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Int J Epidemiol. 2018 Apr 1;47(2):642-653. doi: 10.1093/ije/dyx248.

Community-wide intervention and population-level physical activity: a 5-year cluster randomized trial.

Author information

1
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
2
Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan.
3
Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan.
4
Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Izumo, Shimane, Japan.
5
Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
6
Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
7
Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
8
School of Public Health, The University of Sydney, Sydney, NSW, Australia.
9
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
10
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Abstract

Background:

Evidence from a limited number of short-term trials indicates the difficulty in achieving population-level improvements in physical activity (PA) through community-wide interventions (CWIs). We sought to evaluate the effectiveness of a 5-year CWI for promoting PA in middle-aged and older adults using a cluster randomized design.

Methods:

We randomized 12 communities in Unnan, Japan, to either intervention (9) or control (3). Additionally, intervention communities were randomly allocated to three subgroups by different PA types promoted. Randomly sampled residents aged 40-79 years responded to the baseline survey (n = 4414; 74%) and were followed at 1, 3 and 5 years (78-83% response rate). The intervention was a 5-year CWI using social marketing to promote PA. The primary outcome was a change in recommended levels of PA.

Results:

Compared with control communities, adults achieving recommended levels of PA increased in intervention communities [adjusted change difference = 4.6 percentage points (95% confidence interval: 0.4, 8.8)]. The intervention was effective for promoting all types of recommended PAs, i.e. aerobic (walking, 6.4%), flexibility (6.1%) and muscle-strengthening activities (5.7%). However, a bundled approach, which attempted to promote all forms of PAs above simultaneously, was not effective (1.3-3.4%, P ≥ 0.138). Linear dose-response relationships between the CWI awareness and changes in PA were observed (P ≤ 0.02). Pain intensity decreased in shoulder (intervention and control) and lower back (intervention only) but there was little change difference in all musculoskeletal pain outcomes between the groups.

Conclusions:

The 5-year CWI using the focused social marketing strategy increased the population-level of PA.

PMID:
29228255
PMCID:
PMC5913653
DOI:
10.1093/ije/dyx248
[Indexed for MEDLINE]
Free PMC Article

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