Health Evidence hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on community-wide interventions for increasing physical activity. Key messages and implications for practice were presented on Wednesday January 30, 2013 at 1:00 pm EST. This webinar focused on interpreting the evidence in the following review: Baker, P., Francis, D., Soares, J., Weightman, A., Foster, C. Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews, 2011(4): Art. No.: CD008366. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Philip Baker, the first author of this review.

1. This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Community-wide
Interventions for
Increasing Physical
Activity:
What’s the evidence?
You will be placed on hold until the webinar begins.
The webinar will begin shortly, please remain on the line.

2. What’s the evidence?
 Baker, P.R.A., Francis, D.P., Soares, J.,
Weightman, A.L. & Foster, C. (2011).
Community wide interventions for increasing
physical activity. Cochrane Database of Systematic
Reviews, Issue 4. Art. No.:CD008366. DOI:
10.1002/14651858.CD008366.pub2.
 http://www.health-evidence.ca/articles/show/21588

3. Participant Side Panel
Housekeeping
in WebEx
 Use Q&A to post comments/questions
during the webinar
 ‘Send’ questions to All
(not privately to ‘Host’)
 Connection issues
 Recommend using a wired Internet
connection (vs. wireless), to help Q&A
prevent connection challenges
 WebEx 24/7 help line: 1-866-229-3239

4. This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Community-wide
Interventions for
Increasing Physical
Activity:
What’s the evidence?

5. The Health Evidence Team
Kara DeCorby Heather Husson Jennifer Yost
Managing Director Project Manager Guest Presenter
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori Greco Robyn Traynor Lyndsey McRae
Knowledge Broker Research Coordinator Research Assistant

6. What is www.health-evidence.ca?
Evidence
inform
Decision Making

7. Why use www.health-evidence.ca?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EIDM available
5. Easy to use

8. Knowledge Translation
Supplement Project
CIHR-funded KTB-112487

9. Philip Baker
Professor of Epidemiology, School
of Public Health and Social
Work, Queensland University
of Technology, Brisbane
Australia

10. Review
 Baker, P.R.A., Francis, D.P., Soares, J., Weightman, A.L.
& Foster, C. (2011). Community wide interventions for
increasing physical activity. Cochrane Database of
Systematic Reviews, Issue 4. Art. No.:CD008366. DOI:
10.1002/14651858.CD008366.pub2.

11. Authors and affiliations
 Professor Dr Philip Baker – QUT
 Daniel Francis – Queensland Health /
QUT
 Prof Alison Weightman – Cardiff
University, Wales
 Dr Charlie Foster – Oxford University,
UK
 Dr Jesus Soares – CDC, USA

12. Questions?

13. Summary Statement:
Baker(2011)
 P General population, i.e. communities.
 I Community wide, multi-strategic interventions
with at least two strategies aimed at promoting
physical activity.
 C Usual practice.
 O Population levels of physical activity.
Quality Rating: 9 (strong)

14. Included intervention s:
Multi-strategic interventions that aim to reach the whole
community, which must have included at least 2 of a
possible 6 components:
 social marketing;
 other communication strategies;
 individual counselling by health practitioners;
 partnerships with government or non-government
groups;
 working in specific settings; and
 environmental change strategies.

15. Overall Considerations
 Insufficient evidence, most included studies at high risk
of bias. Serious issues in the design affecting their
trustworthiness
 There may be efficacious approaches
 Different interventions seemed to reach different
segments of the population.
 Some studies showed positive effect, others decreased
or no effect
 High intensity interventions did not necessary result in
more effective interventions

16. General Implications
Public health should promote/support/implement:
 Can not assume combining interventions will yield a
measurable health outcome.
 Should not group label “evidence-based”.
 There is a need for more robust studies to investigate
community wide interventions. Need to measure PA
accurately, continuous measures best.
 New studies should be rigorously designed and
analysed and should include process evaluations
 Consider individual components e.g. School-based

17. General implications
 Robust, continuous measurement
better
 Might be promise in the environmental
strategies
 long term perspective
 Reaching whole community difficult

18. Public health should consider that…
 Interpretation limited by the included studies
 many at high risk of bias
 Selection bias- e.g. “purposely” different communities, “head
start”
 Detection –poor outcome measurement, low response rate
 Reporting bias – outcomes measured – but missing

19. What’s the evidence?
Outcomes reported in the review
 Dichotomous outcomes
 % Physical activity
 % Not sedentary
 % Leisure time physical activity
 Continuous outcomes
 Time physically active
 Walking
 METs (energy expenditure)

20. What the review found
 There was much variation in interventions, population and
outcomes.
 The results of the studies themselves were inconsistent,
making it especially difficult to identify the key, reliable
findings.
 Few studies reported a substantial or sustained increase in
physical activity
 There was no evidence that more intense interventions
worked better then others.

