Summary of studies reviewed
| Effective* | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Project | Nature of sample completing study | Country | Design | Experimental intervention | Control condition | Follow up period | Results | Short term** | Long term |
| *Effective represents any evidence of superiority of TTM based intervention compared with control in terms of stage progression or activity levels using a significance level of p<0.05. | |||||||||
| **Short term effectiveness represents studies that show an effect over 6 months or less; long term effectiveness represents studies that show an effect over more than 6 months. | |||||||||
| BMI, Body mass index; GP, general practitioner; TTM, transtheoretical model of behaviour change; N/A, not applicable. | |||||||||
| Marcus et al11 | 236 of 610 (39%) adults in contemplation, preparation and action stages of activity change, recruited via advertising campaign. Follow up results from stratified random sample of participants. | USA | Before and after, uncontrolled | Stage specific written activity information on how to start and continue physical activity and leisure facilities in area – one pamphlet for each stage of change. | N/A | 6 weeks | Subjects significantly more active after intervention than before (p<0.0001). 62% of those originally in contemplation stage and 61% of those originally in preparation stage showing stage progression. 9% of those originally in action stage showed stage regression. | Yes | N/A |
| Fresh start12 | 382 of 758 (50%) adults with ⩾1 modifiable cardiovascular risk factors (BMI>25 kg/m2, blood pressure>140/95 mm Hg, cholesterol>5.5 mmol/l, current smoker) recruited in primary care using methods devised and identified as suitable by individual physicians | UK | Randomised (by GP practice), controlled | TTM based videoed activity counselling +/− TTM based written information – one video and information leaflet per risk factor | Routine care – assessment of cardiovascular risk with appropriate, routine feedback | 4–6 months and 12–18 months | Significant increase in energy expenditure in all groups but no difference between groups (figures not given). At 4 months, 20% of those in intervention groups and 27% of those in control group (p=0.02) showed stage progression At 12 months, 20–22% of subjects in all groups made stage progression (p=0.81). | No | No |
| Cardinal and Sachs14 | 81 of 113 (72%) female university clerical staff in all stages of activity change. Recruitment method not described. | USA | Stratified (by baseline stage of activity change), randomised (by individual), controlled | Stage specific written information promoting structured (traditional exercise classes and sessions) or lifestyle (integrating exercise into daily routine) activity using TTM theory | Non-staged written feedback on current activity levels | 1 and 7 months | Significant stage progression in all groups at 1 and 7 months (p<0.05). No intergroup differences. At 1 month, of those who could show stage progression (i.e. not in maintenance stage at baseline), 39% did. At 7 months, 57% of subjects who could show stage progression did, 30% maintained their original stage and 13% regressed. | No | No |
| Loughlan and Mutrie41 | Unknown number completed of 179 recruited. Sedentary adults in preparation and contemplation stage recruited in workplace | UK | Randomised (by individual), controlled | ‘Exercise consultation’ (a 30 minute, one-to-one consultation based in TTM theory), delivered by trained research assistants | Fitness assessment and feedback or written activity information (unstaged) | 1, 3 and 6 months | All subjects increased number of hours of exercise per week from 3.5 hours at baseline, to 6.75 hours at 1 month, to 6 hours at 3 months and 5 hours at 6 months (p<0.001). No intergroup differences | No | N/A |
| Project PACE - 116–18 | 212 of 255 (83%) adults in contemplation stage of activity change recruited in primary care by telephone assessment of all those booked for non-acute visits over study period | USA | Non-randomised, controlled | Stage specific activity counselling delivered by trained physician, selected for interest in activity counselling, following written stage assessment completed in waiting room, and follow up phone call delivered by research team | Routine care – from physicians selected for lack of interest in activity counselling, given training in hepatitis B diagnosis and treatment | 4–6 weeks | Significantly more stage progression in intervention compared with control subjects (figures not given). 52% of intervention subjects regularly active at follow up compared with12% of control subjects. Intervention subjects reported 40 min increase in time spent walking per week compared with 10 min increase in control subjects (p<0.05) | Yes | N/A |
| Project PACE - 219 | 822 of 847 (97%) adults in all stages of activity change recruited in primary care by telephone assessment of all those booked to attend for a non-acute visit over the study period | USA | Randomised (by physician), controlled | Stage specific activity counselling delivered by trained physician following written stage assessment in waiting room + follow up ‘phone call at 1 month from research assistant +/− follow up phone calls at 2, 3 and 4 months and postcard reminders at 2, 3, 4 and 5 months | Routine care from physicians receiving minimal information on study (physicians randomly allocated to intervention or control groups) | 6 months | No overall intergroup differences in physical activity variables. Overall significantly more stage progression in intervention than control group: 33% (p=0.05) more contemplators made stage progression in intervention compared to control group. | Yes | N/A |
