It’s not news that exercise is good for us, but exercise and health have grabbed the headlines again this week with the publication of new research in the BMJ which, according to the BBC, finds ‘exercise can be as good as pills’. For a nice summary of this research and a reminder that actually the data was patchy and the researchers warn that the findings should be interpreted with caution, read this blog by the Lifestyle Elf. Patchy data notwithstanding, we can agree that exercise is a Good Thing, but how can we get people to do it? Most adults are not active at the recommended level. A team at the Cochrane Heart Group has been busy pulling together the research on whether face-to-face interventions and remote and web 2.0 interventions can help promote physical activity (PA) and how they compare with each other and the results have just been published in three new reviews.The evidence base for both face-to-face methods of encouraging adults to increase their levels of physical activity and harnessing new media technologies for this purpose is growing, but there are gaps. Their ability to achieve long term change, in particular, is unknown. What’s more, it is now important to have a better understanding of how they compare to each other. With this in mind, three complementary Cochrane reviews have been prepared.
Face-to-face interventions: can these get adults exercising?
These continue to be popular, but how effective are they? The review considering this included ten randomized controlled trials (RCTs) comparing face-to-face PA interventions with a control group who had a minimal or no intervention. The participants were 6292 apparently healthy adults in high income countries; most were white, well-educated and middle aged. The effectiveness of interventions was measured by self-reported physical activity after a year.
The evidence was moderate quality and there was a lot of variation between studies and results, so the conclusions drawn are rather tentative. While benefits in terms of PA were seen at one year, this was no longer so at the end of two years in the three studies which followed participants for that long. There is some indication that the most effective interventions were those that offered both individual and group support for changing PA, using a tailored approach. Just one study looked at adverse effects and found no difference between groups.
How about remote and web 2.0 interventions?
These interventions can be delivered via the internet or smartphones, more traditional routes such as telephone or mail-outs, or both. Web 2.0 interventions have been categorized as more interactive methods that encourage a higher level of user involvement than web 1.0 internet programmes. Delivered to groups or individuals, they typically involve sending tailored messages via email or short message service (SMS), which could include goal-setting, motivational messages and feedback on current PA levels against recommendations. They are increasingly popular, as we might expect, but do they work? This review was able to include 11 RCTs with 5862 healthy adults, again in high income countries.
These interventions had positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at a year and this comes from moderate to high quality studies. They didn’t increase the risk of exercise-related injuries. The most effective interventions used a tailored approach and included telephone contact to give feedback and support changes. What’s lacking is cost-effectiveness data and studies including people from varying socioeconomic or ethnic groups.
Face-to-face or remote and web 2.0: head to head
So both these approaches sound promising and it would be useful to know how they compare. Regrettably, we still don’t. The review looking for trials comparing the two found only one small study to include, looking at fitness, which found no difference between the two approaches. We need rather more than this one trial to draw any conclusions about their relative effectiveness.
Filling the gaps
The authors are clear about the gaps and what future research needs to address, not least satisfying basic quality criteria such as having an appropriate control group. Follow-up should be at least a year and preferably two. They suggest how well people complied with the intervention should be assessed and stress the importance of evaluating the effect of the interventions on people from different backgrounds and gathering data on costs, quality of life and adverse effects. There is also a need to know which elements of the interventions are most effective.
Clearly there is much to do, but it sounds as though these interventions are worth pursuing and properly evaluating. Certainly the end point of increasing our physical activity is one that is high on the NHS agenda and one which we, as individuals, ignore at our peril.
Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577.
Roberts M. Exercise can be as good as pills [Internet]. BBC News online: health; 2013 October 2 (cited 2013 Oct 3).
The Lifestyle Elf. Systematic review highlights the dearth of evidence on exercise in reducing mortality [Internet]. 2013 October 2.
Richards J, Hillsdon M, Thorogood M, Foster C. Face-to-face interventions for promoting physical activity. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD010392. DOI: 10.1002/14651858.CD010392.pub2.
Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD010395. DOI: 10.1002/14651858.CD010395.pub2.
Richards J, Thorogood M, Hillsdon M, Foster C. Face-to-face versus remote and web 2.0 interventions for promoting physical activity. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD010393. DOI: 10.1002/14651858.CD010393.pub2