Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy

Johan de Jong, Gesa Czwikla, Filip Boen, Derek G. Cook, Tess Harris, Lisa K. Hilz, Steve Iliffe, Lilian Lechner, Richard W. Morris, Saskia Muellmann, Denise A. Peels, Claudia R. Pischke, Benjamin Schüz, Martin Stevens, Klaus Telkmann, Frank J. van Lenthe, Julie Vanderlinden, Gabriele Bolte

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration.

METHODS: The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis.

RESULTS: The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status.

CONCLUSIONS: To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.

Original languageEnglish
Article number65 (2021)
Number of pages17
JournalJournal of Behavioral Nutrition and Physical Activity
Volume18
Issue number65 (2021)
DOIs
Publication statusPublished - 17 May 2021

Keywords

  • physical activity
  • social inequalities
  • equity impact assessment
  • older adults

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