| Physically active for life20–22 | 322 of 355 (91%) sedentary subjects over 50, recruited in primary care by telephone assessment of all those booked to attend for a non-acute visit over the study period | USA | Randomised (by physician), controlled | Stage specific activity counselling delivered by trained physicians (who were paid to take part) following written stage assessment in waiting room + stage specific written information, a written exercise prescription, a free follow up clinic visit at 4 weeks and non-staged monthly mailings listing the benefits of exercise and local facilities | Routine care from physicians who received no intervention but were paid to take part | 6 weeks and 8 months | At 6 weeks, 89% of intervention group and 74% of control group were in preparation or action stage (p<0.001). 27% of intervention group and 21% of control group met activity recommendations (30 minutes of moderate exercise on 5+ days per week or 20 minutes of vigorous exercise on 3+ days per week) (p=0.27). At 8 months, 79% of intervention group and 88% of control group were in preparation or action stage (p=0.07). 28% of intervention group and 23% of control group met activity recommendations (p=0.41). | Yes | No |
| Newcastle exercise project23 | 442 of 523 (85%) sedentary adults recruited in primary care either opportunistically at appointments or via mailed invitations to participate | UK | Randomised (by individual), controlled | TTM based activity counselling delivered by trained lifestyle advisor +/− financial incentive. Four intervention groups: one interview, one interview plus tokens for free use of local leisure facilities (financial incentive), six interviews or six interviews plus financial incentive | Routine care – no further intervention from study team | 3 and 12 months | At 3 months, 55% of most intensive intervention group (six interviews & financial incentive) and 38% of combined intervention groups showed improved activity scores compared with 16% of controls (p=0.001). At 12 months, no intergroup differences (23% of controls and 26% of combined intervention groups showed increased activity scores, p>0.05). | Yes | No |
| Marcus et al24and Bock et al25 | 150 of 194 (77%) sedentary adults recruited through newspaper advertisements | USA | Randomised (by individual), controlled | Computer generated TTM based individualised written activity counselling compiled from a large bank of standardised messages in response to individuals reported stage of activity change and current activity levels + stage specific written activity information (as used in Jump Start to Health28) sent at baseline, 1 and 3 months | One of five non-staged written activity information developed by American Heart Association and of similar length to intervention information | 1, 3, 6 and 12 months | At 6 months, intervention group reported an average of 151.4 minutes of activity/week compared to 97.6 in control group (p<0.01) (improved from 5.5 and 20.0 minutes respectively at baseline). 43.6% of intervention group and 18.1% of control groups reached recommended levels of activity (30 minutes on 5 or more days/week) (p<0.05). 42.3% of intervention group and 18.8% of control group reached action stage of activity change (p<0.05). At 12 months, intervention group reported an average of 187 minutes of activity/week compared to 133 in control group (p=0.1). 42% of intervention group and 25% of control groups reached recommended levels of activity (p<0.05). 45.1% of intervention group and 23.5% of control group reached action/maintenance stage of activity change (p<0.05). | Yes | Yes |
| Jump start to health28 | 903 of 1559 (58%) adults in all stages of activity change, recruited from worksites involved in a wider health promotion intervention, exact recruitment method not stated | USA | Randomised (by individual), controlled | Stage specific written activity information on how to start and continue physical activity and facilities in their area – one pamphlet for each stage of change. Appropriate stage pamphlet delivered at baseline, and pamphlet for next consecutive stage delivered at one month | Two of five non-staged, “action orientated” written activity pamphlets developed by American Heart Association and of similar length to intervention information delivered at baseline and one month | 3 months | Overall, 31% of subjects showed stage progression: 37% of intervention group and 27% of control group (p<0.01). Overall, 13% of subjects showed stage regression : 11% of intervention group and 15% of control group. No significant effect of intervention on overall activity levels but those who showed stage progression, showed an average increase from 39 to 115 minutes of activity/week. | Yes | N/A |
