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Theory-based interventions to promote physical activity: Lessons learned
from a meta-analysis (regression) including 77 randomized controlled trials
Bernard Pabcd
, Carayol Mab
, Gourlan Ma,b,e
,Boiché Ja,b
,Romain AJa,b,f
,Bortolon Ca,b,g
, Lareyre O a,b,e
, Ninot Ga,b
a Laboratory Epsylon, University of Montpellier
b Challenge for the Change of Behaviour (CCB) group
c Département des Sciences de l'Activité Physique, Université du Québec à Montréal, QC, Canada
d Institut Universitaire en Santé Mentale de Montréal, QC, Canada
e Prevention Department of Institut Regional du Cancer de Montpellier
f Unit of Nutrition and Diabetes & University Department of Adult Psychiatry, CHU de Montpellier
g
University Department of Adult Psychiatry, CHU de Montpellier
Gourlan et al. 2016/Bernard et al (in press)
Public Health
Respiratory Medicine
Prevention
Psychology
of Physical Activity
& Health
Evidence Based
Medicine (RCT)
EFFICACY ???
Gourlan et al. 2016/Bernard et al (in press)
EFFICACY ???
Moderators
Ioannidis et al. (2007). Uncertainty in heterogeneity estimates in meta-analyses. BMJ
Coyne et al. (2010). Ain’t necessarily so: review and critique of recent meta-analyses of behavioral
medicine interventions. Health Psy
Public Health
Respiratory Medicine
Prevention
Psychology
of Physical Activity
& Health
Evidence Based
Medicine (RCT)
Gourlan et al. 2016/Bernard et al (in press)
Public Health
Respiratory Medicine
Prevention
Participants : age, sex, chronic illness
Interventions : length, mode of delivery, care givers
Comparisons : alternative treatment intervention
Outcomes : self-report questionnaire, objective measure
Gourlan et al. 2016/Bernard et al (in press)
Psychology
of Physical Activity
& Health
Theoretical implementation quality
Michie & Prestwich (2010). Health Psy
Gourlan et al. 2016/Bernard et al (in press)
Evidence Based
Medicine (RCT)
Gourlan et al. 2016/Bernard et al (in press)
Aims
1- to investigate the efficacy of theory-based PA promotion interventions in adult individuals
2- to examine and compare the efficacy of PA promotion interventions according to the
theory they were based on
3- to assess and compare the efficacy of PA promotion interventions based on a single
theory and that of interventions based on combined theories
4- Investigate the moderation effect of
(a) sample and intervention characteristics,
(b) theoretical implementation quality criteria
(c) methodological quality criteria
on the efficacy of theory-based interventions devoted to PA in RCTs
Gourlan et al. 2016/Bernard et al (in press)
Inclusion Criteria
Participants
Adults (≥ 18 years)
Intervention
At least one theoretical framework(s) explicitly mentioned in the text.
They could target only PA, or PA and other outcomes
Comparison
Control group (minimal intervention, attention placebo or active comparison control
condition)
Outcomes
PA as a primary or secondary outcome (self-reported or objective–measurement)
Design only Randomized Controlled Trials
Liberati et al., 2007. Plos Med
Gourlan et al. 2016/Bernard et al (in press)
11 theories used
Gourlan et al. 2016/Bernard et al (in press)
Public Health
Respiratory Medicine
Prevention
Psychology
of Physical Activity
& Health
Evidence Based
Medicine (RCT)
Coding procedures
- age, sex, sample, comparison conditions
- supervised PA, frequency of sessions, intervention length, number
of experimental participants
Total quality score +
|_____ 3 items
sample size
blinding
description of care providers or centers
Total implementation score +
|_____ 3 items from the Theory Coding Scheme
Gourlan et al. 2016/Bernard et al (in press)
Statistical analyses
Step 1
Effect sizes of interventions on PA behavior were calculated using Cohen’s d
Heterogeneity = Q test + I² statistic (Higgins, Thompson, Deeks, & Altman, 2003)
Step 2
Univariate meta-regression (model + combined model)
Step 3
Each variable of interest was first tested as a moderator of PA intervention efficacy in
random effects bivariate meta-regression models (p < .10)
Step 3
Multivariable random effects meta-regression model.
