A Cochrane review [Abstract] 1 included 25 studies. The size of the community in which the intervention took place varied from small villages with a total population of less than 1 000 inhabitants to a large region with a population of 1 895 856. Of the studies, 16 studies were located in urban centres or cities, 9 in rural or remote settings. 19 were set in high income countries, the rest in low income countries. At least 2 of the following 6 strategies were applied in the included studies: 1) social marketing through local mass media; 2) other communication strategies (posters, flyers, information booklets, web sites, maps); 3) individual counselling by health professionals; 4) working with voluntary, government, and non-government organisations to encourage participation in walking, other activities, and events; 5) working within specific settings such as schools, workplaces, aged care centres, community centres, homeless shelters, and shopping malls; 6) environmental change strategies such as creation of walking trails and infrastructure. The studies were confounded by serious methodological issues, and the effects reported were inconsistent across the studies and the measures. Some of the better designed studies showed no improvement in measures of physical activity. The body of evidence does not support the hypothesis that multi-component community wide interventions effectively increase population levels of physical activity.
Comment: The quality of evidence is downgraded by limitations in study quality, byinconsistency (variability in results across studies, heterogeneity in interventions and outcomes) and bypotential selection and reporting bias.
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