Interventions to promote walking: systematic review

Abstract

Objective: To assess the effects of interventions to promote walking in individuals and populations.

Design: Systematic review.

Data sources: Published and unpublished reports in any language identified by searching 25 electronic databases, by searching websites, reference lists, and existing systematic reviews, and by contacting experts.

Review methods: Systematic search for and appraisal of controlled before and after studies of the effects of any type of intervention on how much people walk, the distribution of effects on walking between social groups, and any associated effects on overall physical activity, fitness, risk factors for disease, health, and wellbeing.

Results: We included 19 randomised controlled trials and 29 non-randomised controlled studies. Interventions tailored to people's needs, targeted at the most sedentary or at those most motivated to change, and delivered either at the level of the individual (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups, can encourage people to walk more, although the sustainability, generalisability, and clinical benefits of many of these approaches are uncertain. Evidence for the effectiveness of interventions applied to workplaces, schools, communities, or areas typically depends on isolated studies or subgroup analysis.

Conclusions: The most successful interventions could increase walking among targeted participants by up to 30-60 minutes a week on average, at least in the short term. From a perspective of improving population health, much of the research currently provides evidence of efficacy rather than effectiveness. Nevertheless, interventions to promote walking could contribute substantially towards increasing the activity levels of the most sedentary.

Fig 1 Review flowchart. Details of excluded studies are on http://sparcoll.org.uk/images/bmjsupp.pdf

Fig 2 Estimated net increase in walking in general. Studies are ranked by validity (number of criteria met, see tables 1 and 2), then sample size

Fig 3 Estimated net increase in walking as a mode of transport. Studies are ranked by validity (number of criteria met, see tables 1 and 2), then sample size