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Effectiveness of active school transport interventions: a systematic review and update
BACKGROUND: Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a c...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796594/ https://www.ncbi.nlm.nih.gov/pubmed/29390988 http://dx.doi.org/10.1186/s12889-017-5005-1 |
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author | Larouche, Richard Mammen, George Rowe, David A. Faulkner, Guy |
author_facet | Larouche, Richard Mammen, George Rowe, David A. Faulkner, Guy |
author_sort | Larouche, Richard |
collection | PubMed |
description | BACKGROUND: Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. METHODS: Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size. RESULTS: Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. CONCLUSIONS: Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. TRIAL REGISTRATION: Registered in PROSPERO: CRD42016033252 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-017-5005-1) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5796594 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57965942018-02-12 Effectiveness of active school transport interventions: a systematic review and update Larouche, Richard Mammen, George Rowe, David A. Faulkner, Guy BMC Public Health Research Article BACKGROUND: Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. METHODS: Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size. RESULTS: Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. CONCLUSIONS: Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. TRIAL REGISTRATION: Registered in PROSPERO: CRD42016033252 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-017-5005-1) contains supplementary material, which is available to authorized users. BioMed Central 2018-02-01 /pmc/articles/PMC5796594/ /pubmed/29390988 http://dx.doi.org/10.1186/s12889-017-5005-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Larouche, Richard Mammen, George Rowe, David A. Faulkner, Guy Effectiveness of active school transport interventions: a systematic review and update |
title | Effectiveness of active school transport interventions: a systematic review and update |
title_full | Effectiveness of active school transport interventions: a systematic review and update |
title_fullStr | Effectiveness of active school transport interventions: a systematic review and update |
title_full_unstemmed | Effectiveness of active school transport interventions: a systematic review and update |
title_short | Effectiveness of active school transport interventions: a systematic review and update |
title_sort | effectiveness of active school transport interventions: a systematic review and update |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796594/ https://www.ncbi.nlm.nih.gov/pubmed/29390988 http://dx.doi.org/10.1186/s12889-017-5005-1 |
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