Abstract
BackgroundThe majority of adults are not meeting the guidelines for physical activity despite activity being linked with numerous improvements to long-term health. In light of this, researchers have called for more community-level interventions. The main objective of the present study was to evaluate whether a community-level physical activity intervention increased the activity levels of rural communities.Methods128 rural villages (clusters) were randomised to receive the intervention in one of four time periods between April 2011 and December 2012. The Devon Active Villages intervention provided villages with 12 weeks of physical activity opportunities for all age groups, including at least three different types of activities per village. Each village received an individually tailored intervention, incorporating a local needs-led approach. Support was provided for a further 12 months following the intervention. The evaluation study used a stepped wedge cluster randomised controlled trial design. All 128 villages were measured at each of five data collection periods using a postal survey. The primary outcome of interest was the proportion of adults reporting sufficient physical activity to meet internationally recognised guidelines. Minutes spent in moderate-and-vigorous activity per week was analysed as a secondary outcome. To compare between intervention and control modes, random effects linear regression and marginal logistic regression models were implemented for continuous and binary outcomes respectively.Results10,412 adults (4693 intervention, 5719 control) completed the postal survey (response rate 32.2%). The intervention did not increase the odds of adults meeting the physical activity guideline (adjusted OR 1.02, 95% CI: 0.88 to 1.17; P = 0.80), although there was weak evidence of an increase in minutes of moderate-and-vigorous-intensity activity per week (adjusted mean difference = 171, 95% CI: -16 to 358; P = 0.07). The ineffectiveness of the intervention may have been due to its low penetration—only 16% of intervention mode participants reported awareness of the intervention and just 4% reported participating in intervention events.ConclusionsA community-level physical activity intervention providing tailored physical activity opportunities to rural villages did not improve physical activity levels in adults. Greater penetration of such interventions must be achieved if they are to increase physical activity prevalence at the community level.Trial RegistrationCurrent Controlled Trials ISRCTN37321160.
Highlights
The majority of adults are not meeting the guidelines for physical activity despite activity being linked with numerous improvements to long-term health
In order to achieve such benefits, adults are recommended to undertake a minimum of 150 minutes of at least moderate-intensity physical activity per week [2,3]
The study participants were extremely similar to the general village population in terms of their Index of Multiple Deprivation (IMD) scores (mean (SD) 15.8 (4.0) for both populations), and the population density of the village they resided within (mean (SD) 0.63 (0.5) for the study population versus 0.64 (0.6) for the village population). 4,693 participants provided data in the intervention trial mode and 5,719 in the control mode
Summary
The majority of adults are not meeting the guidelines for physical activity despite activity being linked with numerous improvements to long-term health. In the Health Survey for England 2008, only 39% of men and 29% of women reported doing sufficient physical activity [4]. Based on this evidence, interventions to increase physical activity levels are considered to be as important to population health as interventions to lower tobacco use or reduce blood pressure [3]. The majority of physical activity interventions have been delivered at the level of the individual, aimed at changing personal behaviour [9], whereas it is community-level interventions that have the potential to produce long-lasting benefits for the whole community [10]. Stepped wedge designs are beneficial when an intervention cannot be delivered to many clusters at the same time, or when it would be unethical to withhold the intervention because it is strongly believed the intervention will do more good than harm [16]
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