Meta-analysis of patient education interventions to increase physical activity among chronically ill adults

• Published in: Patient education and counseling Vol. 70; no. 2; pp. 157 - 172
• Main Authors: Conn, Vicki S., Hafdahl, Adam R., Brown, Sharon A., Brown, Lori M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.02.2008
• Subjects: Adult; Attitude to Health; Behavioural changes; Chronic Disease - psychology; Chronic Disease - rehabilitation; Chronic sickness; Data Interpretation, Statistical; Effect Modifier, Epidemiologic; Exercise; Exercise Therapy - education; Exercise Therapy - organization & administration; Feedback, Psychological; Goals; Health Behavior; Health behavior change; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; Interventions; Meta-analysis; Outcome Assessment, Health Care; Patient education; Patient Education as Topic - organization & administration; Physical activity; Prescriptions; Problem Solving; Program Evaluation; Research Design; Self Care - methods; Self Care - psychology; Social Support; Socioeconomic Factors; Patient education; Exercise; Meta-analysis; Health behavior change
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2007.10.004

This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses. Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses. Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples. These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect. Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.