UKCRC Centre of Excellence for Public Health/Centre for Public Health Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT 12 6BJ, UK.
Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, UK.
Soc Sci Med. 2017 Nov;192:125-133. doi: 10.1016/j.socscimed.2017.09.021. Epub 2017 Sep 19.
BACKGROUND: Physical activity (PA) interventions are generally effective in supporting short-term behaviour change, but increases are not always maintained. This review examined the effectiveness of PA interventions for behaviour change maintenance in young and middle-aged adults, and investigated which Behaviour Change Techniques (BCTs) and other intervention features were associated with maintenance. METHODS: Six databases (Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Web of Science) were systematically searched. Eligibility criteria were controlled trials investigating the effectiveness of PA interventions with adult (mean age 18-64 years) non-clinical populations using validated measures of PA behaviour at baseline and ≥six months' post-baseline. Results were pooled in meta-analyses using standardised mean differences (SMD) at five time intervals (6-9, 9-15, 15-21, 21-24, >24 months). Moderator analyses investigated the influence of sample and intervention characteristics on PA maintenance at 6-9 months. RESULTS: Sixty-two studies were included. PA interventions had a significant effect on behaviour maintenance 6-15 months post-baseline relative to controls. Interventions had a larger effect on maintenance at 6-9 months (SMD = 0.28; 95% CI: 0.20, 0.35; I = 73%) compared to 9-15 months (SMD = 0.20; 95% CI: 0.13, 0.26; I = 70%). Beyond 15 months, PA measurements were infrequent with little evidence supporting maintenance. Moderator analyses showed some BCTs and intervention settings moderated PA outcomes at 6-9 months. A multivariable meta-regression model showed interventions using the BCTs 'Prompt self-monitoring of behavioural outcome' (b = 1.46, p < 0.01) and 'Use of follow-up prompts' (b = 0.38, p < 0.01) demonstrated greater effectiveness at promoting PA maintenance at 6-9 months. Interventions implemented in primary care (versus community or workplace/university) settings (b = -0.13, p = 0.10) tended to demonstrate less effectiveness. CONCLUSIONS: This review provides evidence of some effective BCTs for maintaining behaviour to 15 months. Greater consideration must be given to how future interventions encourage and measure maintenance of changes, and investigate broader psychological, social and environmental influences of PA behaviour. PROSPERO REGISTRATION: PROSPERO 2015:CRD42015025462.
背景：体力活动（PA）干预措施通常在支持短期行为改变方面是有效的，但增加的行为改变并不总是持续的。本综述考察了 PA 干预措施在年轻和中年成年人中促进行为改变维持的有效性，并调查了哪些行为改变技术（BCTs）和其他干预特征与维持有关。
方法：系统检索了六个数据库（Medline、EMBASE、PsycINFO、Cochrane 系统评价数据库、CINAHL、Web of Science）。合格标准为使用基线和至少 6 个月的随访时的 PA 行为的验证性测量，调查 PA 干预措施对成人（平均年龄 18-64 岁）非临床人群有效性的对照试验。使用标准化均数差（SMD）在五个时间间隔（6-9、9-15、15-21、21-24、>24 个月）进行荟萃分析。在 6-9 个月时，进行了样本和干预特征对 PA 维持影响的调节分析。
结果：纳入了 62 项研究。与对照组相比，PA 干预措施在基线后 6-15 个月对行为维持有显著影响。干预措施在 6-9 个月时对维持的影响更大（SMD=0.28；95%CI：0.20，0.35；I=73%），而在 9-15 个月时（SMD=0.20；95%CI：0.13，0.26；I=70%）。超过 15 个月后，PA 测量频率较低，几乎没有证据支持维持。调节分析表明，一些 BCTs 和干预设置在 6-9 个月时调节了 PA 结果。多变量元回归模型显示，在 6-9 个月时使用 BCTs“行为结果的自我监测提示”（b=1.46，p<0.01）和“使用后续提示”（b=0.38，p<0.01）的干预措施在促进 PA 维持方面更有效。在初级保健（相对于社区或工作场所/大学）环境中实施的干预措施（b=-0.13，p=0.10）往往效果较差。
结论：本综述提供了一些有效的 BCTs 证据，可将行为维持到 15 个月。未来的干预措施必须更加考虑如何鼓励和衡量行为改变的维持，并调查 PA 行为的更广泛的心理、社会和环境影响。
前瞻性注册：PROSPERO 2015：CRD42015025462。
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