Use of behavior change techniques in physical activity programs and services for older adults: findings from a rapid review

Abstract

Background: Understanding behavior change techniques (BCTs) used in randomized controlled trials (RCTs) of physical activity programs/services for older adults can help us to guide their implementation in real-world settings.

Purpose: This study aims to: (a) identify the number and type of BCTs used in physical activity programs/services for older adults evaluated in large, good quality RCTs and (b) explore the impact of different BCTs on different outcome domains.

Methods: This is a secondary data analysis of a WHO-commissioned rapid review of physical activity programs/services for older adults. Fifty-six trials testing 70 interventions were coded for the type and number of BCTs present using a published BCT taxonomy. The proportion of positive effects found from physical activity interventions using the most common BCTs was calculated for the outcomes of physical activity, intrinsic capacity, functional ability, social domain, cognitive and emotional functioning, and well-being and quality of life.

Results: Thirty-nine of the 93 possible BCTs were identified in the included trials and 529 BCTs in total (mean 7.6, range 2-17). The most common BCTs were "action planning" (68/70 interventions), "instructions on how to perform a behavior" (60/70), "graded tasks" (53/70), "demonstration of behavior" (44/70), and "behavioral practice/rehearsal" (43/70). Interventions that used any of the most common BCTs showed overwhelmingly positive impacts on physical activity and social domain outcomes.

Conclusion: Consideration of which BCTs are included in interventions and their impact on outcomes can improve the effectiveness and implementation of future interventions. To enable this, providers can design, implement, and evaluate interventions using a BCT taxonomy.

Keywords: Aged; Behavior change techniques; Exercise; Health behavior; Intervention studies; Physical activity.

Fig. 1.

Number of times each identified BCT was used in PA programs and services for older people evaluated in the included trials

Fig. 2.

Intervention effects by the most common BCTs and outcome domain. The figure under Label presents the effect direction and statistical significance for outcome domains across primary studies. The numbers in each cell indicate the number of intervention groups. All intervention arms from the same study were included as a unique intervention group. The size of the circle depicts the number of intervention groups such that the larger the circle, the greater the number of intervention groups. Large circles represent ≥20 intervention groups; medium circles represent 10–20 intervention groups; and small circles represent <10 intervention groups. Shades of color depict the overall positive effect direction such that the darker the color, the higher the proportion of positive effects across comparisons. No shading reflects <50% positive effect or negative effects (there are none in this figure). *If 50 to 75% of total outcomes were reported as positive and statistically significant. For example, for the goals and physical activity outcomes circle, * indicates that 6–9 of 12 of the interventions tested which included the BCT goal setting had a positive and significant effect on physical activity outcome compared to their comparison no intervention groups. **If >75% of total outcomes were reported as positive and statistically significant.

Fig. 3.

Intervention effects by number of BCTs used and outcome domain. The figure under Label presents the effect direction and statistical significance for outcome domains across primary studies. The numbers in each cell indicate the number of intervention groups. All intervention arms from the same study were included as a unique intervention group. The size of the circle depicts the number of intervention groups such that the larger the circle, the greater the number of intervention groups. Large circles represent ≥20 intervention groups; medium circles represent 10–20 intervention groups; and small circles represent <10 intervention groups. Shades of color depict the overall positive effect direction such that the darker the color, the higher the proportion of positive effects across comparisons. No shading reflects <50% positive effect or negative effects (there are none in this figure). *If 50 to 75% of total outcomes were reported as positive and statistically significant. For example, for the goals and physical activity outcomes circle, * indicates that 6–9 of 12 of the interventions tested which included the BCT goal setting had a positive and significant effect on physical activity outcome compared to their comparison no intervention groups. **If >75% of total outcomes were reported as positive and statistically significant.