This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity.
Data Source.
A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus.
Study Inclusion and Exclusion Criteria.
Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded.
Data Extraction.
Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace.
Data Synthesis.
The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account.
Results.
The most efficient interventions to increase physical activity were community rail-trails ($.006/MET-h), pedometers ($.014/MET-h), and school health education programs ($.056/MET-h).
Conclusion.
Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.
US Dept of Health and Human Services. Physical Activity and Health. A Report of the Surgeon General 1996. Atlanta, Ga: Centers for Disease Control and Prevention; 1996.
2.
ColditzGA. Economic costs of obesity and inactivity. Med Sci Sports Exerc. 1999;31:S663–S667.
3.
PrattMNorrisJLobeloF. The cost of physical inactivity: Moving into the 21st century. Br J Sports Med.2014;48:171–173.
4.
RouxLPrattMTengsTO. Cost effectiveness of community-based physical activity interventions. Am J Prev Med.2008;35:578–588.
5.
SevickMABradhamDDMuenderM. Cost-effectiveness of aerobic and resistance exercise in seniors with knee osteoarthritis. Med Sci Sports Exerc. 2000;32:1534–1540.
6.
SevickMADunnALMorrowMS. Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: Results of project ACTIVE. Am J Prev Med.2000;19:1–8.
7.
WolfenstetterSBWenigCM. Economic evaluation and transferability of physical activity programmes in primary prevention: A systematic review. Int J Environ Res Public Health. 2010;7:1622–1648.
8.
Centre for Reviews and Dissemination. CRD's Guidance for Undertaking Reviews in Health Care. Layerthorpe, York: York Publishing Services Ltd; 2009.
9.
ArmstrongRWatersEJacksonN. Guidelines for Systematic Reviews of Health Promotion and Public Health Interventions. Version 2. Melbourne, Australia: Melbourne University; 2007.
10.
MoherDLiberatiATetzlaffJAltmanDG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg.2010;8:336–341.
11.
DrummondMFJeffersonTO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ economic evaluation working party. BMJ. 1996;313:275–283.
12.
EversSGoossensMde VetH. Criteria list for assessment of methodological quality of economic evaluations: Consensus on health economic criteria. Int J Technol Assess Health Care. 2005;21:240–245.
13.
LangerA. A framework for assessing health economic evaluation (HEE) quality appraisal instruments. BMC Health Serv Res.2012;12:253.
14.
WuSCohenDShiY. Economic analysis of physical activity interventions. Am J Prev Med.2011;40:149–158.
15.
AinsworthBEHaskellWLWhittMC. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(suppl 9):S498–S504.
MoodieMHabyMMSwinburnBCarterR. Assessing cost-effectiveness in obesity: Active transport program for primary school children—TravelSMART schools curriculum program. J Phys Act Health. 2011;8:503–515.
22.
AbildsoCGZizziSJSelinSGordonPM. Assessing the cost effectiveness of a community rail-trail in achieving physical activity gains. J Park Recreat Admi.2012;30:102–113.
23.
CohenDAMarshTWilliamsonS. Impact and cost-effectiveness of family fitness zones: A natural experiment in urban public parks. Health Place. 2012;18:39–45.
24.
DallatMASoerjomataramIHunterRF. Urban greenways have the potential to increase physical activity levels cost-effectively. Eur J Public Health. 2014;24:190–195.
25.
GuoJYGandavarapuS. An economic evaluation of health-promotive built environment changes. Prev Med.2010;50(suppl 1):S44–S49.
26.
StokesRJMacDonaldJRidgewayG. Estimating the effects of light rail transit on health care costs. Health and Place. 2008;14:45–58.
27.
WangGMaceraCAScudder-SoucieB. Cost effectiveness of a bicycle/pedestrian trail development in health promotion. Prev Med.2004;38:237–242.
28.
PringleACookeCGilsonN. Cost-effectiveness of interventions to improve moderate physical activity: A study in nine UK sites. Health Educ J.2010;69:211–224.
29.
CobiacLJVosTBarendregtJJ. Cost-effectiveness of interventions to promote physical activity: A modelling study. PLoS Med.2009;6:e1000110.
30.
McEachanRRLawtonRJJacksonC. Testing a workplace physical activity intervention: A cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2011;8:29.
31.
OlanderEKEvesFF. Effectiveness and cost of two stair-climbing interventions-less is more. Am J Health Promot. 2011;25:231–236.
32.
PetersonMChandleeMAbrahamA. Cost-effectiveness analysis of a statewide media campaign to promote adolescent physical activity. Health Promot Pract. 2008;9:426–433.
33.
De SmedtDDe CockerKAnnemansL. A cost-effectiveness study of the community-based intervention “10 000 Steps Ghent.”Public Health Nutr.2012;15:442–451.
34.
FrewEJBhattiMWinK. Cost-effectiveness of a community-based physical activity programme for adults (be active) in the UK: An economic analysis within a natural experiment. Br J Sports Med.2014;48:207–212.
35.
HaerensLDeforcheBMaesL. Evaluation of a 2-year physical activity and healthy eating intervention in middle school children. Health Educ Res.2006;21:911–921.
36.
HaerensLDeforcheBVandelanotteC. Acceptability, feasibility and effectiveness of a computer-tailored physical activity intervention in adolescents. Patient Educ Couns. 2007;66:303–310.
37.
Manios Y, Kafatos A, Preventive Medicine and Nutrition Clinic University of Crete Research Team. Health and nutrition education in primary schools in Crete: 10 years follow-up of serum lipids, physical activity and macronutrient intake. Br J Nutr.2006;95:568–575.
38.
McKenzieTLNaderPRStrikmillerPK. School physical education: Effect of the child and adolescent trial for cardiovascular health. Prev Med.1996;25:423–431.
39.
VerstraeteSJCardonGMDe ClercqDLDe BourdeaudhuijIM. Increasing children's physical activity levels during recess periods in elementary schools: The effects of providing game equipment. Eur J Public Health. 2006;16:415–419.
40.
De CockerKADe BourdeaudhuijIMBrownWJCardonGM. Effects of “10,000 steps Ghent.” A whole-community intervention. Am J Prev Med.2007;33:455–463.
BrownsonRCHousemannRABrownDR. Promoting physical activity in rural communities: Walking trail access, use, and effects. Am J Prev Med.2000;18:235–241.
43.
BravataDMSmith-SpanglerCSundaramV. Using pedometers to increase physical activity and improve health: A systematic review. JAMA. 2007;298:2296–2304.
44.
KahnEBRamseyLTBrownsonRC. The effectiveness of interventions to increase physical activity: A systematic review. Am J Prev Med.2002;22(suppl 1):73–107.
45.
WangGMaceraCAScudder-SoucieB. Cost analysis of the built environment: The case of bike and pedestrian trials in Lincoln, Neb. Am J Public Health. 2004;94:549–553.
