1. Community wide interventions for physical activity Clinical www.cochranejournalclub.com

2. Public Health questions Do community wide, multi-strategy interventions increase community levels of physical activity? Are the effects different within and between populations? Is there an equity gradient? www.cochranejournalclub.com 2 Source: Baker PRA, Francis DP, Soares J, Weightman AL, Foster C. Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD008366. DOI: 10.1002/14651858.CD008366.pub3.

3. Context Physical activity is important for reducing the overall burden of disease. People who are physically active have higher levels of health-related fitness and are less likely to develop disabling medical conditions and chronic diseases. The prevalence of physical inactivity remains stubbornly high. Community-wide interventions are attractive as they aim to improve the health risk factors of the whole population. They also generally produce visible infrastructure, with the aim of long-lasting benefits for the community. www.cochranejournalclub.com 3

4. Methods Searches were carried out in 24 databases including, the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE and several other electronic databases (including 6 Chinese language databases). For dichotomous measures, net percentage change from baseline, adjusted risk difference, and adjusted relative risk were calculated. For continuous measures, post mean differences, adjusted mean difference and adjusted percentage change relative to control group were calculated. www.cochranejournalclub.com 4

5. PICO(S) to assess eligible studies Participants / Population: A whole community as defined by geographical boundary. Interventions: Interventions that aim to reach the whole community with at least 2 of 6 components: social marketing; other communication strategies; individual counselling; partnerships with government or non-government groups (NGOs); working in specific settings; and environmental change strategies. Comparison: No community wide interventions. Primary outcome: Physical activity. Studies: Randomized (cluster) trials, quasi-experimental controlled designs, and interrupted time-series studies. www.cochranejournalclub.com

6. Description of included studies 33 trials met the inclusion criteria (8 new studies in the update). 267 communities were included, with populations ranging from 500 to 1.9 million people. Only 4 studies contained elements of all 6 strategies with a further 4 including an element from 5 of the strategies. Almost all studies included building partnerships with local government or NGOs. 4 studies were of high quality, with the remainder generally being of low quality. 25 studies were from high income countries and 8 were from lower income countries (including 5 from China). www.cochranejournalclub.com

7. Results There was much variation in interventions, population and outcomes. Few studies reported a substantial or sustained increase in physical activity. None of the 4 high quality studies that used randomisation found an effect for community-wide interventions. There was no evidence that more intense interventions worked better then others. www.cochranejournalclub.com

8. Results: Dichotomous outcomes (mixed measures) of “meeting a criteria of being physically active”, showing risk of bias

9. Conclusions: current findings The existing evidence does not support the hypothesis that multi-component community-wide interventions increase population levels of physical activity. Different interventions seemed to reach different segments of the population. Some strategies resulted in visible signs of people engaging in physical activity. Interventions undertaken in China appeared to have greatest possibility of success, but may not be applicable elsewhere. www.cochranejournalclub.com 9

10. Conclusions: future research Overall, there is a noticeable absence of reporting of benefit in population physical activity levels. Many authors identified reasons for this failure. Community-wide interventions have potential to be effective, but current approaches and low quality methods of evaluation have not shown effectiveness. Communities still need to implement interventions to promote physical activity, but a different approach is required and robust evaluation is necessary. An overview of individual methods is required. www.cochranejournalclub.com 10

11. Useful links Cochrane Journal Club discussion points Community wide interventions for increasing physical activity Community wide interventions for increasing physical activity www.cochranejournalclub.com