Effectiveness of Strategies for Promoting Physical Activity in Chronically Ill Adults: Results of a Meta-Analysis

“Interventions focused on physical activity alone are most effective.” So conclude the authors of an article in the American Journal of Nursing, in which they discuss the clinical implications of a 2008 metaanalysis of findings from 163 published reports on more than 200 tests of interventions aimed at promoting physical activity among chronically ill, sedentary adults.

KEY FINDINGS INCLUDE:

• The most effective interventions:

• a) Focused solely on physical activity, without addressing other health behaviors
• b) Contained at least one behavioral — as opposed to cognitive — strategy
• c) Included self-monitoring.

• Interventions that incorporated any behavioral strategy were more effective than those that included none.
• Interventions using only behavioral strategies were more effective than those with both behavioral and cognitive elements.
• Effectiveness of the interventions was not influenced by sex, age, socioeconomic status, or ethnicity.

Behavioral approaches included: consequences (rewards for performing more physical activity); contracts between patient and provider defining the level and duration of the patient’s physical activity; stimuli and cues used to remind participants to exercise; and self-monitoring by using a diary, calendar, or website log.
“Self-monitoring was found to be particularly effective,” write the authors, “and can be recommended as part of any physical activity intervention program for adults with chronic illness.”

The less effective cognitive approach included such components as barriers management, decisional balance, motivational counseling, problem solving, and social cognitive interventions.

“Although multiple behavior changes may be required to manage some chronic illnesses, modifying physical activity alone may have dramatic effects,” write the authors. Further, it seems that targeting different health behaviors sequentially may be more effective than addressing multiple health behaviors simultaneously.