| Project active5,29–31 | 190 of 235 (81%) sedentary adults recruited via mass media, word of mouth, and recontact of participants in previous studies | USA | Randomised (by individual), controlled | TTM based group activity counselling in groups of 10–13, weekly to week 16, fortnightly to week 24, monthly to week 52 and bimonthly to week 104. Monthly assessment of stage of activity change and delivery of appropriate stage matched activity pamphlet. Significant effort made to ensure attendance including reminder letters before and thank you letters after meetings and phone calls to non-attendees. | Free gym membership for 6 months. Three weeks of closely supervised instruction followed by less supervision and long term planning session with trainer at six months including receipt of all stage matched pamphlets used in intervention group. Participants encouraged to attend at least three gym sessions per week and contacted by phone if attended less than one session in any one week. | 6 and 24 months | At 6 months, both groups significantly increased physical activity and cardiorespiratory fitness. Control group increased fitness more than intervention group (p<0.001), no significant intergroup differences in activity levels or % meeting recommended activity levels (30 minutes of moderate intensity activity on most days of the week). At 24 months, both groups increased average energy expenditure from baseline (p<0.001 in intervention group and p=0.002 in control group). Intervention group increased moderate intensity activity 3 times more than control group (p=0.08), control group increased vigorous activity 2 times more than intervention group (p=0.07). No significant intergroup differences in activity levels. | No | No |
| Naylor et al32 | 180 of 294 (61%) adults in all stages of activity change, recruited in primary care from those attending routine health checks | UK | Non-randomised, controlled | TTM/non-TTM based brief (<5 minutes) activity counselling delivered by practice nurse +/− stage specific written activity information. Three intervention groups: TTM based counselling plus stage specific written information; written information only; non-TTM based brief activity counselling. All participants received information on, and discount vouchers for, local leisure facilities. | Standard practice advice including asking participants about current activity levels and giving advice at nurse’s discretion. | 2 and 6 months | At 2 months, overall, 25% showed stage progression compared with baseline (p=0.003). No intergroup differences in stage progression or activity levels. At 6 months, overall, 20% showed stage progression compared with baseline (p=0.009). No intergroup differences in stage progression or activity levels. Stage progression was not significantly associated with increased activity levels. No effect of time or intervention on activity levels. | No | N/A |
| Peterson and Aldana33 | 527 of 784 (67%) adults in all stages of activity change recruited by random sampling of all employees of a large telecommunications firm | USA | Randomised (by individual), controlled | Stage specific written activity information or generic written activity information. Two intervention groups: stage specific written information drawing on stages and processes of change or generic written information focusing on known benefits of exercise and recommended levels. Both interventions similar in size, layout, and length. | No intervention | 6 weeks | Subjects receiving staged information increased activity by 13%, those receiving generic information increased activity by 1% and control group decreased activity by 8% (p<0.05). 33% of staged intervention group showed stage progression, 19% of generic intervention, and 14% of control group (p<0.0001). | Yes | N/A |
| Change of heart34–36 | 473 of 699 (68%) adults with BMI>25 and taking part in less than 12 exercise sessions in last month recruited in primary care as part of multiple risk factor intervention project (targeting overweight and sedentary, smoking, high cholesterol) | UK | Randomised (by GP practice), controlled | TTM based activity counselling (2 or 3 sessions – depending on number of risk factors – of 20 minutes each) and 1 or 2 follow up phone calls delivered by practice nurses | Counselling from practice nurses not trained in TTM based counselling | 4 and 12 months | At 4 months, 32% of intervention and 24% of control subjects were in action/maintenance: odds of having moved into action/maintenance stage in intervention compared with control group was 1.89 (95% CI=1.07, 3.36). Intervention subjects had increased the number of sessions of exercise they undertook to 169% of baseline, control subjects had to decreased to 64% of baseline. At 12 months, 31% of intervention and 29% of control subjects in action/maintenance stage: odds ratio 1.68 (95% CI=1.08, 2.61). Intervention subjects had increased the number of sessions of exercise they undertook to 146% of baseline, control subjects had to decreased to 89% of baseline. | Yes | Yes |
| Hassler et al37 | 22 of 34 (65%) sedentary adults with type 1 diabetes mellitus recruited at 6 month diabetes review clinic | UK | Randomised (by individual), controlled | “Exercise consultation” (a 30 minute, one-to-one consultation based in TTM theory) | Non-staged written information | 3 weeks | Leisure time physical activity increased from 398 to 598 minutes per week in intervention group (p=0.045) and decreased from 420 to 376 minutes per week in control group (p>0.05). This represents a significant intergroup difference (p=0.025). | Yes | N/A |
| Kirk et al38 | 23 of 26 (88%) sedentary adults in contemplation or preparation stage with type 2 diabetes mellitus, recruited via patient databases and at diabetes outpatient clinics | UK | Randomised (by individual), controlled | “Exercise consultation” (a 30 minute, one-to-one consultation based in TTM theory) plus written information | Written information plus 30 minutes of non-exercise specific contact with researcher | 5 weeks | 82% of intervention group and 33% of control group showed stage progression (p=0.02). Electronic activity measurement showed 4% increase in intervention group and 9% decrease in control group (p value not given). Self reported participation in activity increased in 55% of intervention group and decreased in 6% of control group (p>0.05). | Yes | N/A |