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By Melinda Craike, PhD, Associate Professor, Physical Activity and Health, Victoria University; Glen Wiesner, PhD, Research Fellow, Physical Activity and Health, Victoria University; Toni A Hilland, PhD, Senior Lecturer, Health and Physical Education, Royal Melbourne Institute of Technology (RMIT); and Enrique García Bengoechea, PhD, Dean’s Research Fellow, Faculty of Education and Health Sciences, University of Limerick
Although policies and programs to support physical activity exist, they may not be accessed or utilized by individuals from socio-economically disadvantaged groups.
This WellSpring highlights effective evidence-based approaches that can assist practitioners and decision-makers when designing and implementing physical activity policies and programs to reach these disadvantaged groups.
It has been consistently reported that insufficient physical activity is a global pandemic,1,2 due to its prevalence, global reach, and health effects.3 Therefore, physical activity needs to be promoted and addressed to control non-communicable diseases.4 Compared to those who are more affluent, individuals from socio-economically disadvantaged groups are far less likely to achieve recommended levels of physical activity and, consequently, are more likely to experience poor health outcomes.5,6 In addition, policies and programs that do not consider the physical activity needs of disadvantaged groups may not be successful at increasing overall physical activity and may, in fact, widen health inequities.7,8
To improve physical activity and health outcomes among disadvantaged groups, it is important that evidence-based programs and policies which support engagement in physical activity are implemented in practice. Therefore, our team examined the effectiveness of interventions for increasing physical activity among disadvantaged populations and the characteristics that were associated with effective interventions. This will assist practitioners and decision-makers to design and implement effective interventions for disadvantaged groups.
Examining the literature
We conducted a “review of reviews” to evaluate the effectiveness of interventions for increasing physical activity among individuals who are socio-economically disadvantaged. These individuals were described as low socio-economic status, low income, low education, or from areas defined as socio-economically disadvantaged (often characterized by low income levels).6,9 We summarized published findings of systematic reviews that examined the effectiveness of physical activity interventions relating to preschool children (0-4 years), primary school children (5-12 years), adolescents (13-17 years), adults (18-64 years), and older adults (65 years and over). Following a systematic search of the literature and a screening process to identify suitable reviews, we selected 17 reviews for synthesis.9
Evidence and recommendations by age group
Preschool-aged children (0–4 years)
Parent-focused, family-based interventions in community settings, such as playgroups and kindergarten classes, showed some evidence of increasing young children’s engagement in physical activity. This should be considered emerging evidence, since the quality of existing studies is weak. The following features of parent-focused interventions were found to be effective and should be incorporated into the design of programs and/or policies:
- offer group sessions;
- include high levels of parental engagement;
- use behavioural strategies such as goal setting and self-monitoring of progress;
- focus on parental skill-building in facilitating active play with and for their child;
- link parents to other community resources and programs. Let parents know what already exists (e.g., parks or support programs) to support them and their children to be physically active.
At the same time, many studies reported poor parental attendance and adherence to programs. Practitioners should consider the following strategies when seeking to engage parents in physical activity programs:
- target recruitment to disadvantaged parents;10
- partner with respected community stakeholders and organizations;
- utilize well-trained staff who are ethnically, linguistically, and culturally matched to the population of interest;
- use multiple advertising channels; and
- provide culturally-tailored content.11
Children (5–12 years)
School-based interventions were considered effective in improving physical activity among children from socio-economically disadvantaged groups. Several features were associated with effective school-based interventions, which practitioners and decision-makers should consider incoporating into their school-based programs and policies:
- embed physical activity sessions into the school curriculum and class timetabling (e.g., four 45-minute physical activity lessons per week; workbooks including assignments for children and parents to perform in class and at home);
- support extracurricular activities (e.g., encouragement of physical activity outside of school hours, attendance at local sports clubs, accessible school sports activities offered daily during out-of-school hours);
- encourage school leadership to undertake self-assessments of their physical activity-related policies, facilities, and programs; and
- include teachers, parents, and students in physical activity education.
Practitioners can also advocate to ensure that school-based physical activity interventions are implemented in schools, as a study in the United States showed only 46% of districts followed physical education mandates.12 Unfortunately, evidence relating to the effectiveness of physical activity interventions for children in community-based settings (e.g., sport clubs) is scarce.
