EndocrinologyThe Most Effective Ways Of Promoting Physical Exercise In Adults, In Terms Of Health Benefits And Financial Cost
A study published this week in the open access journal PLoS Medicine has
found that of six interventions promoting exercise in adults in Australia,
encouraging the use of pedometers - simple step counting devices that can
be used as a motivational tool - and promoting physical activity through
mass media campaigns are the most cost-effective in terms of the money
spent for the health benefits they result in. Considered as a package,
researchers at the University of Queensland also conclude that these six
interventions could reduce death and illness from heart disease, stroke,
cancer and diabetes in Australia, with an overall cost saving for the
health sector.
Despite its image as a sporting nation, physical inactivity in Australia,
in common with many countries in the developed world and an increasing
number of developing countries, is a major public health problem. The
World Health Organisation recommends at least 30 minutes of moderate
physical
activity - which could just be brisk walking - five times per week, but at
least 60% of Australia"s population does not even do this modest
amount. In Australia, physical inactivity leads to 10% of all deaths,
largely as a result of cardiovascular disease and diabetes, and globally
it is
thought to cause 1.9 million deaths per year.
Linda Cobiac and colleagues at the University of Queensland reviewed the
medical literature to identify a range of interventions to promote
physical
activity and transport use in adults, which had evidence of effectiveness
and which were suitable programs to implement in Australia. They then
calculated the cost-effectiveness of six interventions. These included
TravelSmart - a program that targeted households in Australia with
information about walking paths, bus timetables, and offered incentives to
reduce reliance on the car. The six interventions also included two that
involved general practitioners (GPs): the standard practice amongst GPs
in Australia to screen and prescribe physical activity to inactive
patients
who visit them, as well as the practice of GPs referring patients to
counselling sessions with an exercise physiologist at their local general
practice. Internet advice on physical activity, the promotion of
pedometers in the community, and a mass media campaign that promoted
physical
activity and community events and activities, were also assessed.
A standardized approach has been developed to assess cost-effectiveness of
different physical activity programs that are suitable in an Australian
context, so the researchers were able to compare these six interventions.
They calculated the health outcomes of each intervention in terms of
disability adjusted life years (DALYs) - the number of healthy years of
life lost as a result of premature death or illness - through already
published data on how physical activity causes heart disease, stroke,
colon and breast cancer, and diabetes. Offsetting the financial cost of
each
intervention against the number of years of death or injury (or DALYs)
that the intervention averted, they concluded that the program promoting
the
pedometer as a motivational tool for physical exercise and the mass media
campaign were the most cost-effective. The GP practice of referring
patients
to an exercise physiologist was the least cost-effective, especially if
time and travel costs were considered.
Only the pedometer program and the mass media campaign of the six
interventions resulted in an overall cost-saving, but the researchers
stress that if
the six interventions are considered together "it is likely that the
package of interventions would not only be cost-effective by very likely
cost-saving to the health sector." The researchers point out that
questions remain about the long-term effectiveness of these programs, and
that the
quality of the evidence in the literature they reviewed varied. But
importantly, the standardized approach to cost-effectiveness offers a
model to
guide policy-makers in other countries to identify approaches to decrease
the burden of disease caused by cardiovascular disease, cancer and
diabetes
as a result of physical inactivity.
Note about the embargo for print publications in Australia: In order for
journalists working in print in Australia not to be at a disadvantage
print
publications in Australia may publish stories about this research on the
14th ahead of the 10AM embargo, but we expect all online coverage to
observe
the embargo.
Funding: This research was funded by an Australian National Health and
Medical Research Council Health Services Research grant (no. 351558,
http://www.nhmrc.gov.au/grants/types/granttype/strategic/healthserv.htm).
The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests
exist.
Citation:
"Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study."
Cobiac LJ, Vos T, Barendregt JJ (2009)
PLoS Med 6(7): e1000110. doi:10.1371/journal.pmed.1000110
PLoS Medicine