively confirmed). Many factors affected commuting decisions, including childcare and parking. People often combined walking and cycling with longer bus or car journeys. Overall, those living closer to the busway were more likely to have increased their active commuting time, reduced the number of car-only trips, and increased their weekly cycle commuting time. Those who spent more time actively commuting were more likely to show higher accelerometer-recorded levels of overall physical activity, and report higher levels of physical well-being.
Ogilvie D, Panter J, Guell C, Jones A, Mackett R, Griffin S. Health impacts of the Cambridgeshire Guided Busway: a natural experimental study. Public Health Research 2016;4(1)
Principal Investigator David Ogilvie
(Funding: NIHR PHR - 11/3005/07)
This study assessed the health effects of a new urban motorway on local communities. The study repeatedly surveyed adults recruited in 2005 (n=1345) and 2013 (n=1343). Of these, 365 participants provided data at baseline and follow-up. 196 survey participants used accelerometers and global positioning system receivers to measure physical activity. Researchers conducted interviews and analysed national road traffic accident and travel behaviour data. Motorway intervention area participants were compared with those in two matched control areas: one near an existing motorway, and one with no major road infrastructure. The main outcome measures were differences in self-reported travel behaviour, physical activity and well-being, and in the number of road traffic accidents. The researchers identified both benefits and harms. People living closer to the new motorway experienced significantly reduced mental well-being over time compared with those living further away. There was an increase in travel generally (particularly car use), no overall change in active travel or accidents, and weak evidence of reduced physical activity participation. Qualitative evidence suggested the new motorway helped connect people with dispersed social networks and car access, but cut off others from local people and places. The researchers concluded that large urban infrastructure projects can increase inequalities and reduce health outcomes in already disadvantaged communities.
Ogilvie D, Foley L, Nimegeer A, Olsen JR, Mitchell R, Thomson H, et al. Health impacts of the M74 urban motorway extension: a mixed-method natural experimental study. Public Health Research 2017;5(3).
Principal Investigator Steven Cummins
(Funding: NIHR PHR - 09/3005/09)
This study assessed how the London 2012 Olympic and Paralympic Games affected the physical activity and mental health and well-being of local residents. Participants were adolescents (n=2254) aged 11-12 years at baseline, and a sample of their parents/carers. The Olympic Park was redeveloped for ongoing public use. Residents in the intervention area were compared with those living in nearby Boroughs but not receiving urban regeneration on the same scale. The main outcome measures were change in self-reported physical activity, self-reported depression and anxiety, and well-being score. Data were collected before the intervention and at six and 18 months afterwards. At six months, adolescents who became inactive were less likely to come from the intervention borough. At 18 months, there were no significant differences between intervention and comparison boroughs for all adolescent physical activity. No impacts on parent/carer physical activity were observed. Over time, people’s mental health or well-being did not improve. Interviews found that residents generally welcomed their cleaner, safer and more ‘unified’ living environment. The authors concluded that the Games generated a sense of social inclusion and relief from everyday stressors, even if only temporarily. The most strongly expressed local need was for housing, which was not part of the intervention. Limitations included reductions in central and local public spending at the time.
Cummins S, Clark C, Lewis D, Smith N, Thompson C, Smuk M et al. The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment. Public Health Research 2018;6(12)
Study A: Startwell: a service evaluation of nutritional and physical activity training for early years staff
Principal Investigator or Lead Author: Kate Jolly
Study B: NAP SACC UK: A feasibility cluster randomised controlled trial in child care settings to increase physical activity and healthy eating in 2-4 year olds
Principal Investigator or Lead Author: Ruth Kipping
Study C: CLASS PAL Study
Principal Investigator or Lead Author: Lauren Sherar
Study D: The impact of a family-based physical activity promotion programme on child physical activity: feasibility and pilot of the Families Reporting Every Step to Health (FRESH) intervention
Principal Investigator or Lead Author: Esther Van Sluijs
Study E: Stand Out in Class: Restructuring the classroom environment to reduce sedentary behaviour - a pilot cluster randomised controlled trial
Principal Investigator or Lead Author: Stacey Clemes
Study F: Action 3:30: A cluster randomised feasibility study evaluation of a teaching assistant led, extracurricular physical activity intervention for 8 to 10 year olds
Principal Investigator or Lead Author: Russ Jago
Study G: Engaging adolescents in changing behaviour (EACh-B): a programme of research to improve the diets and physical activity levels of teenagers
Principal Investigator or Lead Author: Mary Barker