Adolescents (13–17 years)
Only a small number of studies have focused on adolescents from socio-economically disadvantaged groups and few were effective at improving physical activity. Based on the available findings, practitioners can include the following promising strategies:
- involve adolescents in the development and delivery of physical activity interventions (empowerment and engagement) and involve family;13,14
- include peer leadership and training of adolescents to lead physical activity or educational sessions for their peers; and
- focus on engaging adolescents in physical activity, including community-based interventions (e.g., fitness centres, sporting clubs).
Adults (18–64 years)
Evidence was mixed for the effectiveness of physical activity interventions among adults and long-term outcomes were seldom reported. Interventions with a group-based component were found to be more effective than individual-focused interventions.
Practitioners and decision-makers should include group-based components when designing programs for adult participation, such as:
- group education meetings,
- group physical activity sessions, or
- a combination of individual and group physical activity, facilitated by a trained educator or health practitioner.
The importance of group interventions likely lies in the social support mechanisms provided by group settings. Group programs should encourage social support among participants by allowing participants to interact with others, share ideas, discuss goals, address barriers to physical activity, and identify sources of support.
Older adults (65 years and older)
Few studies have examined the effectiveness of interventions among older adults from socio-economically disadvantaged groups. Based on the limited available evidence, we cautiously recommend the following:
- print material tailored for older adults; and
- provide group exercise programs that incorporate self-monitoring through devices such as pedometers.15
Given that few studies have been conducted with older adults, future research is needed to understand the effectiveness of interventions for improving physical activity among older adults from socio-economically disadvantaged population groups.
Overall summary of evidence and recommendations
We found that the strength of evidence for effective physical activity interventions varied depending on the age group examined. Among preschool and school-aged children, there was evidence of intervention effectiveness. However, few studies have focused on adolescents and interventions were generally not effective. Among adults, findings were mixed and thus inconclusive. Findings were also inconclusive for older adults as few studies have focussed on this age group.
Across all age groups, interventions that were more intensive (e.g., more contacts over a longer time) were more successful at improving engagement in physical activity than less intensive interventions. However, because few studies examined long-term outcomes, there is uncertainty about whether the changes in physical activity from intensive interventions are sustained over time. In addition, 41% of the included reviews focused on obesity prevention (along with physical activity outcomes).13,16-21
Practitioners and decision-makers should consider the additional barriers to physical activity experienced by people who are disadvantaged. This may mean that more intensive support is needed to engage them in physical activity. For these interventions to be sustainable in practice, a process of initial intensity and tapering off or peer-leadership and support may be required.
A focus on obesity prevention and treatment could discourage some people from engaging in physical activity.22 Practitioners and decision-makers should consider the broad range of benefits of physical activity, beyond weight management, including social support, community connectedness, and mental wellbeing, and design physical activity programs and policies accordingly.
To learn more about the findings and access the study, visit: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-018-0676-2
About the Authors
|Melinda Craike, PhD, is an Associate Professor of Physical Activity and Health at the Institute for Health and Sport and Principal Research Fellow at the Mitchell Institute, Victoria University. Her research aims to better understand and increase participation in physical activity. She also has a particular interest in research translation.|
|Glen Wiesner PhD, is a Research Fellow in Physical Activity and Health at the Institute for Health and Sport, Victoria University. His main research interests are health promotion and public health, with a focus on mental health and clinical outcomes.|
|Toni A Hilland, PhD, is a Senior Lecturer in Health and Physical Education at the School of Education, Royal Melbourne Institute of Technology (RMIT) in Australia. Her main research interests are the correlates and determinants of physical activity and physical activity promotion, with a focus in physical education.|
|Enrique García Bengoechea, PhD, is a Dean’s Research Fellow in Physical Activity and Health in the Faculty of Education and Health Sciences at the University of Limerick, Ireland. His main research interests are community-based physical activity and health promotion for youth development, socialization, and sport.|
- Kohl MT. Foundations of Physical Activity and Public Health. Champaign, IL: Human Kinetics; 2012.
- Hills AP, Dengel DR, Lubans DR. Supporting public health priorities: recommendations for physical education and physical activity promotion in schools. Prog Cardiovasc Dis. 2015;57(4):368-374. doi: 10.1016/j.pcad.2014.09.010.
- Kohl HW, 3rd, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294-305. doi: 10.1016/S0140-6736(12)60898-8.
