Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
St Hugh's College, University of Oxford, Oxford, UK.
BMJ. 2024 Jul 10;386:e078713. doi: 10.1136/bmj-2023-078713.
To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults.
Systematic review and meta-analysis.
A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time.
Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined.
129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples.
Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year.
PROSPERO CRD42020219881.
评估包含动机访谈的行为干预措施对成年人身体活动结果的有效性。
系统评价和荟萃分析。
对七个数据库进行检索，以查找自成立至 2023 年 3 月 1 日期间发表的比较行为干预措施（包含动机访谈）与不包含动机访谈的比较者对成年人身体活动结果的随机对照试验。感兴趣的结果是定量测量的总身体活动、中等到剧烈体力活动（MVPA）和久坐时间变化的差异。
两名审查员提取数据并评估偏倚风险。总结研究的人群特征、干预措施组成部分、比较组和结局。对于总体主要效应，使用随机效应荟萃分析报告标准化均数差（SMD）和 95%置信区间（CI）。还检查了基于随访时间、比较类型、干预持续时间和参与者的疾病或健康状况的差异效果。
纳入了 129 篇报告了 97 项随机对照试验的论文，共涉及 27811 名参与者和 105 项比较。包含动机访谈的干预措施在总身体活动（SMD 0.45，95%CI 0.33 至 0.65，相当于每天增加 1323 步；低确定性证据）和 MVPA（0.45，0.19 至 0.71，相当于每周增加 95 分钟；极低确定性证据）以及减少久坐时间（-0.58，-1.03 至-0.14，相当于每天减少 51 分钟；极低确定性证据）方面优于对照组。与对照组类似强度的任何结果的差异证据均缺乏。随着时间的推移，效应的幅度减小，且缺乏动机访谈对一年以上时间内增加 MVPA 或减少久坐时间的效果证据。大多数干预措施涉及特定健康状况的患者，且缺乏动机访谈在一般人群样本中增加 MVPA 或减少久坐时间效果的证据。
使用动机访谈作为促进成年人总身体活动的复杂行为干预措施的一部分的证据的确定性较低，而用于 MVPA 和久坐时间的证据则极低。总体证据表明，尽管包含动机访谈的干预措施可以增加身体活动并减少久坐行为，但在可以孤立出动机访谈效果的研究中并未发现差异。随着时间的推移，有效性减弱，且没有证据表明动机访谈在一年以上时间内增加身体活动的益处。
PROSPERO CRD42020219881。