Study H: Understanding the sustainable processes and impact of engaging young people in a peer-led dance group, the TR14ers
Principal Investigator or Lead Author: Katrina Wyatt
Study I: A cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the GoActive programme to increase physical activity among 13-14 year-old adolescents
Principal Investigator or Lead Author: Kirsten Corder
Study J: A cluster randomised controlled trial of a Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A)
Principal Investigator or Lead Author: Russ Jago
Study K: The Yoga Study
Principal Investigator or Lead Author: Tom Yates
Study L: Delivering a realistic Diabetes Prevention Programme in a UK community
Principal Investigator or Lead Author: Mike Sampson
Study M: Active buildings: modelling physical activity and movement in office buildings. An observational study protocol
Principal Investigator or Lead Author: Lee Smith
Study N: Impact of sit-stand desks at work on energy expenditure, sitting time and cardio-metabolic risk factors: Multiphase feasibility study with randomised controlled component
Principal Investigator or Lead Author: Eleni Mantzari
Study O: UP FOR 5
Principal Investigator or Lead Author: Charlotte Edwardson
Study P: Stand Up For Health: A Feasibility Cluster Randomised Controlled Trial (RCT) Of A Theory Based Intervention To Reduce Sedentary Behaviour In Contact Centres
Principal Investigator or Lead Author: Ruth Jepson
Study Q: A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMART Work & Life intervention for reducing daily sitting time in office workers
Principal Investigator or Lead Author: Charlotte Edwardson
Study R: The effectiveness and cost effectiveness of an employer-led intervention to increase walking during the daily commute: Cluster randomised controlled trial
Principal Investigator or Lead Author: Suzanne Audrey
Study S: A cluster randomised controlled trial to investigate the effectiveness and cost-effectiveness of a Structured Health Intervention For Truckers (The SHIFT Study)
Principal Investigator or Lead Author: Stacey Clemes
Study T: A randomised controlled trial and economic evaluation of a communitybased physical activity intervention to prevent mobility-related disability for retired older people. The REACT (REtirement in ACTion) study
Principal Investigator or Lead Author: Afroditi Stathi
Study U: A feasibility study and pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults: Walk With Me Study
Principal Investigator or Lead Author: Mark Tully
Study V: Chair based exercise in community settings: a cluster randomised feasibility study
Principal Investigator or Lead Author: Tahir Masud
Study W: A pilot study of a peer volunteering intervention for promoting active ageing in the community: Project ACE
Principal Investigator or Lead Author: Afroditi Stathi
Study X: The long-term health and wellbeing impacts of Healthy New Towns: a six-month feasibility study of Healthy New Town demonstrator sites in England
Principal Investigator or Lead Author: Angela Harden
Study Y: Does active design increase walking and cycling? Evaluation of a natural experiment examining whether moving into housing in East Village increases family levels of physical activity, particularly walking and cycling.
Principal Investigator or Lead Author: Christopher Owen
Investigating how the design of cities can reduce the risk of type 2 diabetes
Principal Investigator or Lead Author: Christopher Owen
Study Z: Is 20 plenty for health? Evaluation of the 20mph speed limit networks in Edinburgh and Belfast on a range of public health outcomes
Principal Investigator or Lead Author: Ruth Jepson
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Available from: https://europepmc.org/grantfinder/results?gid=RP-PG-0216-20004&page=1
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This report was written by Duncan Fortescue-Webb with Tansy Evans, Katharine Hanss and Tara Lamont of the NIHR Dissemination Centre.
Expert input was provided by a steering group consisting of:
Hannah Behrendt – Senior Advisor, Behavioural Insights Team, Cabinet Office
Michael Brannan – National Lead for Physical Activity, Public Health England
Angel Chater – Deputy Director, Institute for Sport and Physical Activity Research & Chair, Behavioural Science and Public Health Network
Allison Coles - Research, Insight and Projects Manager, British Cycling
Andy Cope – Director of Insight, Sustrans
Michael Dooley – Previous Director of Sports Medicine and Science to the British Equestrian Team & Medical Director of The Poundbury Clinic
Deborah Hardoon – Head of Evidence, What Works Wellbeing
Philip Insall – Public Contributor
Andrew Morrison – Deputy Director, Local Transport, Local and Regional Transport Analysis, Department for Transport
Vincent Paliczka – Hon. Treasurer, Chief Cultural & Leisure Officers Association & Director of Environment, Culture and Communities, Bracknell Forest Council
Sarah Ruane – Strategic Lead for Health, Sport England
Russ Jago – Professor of Paediatric Physical Activity & Public Health, University of Bristol
Rupert Suckling – Director of Public Health, Doncaster Council
James Steele – Associate Professor of Sports and Exercise Science, Southampton Solent University & Principal Investigator, ukactive
Julia Thrift – Projects & Operations Director, Town & Country Planning Association
Helen Walters – Public Health Consultant Advisor, National Institute for Health Research
Tom Yates – Professor of Physical Activity, Sedentary Behaviour and Health, University of Leicester