- World Health Organization. Global recommendations on physical activity for health. http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/. Published 2010.
- Glover JD, Hetzel DM, Tennant SK. The socioeconomic gradient and chronic illness and associated risk factors in Australia. Aust New Zealand Health Policy. 2004;1(1):8. doi: 10.1186/1743-8462-1-8.
- Ball K, Carver A, Jackson M, Downing K. Evidence review: addressing the social determinants of inequities in physical activity and related health outcomes. Carlton South, Victoria: Victorian Health Promotion Foundation. 2015.
- Humbert ML, Chad KE, Spink KS, et al. Factors that influence physical activity participation among high- and low-SES youth. Qual Health Res. 2006;16(4):467-483. doi: 10.1177/1049732305286051.
- Ball K, Salmon J, Giles-Corti B, Crawford D. How can socio-economic differences in physical activity among women be explained? A qualitative study. Women Health. 2006;43(1):93-113. doi: 10.1300/J013v43n01_06.
- Craike M, Wiesner G, Hilland TA, Bengoechea EG. Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review. Int J Behav Nutr Phys Act. 2018;15(1):43. doi: 10.1186/s12966-018-0676-2.
- Harkins C, Shaw R, Gillies M, et al. Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study. BMC Public Health. 2010;10:391. doi: 10.1186/1471-2458-10-391.
- Carroll JK, Yancey AK, Spring B, et al. What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings. Transl Behav Med. 2011;1(2):234-251. doi: 10.1007/s13142-011-0034-2.
- Sanchez-Vaznaugh EV, Goldman Rosas L, Fernandez-Pena JR, Baek J, Egerter S, Sanchez BN. Physical education policy compliance and Latino children’s fitness: Does the association vary by school neighborhood socioeconomic advantage? PLoS One. 2017;12(6):e0178980. doi: 10.1371/journal.pone.0178980.
- Kornet-van der Aa D, Altenburg T, van Randeraad-van der Zee C, Chinapaw M. The effectiveness and promising strategies of obesity prevention and treatment programmes among adolescents from disadvantaged backgrounds: a systematic review. Obesity Reviews. 2017;18(5):581-593.
- van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007;335(7622):703. doi: 10.1136/bmj.39320.843947.BE.
- Lehne G, Bolte G. Impact of universal interventions on social inequalities in physical activity among older adults: an equity-focused systematic review. Int J Behav Nutr Phys Act. 2017;14(1):20. doi: 10.1186/s12966-017-0472-4.
- Laws R, Campbell KJ, van der Pligt P, et al. The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or Indigenous families: a systematic review. BMC Public Health. 2014;14:779. doi: 10.1186/1471-2458-14-779.
- Kader M, Sundblom E, Elinder LS. Effectiveness of universal parental support interventions addressing children’s dietary habits, physical activity and bodyweight: A systematic review. Preventive Medicine. 2015;77:52-67. doi: 10.1016/j.ypmed.2015.05.005.
- Magnee T, Burdorf A, Brug J, et al. Equity-specific effects of 26 Dutch obesity-related lifestyle interventions. American Journal of Preventive Medicine. 2013;44(6):E61-E70.
- Olstad DL, Ancilotto R, Teychenne M, et al. Can targeted policies reduce obesity and improve obesity-related behaviours in socioeconomically disadvantaged populations? A systematic review. Obes Rev. 2017;18(7):791-807. doi: 10.1111/obr.12546.
- Wijtzes AI, van de Gaar VM, van Grieken A, et al. Effectiveness of interventions to improve lifestyle behaviors among socially disadvantaged children in Europe. Eur J Public Health. 2017;27(2):240-247. doi: 10.1093/eurpub/ckw136.
- Olstad DL, Teychenne M, Minaker LM, et al. Can policy ameliorate socioeconomic inequities in obesity and obesity-related behaviours? A systematic review of the impact of universal policies on adults and children. Obes Rev. 2016;17(12):1198-1217. doi: 10.1111/obr.12457.
- Weiler R, Stamatakis E, Blair S. Should health policy focus on physical activity rather than obesity? Yes. BMJ. 2010;340:c2603. doi: 10.1136/bmj.c2603.
June 2019, Volume 30, No. 06
Click here for a print copy (5 pages, PDF).
|Don't miss the next WellSpring. Subscribe to CAL's Active Living E-News to receive our monthly notice.|