Behaviour change interventions to increase physical activity in hospitalized patients: A systematic review, meta-analysis and meta-regression

Abstract

Background: Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. Objective: This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalized patients.Methods: Randomized controlled trials of behaviour change interventions to increase physical activity in hospitalized patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesized with random effects meta-analyses and and meta-regression analyses, applying GRADE criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. Results: Twenty randomized controlled trials of behaviour change interventions involving 2568 participants (weighted mean age 67 years) included 6 trials with a high risk of bias. There was moderate certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14 to 0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05 to 0.53) and feedback (excluding high risk of biastrials) (SMD 0.35, 95% CI 0.11 to 0.60) were independently associated with increased physical activity. Conclusions: Targeted behaviour change interventions were associated with increases in physical activity in hospitalized patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital.