Community wide interventions for increasing physical activity
Community wide interventions for increasing physical activity
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社区范围内增加身体活动的干预措施
DOI：
10.1590/s1516-31802011000600013
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
V. Trevisani
中科院分区：
文献类型：
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作者：
P. Baker;D. Francis;J. Soares;A. Weightman;C. Foster;V. Trevisani
背景：多策略社区范围的身体活动干预措施越来越受欢迎，但其实现人群水平改善的能力尚不清楚。目的：评价社区范围内多策略干预对人群身体活动水平的影响。检索策略：我们检索了Cochrane公共卫生组专业注册、Cochrane图书馆、MEDLINE、MEDLINE in Process、EMBASE、CINAHL、LILACS、PsycINFO、ASSIA、英国护理索引、中国知网数据库、EPPI中心（DoPHER、TRoPHI）、ERIC、HMIC、社会学文摘、SPORT Discus、Transport数据库和Web of Science（科学引文索引、社会科学引文索引、会议论文集引文索引）。我们还浏览了欧盟饮食、身体活动与健康平台、Health- evidence .ca、国际健康促进和教育联盟；国家卫生研究院卫生技术协调中心（NCCHTA）以及NICE和SIGN指南。对所有相关系统评价、指南和初步研究的参考文献进行了跟踪。我们联系了牛津大学国家肥胖观察中心的专家；昆士兰卫生部、昆士兰科技大学、中昆士兰大学；田纳西大学和华盛顿大学；并手工检索了六份相关期刊。这些搜索最后一次更新到2009年11月底，不受语言或出版状态的限制。选择标准：包括聚类随机对照试验、随机对照试验（RCT）、使用对照人群进行比较的准实验设计、中断时间序列研究（ITS）和前瞻性对照队列研究（PCCS）。仅包括从干预开始到测量结果至少随访6个月的研究。社区范围的干预措施必须包括至少两项针对全体人口身体活动的广泛战略。排除了来自同一社区的随机个体的研究。数据收集和分析：至少有两名综述作者独立提取数据并评估每项纳入研究的偏倚风险。非英语文件在流行病学家口译员的协助下进行了审查。对每项研究的设置、纳入成分的数量及其强度进行评估。结果测量根据是否分为两类（身体活动，闲暇时间身体活动，久坐或不活动）或连续（闲暇时间身体活动，步行，能量消耗）进行分组。对于二分法，我们计算了未调整和调整的风险差异，以及未调整和调整的相对风险。对于连续测量，我们计算了从基线的净百分比变化，未调整和调整的风险差异，以及未调整和调整的相对风险。主要结果：选择过程完成后，纳入了25项研究。在纳入的研究中，19项是在高收入国家进行的，使用的是世界银行的经济分类，其余6项是在低收入国家进行的。干预措施因所包括策略的数量及其强度而异。几乎所有的干预措施都包括与地方政府或非政府组织建立伙伴关系（22项研究）。没有一项研究提供社会经济劣势或其他公平考虑指标的结果。然而，在那些在高收入国家进行的研究中，有11项研究被作者描述为提供给贫困、弱势或低社会经济社区。15项研究被确定为具有高偏倚风险，10项研究不清楚，没有研究具有低偏倚风险。选择偏差是这些研究的主要问题，只有一项研究使用随机化来分配社区（Simon 2008）。尽管有16项研究被认为存在不明确的偏倚风险，但没有研究被判定为具有低选择偏倚风险。11项研究存在较高的检测偏倚风险，10项风险不明确，4项无风险。检测偏倚的评估包括评估测量工具的有效性和结果测量的质量。报告的影响在研究和测量中是不一致的。一些设计较好的研究显示，在体力活动方面没有任何改善。发表偏倚是明显的。作者的结论：尽管已经进行了大量的研究，但现有研究的结果存在明显的不一致，这与纳入研究的严重方法学问题相混淆。本综述的大量证据并不支持多组分社区干预有效提高人群身体活动水平的假设。显然需要精心设计的干预研究，此类研究应侧重于身体活动测量的质量、测量的频率以及对干预和控制社区的分配。
ABSTRACT BACKGROUND: Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown. OBJECTIVES: To evaluate the effects of community-wide, multi-strategic interventions upon population levels of physical activity. SEARCH STRATEGY: We searched the Cochrane Public Health Group Specialized Register, The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, The British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORT Discus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platformon Diet, Physical Activity and Health;Health-Evidence.ca; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were followed up. We contacted experts in the field from the National Obesity Observatory Oxford, Oxford University; Queensland Health, Queensland University of Technology, the University of Central Queensland; the University of Tennessee and Washington University; and hand-searched six relevant journals. The searches were last updated to the end of November 2009 and were not restricted by language or publication status. SELECTION CRITERIA: Cluster randomized controlled trials, randomized controlled trials (RCT), quasi-experimental designs which used a control population for comparison, interrupted time-series (ITS) studies, and prospective controlled cohort studies (PCCS) were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community-wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomized individuals from the same community were excluded. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted the data and assessed the risk of bias of each included study. Non-English language papers were reviewed with the assistance of an epidemiologist interpreter. Each study was assessed for the setting, the number of included components and their intensity. Outcome measures were grouped according to whether they were dichotomous (physically active, physically active during leisure time and sedentary or physically inactive) or continuous (leisure time physical activity, walking, energy expenditure). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated net percentage change from baseline, unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. MAIN RESULTS: After the selection process had been completed 25 studies were included in the review. Of the included studies, 19 were set in high income countries, using the World Bank economic classification, and the remaining six were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organizations (NGOs) (22 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity consideration. However of those included studies undertaken in high income countries, 11 studies were described by the authors as being provided to deprived, disadvantaged, or low socio-economic communities. Fifteen studies were identified as having a high risk of bias, 10 studies were unclear, and no studies had a low risk of bias. Selection bias was a major concern with these studies, with only one study using randomization to allocate communities (Simon 2008). No studies were judged as being at low risk of selection bias although 16 studies were considered to have an unclear risk of bias. Eleven studies had a high risk of detection bias, 10 with an unclear risk and four with no risk. Assessment of detection bias included an assessment of the validity of the measurement tools and quality of outcome measures. The effects reported were inconsistent across the studies and the measures. Some of the better designed studies showed no improvement in measures of physical activity. Publication bias was evident. AUTHORS’ CONCLUSIONS: Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings of the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that multi-component community wide interventions effectively increase population levels of physical activity. There is a clear need for well-designed intervention studies and such studies should focus on the quality of the measurement of physical activity, the frequency of measurement and the allocation to intervention and control communities.
DOI：
10.1146/annurev.resource.012809.103957
发表时间：
2011-01-01
期刊：
ANNUAL REVIEW OF RESOURCE ECONOMICS, VOL 3
影响因子：
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作者：
Kiesel, Kristin;McCluskey, Jill J.;Villas-Boas, Sofia B.
通讯作者：
Villas-Boas, Sofia B.