21. What the review found
Countries of origin
USA 8 Demark 1
China 4 Finland 1
Australia 2 France 1
Netherlands 2 Iran 1
Norway 2 Pakistan 1
Canada 1
Belgium 1

22. What the review found
included strategies
 Building partnership (22 studies)
 Some form of counselling (18)
 Mass media (15)
 Other communication (18)
 Specific settings (11)
 Environmental change strategies (10)

23. Dichotomous outcomes –
Physical activity
2.5
Favours intervention
2
1.5
1
Favours control
0.5
0
Wendel-Vos Reger-Nash Brown 2006 Lupton 2003 Sarrafzadegan Kloek 2006 NSW Health Jiang 2008
2009 2005 2009 2002

24. Dichotomous outcomes –
Physical activity during leisure time
1.4
Favours intervention
1.3
1.2
1.1
1
Favours control
0.9
0.8
0.7
0.6
Nishtar 2007 Kumpusalo 1996 Luepker 1994a Luepker 1994b

25. Dichotomous outcomes –
Sedentary or physically inactive
3
2
Favours control
1
Favours intervention
0
Jenum 2006 Nafziger 2001 Osler 1993 Goodman

26. Continuous outcomes
 7 included studies
 3 showing some evidence (DeCocker
2007 (women), Simon 2008, Wendel-
Vos 2009
 Measured a against background
decreasing PA levels
 Continuous measures more useful

27. Continuous measures –
Leisure time spent in PA
Study Measure Subgroups Post-mean Adjusted Adjusted %
(labelled) difference mean change
difference relative to
the control
mean
Wendel-Vos Leisure time Men -0.2 -0.4 -2.06
2009
PA
(hours/wk)
Women -0.7 2.2 14.01
(P<0.5)
DeCocker 2008 Leisure time Leisure time 0 32 25.60
PA PA (P<0.05)
(min/week)
Simon 2008 Supervised Children 0.9 1.1 43.14
leisure time only (P<0.0001)
PA measured

28. Continuous outcomes
walking
Study Measure Sub-groups Post mean Adjusted Adjusted %
(labelled) difference mean change
difference relative to
the control
mean
Wendel-Vos Walking Men 1.8 1.1 15.94 NS
2009 (hours/week)
Women 1.8 2.0 29.41 NS
DeCocker Walking Walking 34 47 17.34
2007 (min/week) (P<0.05)
Brownson Walking N/A -0.8 5.2 4.75 NS
2005 (mean
min/week)
Brownson 7 day total N/A -5.3 -1.4 -1.38 NS
2004 walking
(mean

29. Continuous outcomes –
Energy expenditure METs
Study Measure Post mean Adjusted Adjusted %
(labelled) difference mean change
difference relative to the
control mean
Sarrafzegan Total daily PA 32 46 9.09 (P<0.05)
2009 (MET –m/week
+SD)
Leisure time PA 14 13 12.26 (P<0.01)
(MET- m/week)
Kloek 2006 METs/week 81 -241 -3.54 (P=0.95)

30. Intensity of the
Intervention
 9 high intensity
 10 medium intensity
 6 low intensity
 Interventions by Gu 2006, Jiang 2008,
and Zhang 2003 reached every
individual in their target communities

31. High intensity studies
Of the 9 studies assessed of high intensity
 5 of these reported some improved PA
outcomes
 3 of these found no effects
 Some high intensity interventions not
appropriate for western settings

32. Environmental – possible?
 Brown -2006 (wide range) women
 Brownson 2004 (walking trails)
 De Cocker 2007 (signage)
 Eaton 1999 (trails, paths)
 Goodman 1995 (walking trails)
 Jenum 2006 (approaches) maybe
 Leupker 1994 (change)
 NSW Health 2002 (parks) maybe
 O’Loughlin 1999 (minimal)

33. General Implications
 Review is a foundation of relevant evidence
 Reviews of specific components
 Environmental change strategies and settings based
approaches may provide a promising direction for
future interventions
 Incorporation of strong evaluation designs

34. Take home messages
 Many of the included studies had significant methodological
issues
 The effects reported from the 25 studies included in the review
were inconsistent across both studies and measurements.
 This review has established a foundation of the relevant evidence
 Improved evaluation design is required to better understand
what strategies work for whom, what components are essential
and what measures are reliable
 Environmental change strategies and/or settings based approach
may be the place to start for further research

35. Questions?

36. Posting Board
For a copy of the presentation please visit our
posting board:
http://forum.health-evidence.ca/
Login with your health-evidence username and password or
register if you aren’t a member yet.

37. Canadian Institutes of Health Research
Institute of Population and Public Health
Funding Opportunities
• Population Health Intervention Research to
Promote Health and Health Equity
• Knowledge Translation Awards
• Institute Community Support Grants and
Awards
• CIHR’s Open Operating Grants Program
37

38. Population Health Intervention Research
Example
Evaluation of traffic safety interventions in B.C.
Jeffrey Brubacher, et. al (UBC)
Looking at whether number of vehicle crashes changed after
changes to the province’s Motor Vehicle Act.
Findings will influence B.C.’s road safety strategy and will be of
interest to traffic safety lawmakers from other Canadian
provinces and territories.
38

39. • Visit ResearchNet for current CIHR
funding opportunities:
http://www.researchnet-
recherchenet.ca/
• For further information please contact us
ipph-ispp@uottawa.ca
39