Gourlan et al. 2016/Bernard et al (in press)
Gourlan et al. 2016/Bernard et al (in press)
Results
Transtheoretical Model, Social Cognitive Theory, Theory of Planned Behavior, Self-
Determination Theory and Protection Motivation Theory.
Sample sizes in experimental arms
|_____M = 129 individuals (SD = 206, med = 70, range: 11 to 1,529)
Age
|_____M = 48.4 years (SD = 13.93)
Length of interventions
|_____M = 25.3 weeks (SD = 25.5, median = 14.0, range: 2 to 104 weeks).
Face-to-face
|_____41 (50%) of interventions
Control groups
|_____ minimal intervention 36 (44%)
no intervention 18 (22%)
active control 16 (19%)
attention placebo 12 (15%)
Gourlan et al. 2016/Bernard et al (in press)
Gourlan et al. 2016/Bernard et al (in press)
Methodological global scores 2 to 11 (M = 6.3, SD = 2.0)
Theoretical implementation score 1 to 8 (M = 6.4, SD = 2.0)
Gourlan et al. 2016/Bernard et al (in press)
Effect size
d = 0.31, 95% CI [0.24, 0.37]
(Q = 348.52, p < .001, I2
= 76.9%)
?
Gourlan et al. 2016/Bernard et al (in press)
Moderator
Inter
venti
ons
d [95 % CI] I2 Qw Qb
Theory used
5.26
SDT 5 0.61 [0.32, 0.89] 51.28 8.21*
SCT 16 0.42 [0.28, 0.56] 42.89 26.26*
TTM 31 0.31 [0.20, 0.42] 80.13 151.01***
TPB 8 0.26 [0.03, 0.48] 83.22 41.72***
Single- vs combined-
theory interventions
4.03*
Single theory 61 0.35 [0.26, 0.43] 77.85 270.99***
Combined theories 21 0.21 [0.11, 0.32] 73.13 74.44***
Gourlan et al. 2016/Bernard et al (in press)
Gourlan et al. 2016/Bernard et al (in press)
Moderators
Intervention length (≥14 vs. <14 weeks)
β = -0.22, 95% CI: −0.375 to −0.072, p = .004
Number of experimental participants
β = -0.10, 95% CI: −0.162 to −0.040, p = .002
Total methodological quality score
β = -0.08, 95% CI: −0.167 to −0.002, p = .04
Adjusted R2 = 31%, F (3, 62) = 7.83, p < .001.
Residual heterogeneity (I2 = 74%)
Gourlan et al. 2016/Bernard et al (in press)
Lessons learned
1- Efficacy of theory-based interventions to promote PA could be OVERESTIMATED due to
methodological weaknesses of RCTs.
2- Smaller sample sizes in RCTs were associated with higher efficacy of interventions
on PA behavior.
consistent with previous meta-analyses
psychotherapy (Cuijpers et al. 2010)
rehabilitation (Nüesch et al., 2010)
pharmacotherapy (Dechartres et al. 2013, BMJ)
3- Possible ceiling effect after 14 weeks of intervention
Optimal PA behavior change during the first 3 months of intervention
4- “Theory-inspired” or “Theory-driven” ? (Michie & Johnston, 2012)
5- Theoretical implementation (done and/or (mis)reported )
Gourlan et al. 2016/Bernard et al (in press)
Lessons learned
5- Theory-based >>>> theories based (based on evidence)
6- No evidence of superiority among
Transtheoratical model
Self Determination Theory
Social-cognitive Theory
Theory of planned behavior
Gourlan et al. 2016/Bernard et al (in press)
Bernard P, Carayol M, Gourlan, Boiché, Romain AJ J M.Bortholon C, Lareyre O, Ninot G, Moderators of theory-
based interventions to promote physical activity in 77 randomized controlled trials. (in press)
Gourland M, Bernard P, Bortholon C, Romain AJ, Lareyre O, Carayol M, Ninot G, Boiché J. Efficacy of theory-based
interventions to promote physical activity. A meta-analysis of randomized controlled trials. Health Psychology
Review (2016).
bernard.paquito@uqam.ca
Collaborative work !!!!
