Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions

Abstract

BackgroundTo develop more efficient programmes for promoting dietary and/or physical activity change (in order to prevent type 2 diabetes) it is critical to ensure that the intervention components and characteristics most strongly associated with effectiveness are included. The aim of this systematic review of reviews was to identify intervention components that are associated with increased change in diet and/or physical activity in individuals at risk of type 2 diabetes.MethodsMEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library were searched for systematic reviews of interventions targeting diet and/or physical activity in adults at risk of developing type 2 diabetes from 1998 to 2008. Two reviewers independently selected reviews and rated methodological quality. Individual analyses from reviews relating effectiveness to intervention components were extracted, graded for evidence quality and summarised.ResultsOf 3856 identified articles, 30 met the inclusion criteria and 129 analyses related intervention components to effectiveness. These included causal analyses (based on randomisation of participants to different intervention conditions) and associative analyses (e.g. meta-regression). Overall, interventions produced clinically meaningful weight loss (3-5 kg at 12 months; 2-3 kg at 36 months) and increased physical activity (30-60 mins/week of moderate activity at 12-18 months). Based on causal analyses, intervention effectiveness was increased by engaging social support, targeting both diet and physical activity, and using well-defined/established behaviour change techniques. Increased effectiveness was also associated with increased contact frequency and using a specific cluster of "self-regulatory" behaviour change techniques (e.g. goal-setting, self-monitoring). No clear relationships were found between effectiveness and intervention setting, delivery mode, study population or delivery provider. Evidence on long-term effectiveness suggested the need for greater consideration of behaviour maintenance strategies.ConclusionsThis comprehensive review of reviews identifies specific components which are associated with increased effectiveness in interventions to promote change in diet and/or physical activity. To maximise the efficiency of programmes for diabetes prevention, practitioners and commissioning organisations should consider including these components.

Can physical activity interventions for adults with type 2 diabetes be translated into practice settings? A systematic review using the RE-AIM framework

“…In comparison, two of the studies reporting an insignificant trend for increasing physical activity levels were of short duration (4-6 weeks) and involved fewer sessions (range 1-6). A review by Greaves et al [5] identified that the most effective physical activity interventions within the diabetes population were those associated with a greater frequency of participant/counsellor contact. If these interventions had been of longer duration and greater frequency of contact they may have also resulted in significant physical activity outcomes.…”

“…Physical activity interventions based on theoretical models of behaviour change have been shown to be more effective than non-theory based interventions [5,43,44]. Guidelines on physical activity for type 2 diabetes recommend the development of physical activity interventions based on a valid theoretical framework [7,8]; therefore, it is positive to note that all 12 interventions adhered to these recommendations.…”

“…It is known that physical activity interventions based on a theoretical framework of behaviour change and tailored to the needs of individuals with type 2 diabetes are more effective than general physical activity promotion [5,6]. A 2012 review and meta-analysis by Avery et al [12] found behavioural interventions aimed at increasing physical activity in adults with type 2 diabetes produced significant increases in physical activity in addition to significant improvements in BMI and HbA1c.…”

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

“…The BCTs are those known to be effective in PA and dietary interventions (self-monitoring, goal-setting, implementation intentions and feedback on behaviour) 4 and social support, both from other participants and from their wider social networks, 5 is also promoted (a full description of the use of BCTs within the FFIT programme is provided elsewhere 46 ). Throughout the FFIT programme, men are encouraged to make behavioural changes that they can sustain long term, and to incorporate PA and healthy eating into their daily lives.…”

“…1 In 2011, it was estimated that there would be 11 million more obese adults in the UK by 2030, resulting in up to 668,000 additional cases of diabetes, 461,000 additional cases of heart disease and stroke, 130,000 additional cases of cancer and up to 6.3 million quality-adjusted life-years (QALYs) lost, with associated medical costs set to increase by £1.9B-2B per year. 2 Although the behaviour change techniques (BCTs) and strategies that are effective in helping people achieve clinically significant short-term weight loss (by at least 5% 3 of their initial body weight), by increasing physical activity (PA) and improving diet, are now well described, [4][5][6] longer-term weight loss is less well researched and remains a challenge. Weight loss as a result of taking part in behavioural interventions typically peaks at around 6 months, followed by a plateau and then a gradual regain in weight at a rate of 1-2 kg per year (often with larger regains in the earlier years).…”