Thursday, July 23, 2015

3 Years of Telling People to Exercise More Doesn't Make Them Exercise More (at Least Not in Japan)

I've asked before whether or not anyone is aware of any public health intervention that has led to a sustained and objectively measurable increase in the activity level of a population (adults, kids, both, whatever)

Unfortunately, I've yet to hear of any exciting outcomes (nor have I by the way for simply telling people to eat better).

As I see it, the value of exercise as health promoting is well known. Public health campaigns that in turn simply spread that message, probably aren't teaching people anything new, and consequently, may not lead to any sustained changes in behaviour.

And that's precisely what researchers in Japan recently found whereby a 3 year-long, cluster randomized controlled trial designed to evaluate extensive, community wide interventions designed to encourage more physical activity, failed to show any significant benefits.

The interventions were definitely not trivial either, but they were definitely all geared to try to encourage conscious, individual behaviour change. According to the paper, they included,
"(1) Information delivery.

Flyers, leaflets, community newsletters, posters (those are them up above), banners, and local audio broadcasts.

(2) Education delivery.

Outreach health education program and mass- and individual encouragement by professionals during community events. Mass-encouragement included a motivating talk and demonstration of PA using a common procedure to ensure standardization of the intervention and individual encouragement including face-to-face promotion of PA while waiting for
community health check-ups

(3) Support delivery.

Development of social support, i.e., promoting encouragement by community leaders and lay health workers; material support, i.e., arranging for residents to obtain light-reflective material for walking safety, pedometers, and videotapes and DVDs on flexibility and muscle-strengthening activities at each relevant community center; and professional support, i.e., establishing a call center for questions about PA and requests for outreach
Now to be fair, evaluation was by way of survey, though given that asked people generally overestimate their activity levels, if anything you would expect a survey to be more likely to yield a positive result than for instance accelerometry data. Ultimately though, there were no significant improvements found. Not to over-all activity, not to walking, not to flexibility (though there was a positive trend), and not to muscle strengthening.

I think this speaks to the fact that good intentions fail in the face of day to day life, and that if we want to see population wide increases in physical activity, we'll likely need to effect that by way of point of action changes (such as signs placed on escalators and elevators suggesting a person might want to instead take the stairs) and re-engineered built environments that make increased activity the unconscious default, or at the very least, the easier choice.