Un grand merci à tous mes anciens collègues de
Monptellier

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Theory-based interventions to promote physical activity: Lessons learned from a meta-analysis (regression) including 77 randomized controlled trials

  • 1. Theory-based interventions to promote physical activity: Lessons learned from a meta-analysis (regression) including 77 randomized controlled trials Bernard Pabcd , Carayol Mab , Gourlan Ma,b,e ,Boiché Ja,b ,Romain AJa,b,f ,Bortolon Ca,b,g , Lareyre O a,b,e , Ninot Ga,b a Laboratory Epsylon, University of Montpellier b Challenge for the Change of Behaviour (CCB) group c Département des Sciences de l'Activité Physique, Université du Québec à Montréal, QC, Canada d Institut Universitaire en Santé Mentale de Montréal, QC, Canada e Prevention Department of Institut Regional du Cancer de Montpellier f Unit of Nutrition and Diabetes & University Department of Adult Psychiatry, CHU de Montpellier g University Department of Adult Psychiatry, CHU de Montpellier
  • 2. Gourlan et al. 2016/Bernard et al (in press) Public Health Respiratory Medicine Prevention Psychology of Physical Activity & Health Evidence Based Medicine (RCT) EFFICACY ???
  • 3. Gourlan et al. 2016/Bernard et al (in press) EFFICACY ??? Moderators Ioannidis et al. (2007). Uncertainty in heterogeneity estimates in meta-analyses. BMJ Coyne et al. (2010). Ain’t necessarily so: review and critique of recent meta-analyses of behavioral medicine interventions. Health Psy Public Health Respiratory Medicine Prevention Psychology of Physical Activity & Health Evidence Based Medicine (RCT)
  • 4. Gourlan et al. 2016/Bernard et al (in press) Public Health Respiratory Medicine Prevention Participants : age, sex, chronic illness Interventions : length, mode of delivery, care givers Comparisons : alternative treatment intervention Outcomes : self-report questionnaire, objective measure
  • 5. Gourlan et al. 2016/Bernard et al (in press) Psychology of Physical Activity & Health Theoretical implementation quality Michie & Prestwich (2010). Health Psy
  • 6. Gourlan et al. 2016/Bernard et al (in press) Evidence Based Medicine (RCT)
  • 7. Gourlan et al. 2016/Bernard et al (in press) Aims 1- to investigate the efficacy of theory-based PA promotion interventions in adult individuals 2- to examine and compare the efficacy of PA promotion interventions according to the theory they were based on 3- to assess and compare the efficacy of PA promotion interventions based on a single theory and that of interventions based on combined theories 4- Investigate the moderation effect of (a) sample and intervention characteristics, (b) theoretical implementation quality criteria (c) methodological quality criteria on the efficacy of theory-based interventions devoted to PA in RCTs
  • 8. Gourlan et al. 2016/Bernard et al (in press) Inclusion Criteria Participants Adults (≥ 18 years) Intervention At least one theoretical framework(s) explicitly mentioned in the text. They could target only PA, or PA and other outcomes Comparison Control group (minimal intervention, attention placebo or active comparison control condition) Outcomes PA as a primary or secondary outcome (self-reported or objective–measurement) Design only Randomized Controlled Trials Liberati et al., 2007. Plos Med
  • 9. Gourlan et al. 2016/Bernard et al (in press) 11 theories used
  • 10. Gourlan et al. 2016/Bernard et al (in press) Public Health Respiratory Medicine Prevention Psychology of Physical Activity & Health Evidence Based Medicine (RCT) Coding procedures - age, sex, sample, comparison conditions - supervised PA, frequency of sessions, intervention length, number of experimental participants Total quality score + |_____ 3 items sample size blinding description of care providers or centers Total implementation score + |_____ 3 items from the Theory Coding Scheme
  • 11. Gourlan et al. 2016/Bernard et al (in press) Statistical analyses Step 1 Effect sizes of interventions on PA behavior were calculated using Cohen’s d Heterogeneity = Q test + I² statistic (Higgins, Thompson, Deeks, & Altman, 2003) Step 2 Univariate meta-regression (model + combined model) Step 3 Each variable of interest was first tested as a moderator of PA intervention efficacy in random effects bivariate meta-regression models (p < .10) Step 3 Multivariable random effects meta-regression model.
