874. What works to promote walking at the population level? A systematic review
Commentary by: Dr Kate White, National Active Living Senior Policy Advisor, Heart Foundation
Source: British Journal of Sports Medicine, 2018; 52: 807-812.
The promotion of walking results in consistent benefits for individuals in terms of physical and mental health. However the evidence on how to promote walking has been focused on individual approaches. Population approaches can reach across whole segments of people, but what works and at what scale remains under-evaluated.
The authors of this study systematically reviewed the effectiveness of population approaches to promote walking among individuals and groups. 12 population-based approaches to promote walking across five types of public health mechanisms were evaluated. Note that these methods were from mostly urban high-income countries.
For this study, the authors defined population-based approaches as methods involving one or more of the following:
1) Mass media, social media and education campaigns – for example, media campaigns with technologial support,
2) Taxation, subsidies and other economic incentives, for example subsidised gym memberships, financial incentives to cycle / disincentives to drive,
3) Regional or federal community, school and workplace,
4) Environmental changes – for example, bike trails, cycle parking, pedestrianised city centres, new parks, improvements to existing parks and closing streets, and
5) Policies with direct restrictions and mandates – for example, building regulations and speed restrictions on roads.
Included for consideration were all studies from an earlier systematic review by the authors (1990-2006), along with and updated search across 10 databases from March 2006 - 2017.
The authors summarised the outcomes of walking for each study in terms of the net change in walking after adjustment for changes in the control group, using the most inclusive measure of walking available for each study, and tabulated the key characteristics and outcomes for the studies within each category in descending order of study validity.
For the first time, the authors found evidence from studies using ‘natural experiments’ on the overall effectiveness of approaches, particularly ones that combined three interventions– mass media, community initiatives and environmental change. These three were found to enable increased walking (ranging from 9 minutes to 75 minutes per week). One explanation is that these approaches are easier to plan and deliver and therefore more likely to appear in the literature than less controllable interventions such as large-scale environmental or policy changes, which could be more prone to disruption (and less likely to be published).
However, the authors note that the limited number of evaluations of the impact of population-based approaches for walking and physical activity promotion compared with individual or group-based interventions is an example of the ‘inverse evidence law’ – the situation where ‘we know the least about the effects of interventions most likely to influence the health of the largest number of people’.
To summarise, it is suggested that the potential for constructing evaluation frameworks for these approaches, and rapidly improving the evidence base should be a priority for research funding.
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