  • 12. Gourlan et al. 2016/Bernard et al (in press)
  • 13. Gourlan et al. 2016/Bernard et al (in press) Results Transtheoretical Model, Social Cognitive Theory, Theory of Planned Behavior, Self- Determination Theory and Protection Motivation Theory. Sample sizes in experimental arms |_____M = 129 individuals (SD = 206, med = 70, range: 11 to 1,529) Age |_____M = 48.4 years (SD = 13.93) Length of interventions |_____M = 25.3 weeks (SD = 25.5, median = 14.0, range: 2 to 104 weeks). Face-to-face |_____41 (50%) of interventions Control groups |_____ minimal intervention 36 (44%) no intervention 18 (22%) active control 16 (19%) attention placebo 12 (15%)
  • 14. Gourlan et al. 2016/Bernard et al (in press)
  • 15. Gourlan et al. 2016/Bernard et al (in press) Methodological global scores 2 to 11 (M = 6.3, SD = 2.0) Theoretical implementation score 1 to 8 (M = 6.4, SD = 2.0)
  • 16. Gourlan et al. 2016/Bernard et al (in press) Effect size d = 0.31, 95% CI [0.24, 0.37] (Q = 348.52, p < .001, I2 = 76.9%) ?
  • 17. Gourlan et al. 2016/Bernard et al (in press) Moderator Inter venti ons d [95 % CI] I2 Qw Qb Theory used 5.26 SDT 5 0.61 [0.32, 0.89] 51.28 8.21* SCT 16 0.42 [0.28, 0.56] 42.89 26.26* TTM 31 0.31 [0.20, 0.42] 80.13 151.01*** TPB 8 0.26 [0.03, 0.48] 83.22 41.72*** Single- vs combined- theory interventions 4.03* Single theory 61 0.35 [0.26, 0.43] 77.85 270.99*** Combined theories 21 0.21 [0.11, 0.32] 73.13 74.44***
  • 18. Gourlan et al. 2016/Bernard et al (in press)
  • 19. Gourlan et al. 2016/Bernard et al (in press) Moderators Intervention length (≥14 vs. <14 weeks) β = -0.22, 95% CI: −0.375 to −0.072, p = .004 Number of experimental participants β = -0.10, 95% CI: −0.162 to −0.040, p = .002 Total methodological quality score β = -0.08, 95% CI: −0.167 to −0.002, p = .04 Adjusted R2 = 31%, F (3, 62) = 7.83, p < .001. Residual heterogeneity (I2 = 74%)
  • 20. Gourlan et al. 2016/Bernard et al (in press) Lessons learned 1- Efficacy of theory-based interventions to promote PA could be OVERESTIMATED due to methodological weaknesses of RCTs. 2- Smaller sample sizes in RCTs were associated with higher efficacy of interventions on PA behavior. consistent with previous meta-analyses psychotherapy (Cuijpers et al. 2010) rehabilitation (Nüesch et al., 2010) pharmacotherapy (Dechartres et al. 2013, BMJ) 3- Possible ceiling effect after 14 weeks of intervention Optimal PA behavior change during the first 3 months of intervention 4- “Theory-inspired” or “Theory-driven” ? (Michie & Johnston, 2012) 5- Theoretical implementation (done and/or (mis)reported )
  • 21. Gourlan et al. 2016/Bernard et al (in press) Lessons learned 5- Theory-based >>>> theories based (based on evidence) 6- No evidence of superiority among Transtheoratical model Self Determination Theory Social-cognitive Theory Theory of planned behavior
  • 22. Gourlan et al. 2016/Bernard et al (in press) Bernard P, Carayol M, Gourlan, Boiché, Romain AJ J M.Bortholon C, Lareyre O, Ninot G, Moderators of theory- based interventions to promote physical activity in 77 randomized controlled trials. (in press) Gourland M, Bernard P, Bortholon C, Romain AJ, Lareyre O, Carayol M, Ninot G, Boiché J. Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomized controlled trials. Health Psychology Review (2016). bernard.paquito@uqam.ca Collaborative work !!!! Un grand merci à tous mes anciens collègues de Monptellier