The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
- Study design: included studies needed to be controlled intervention studies (e.g., randomized/non-randomized controlled studies, cross-over randomized/non-randomized studies, cluster randomized/non-randomized controlled studies, controlled before and after studies).
- Population: participants of all ages, with and without chronic diseases were included.
- Intervention: all types of interventions (interventions targeting the physical or social environment, personal behavior and multicomponent interventions) aiming at reducing sedentary time were deemed eligible, irrespective of whether sedentary time was the primary or secondary outcome.
- Control: any control condition was considered eligible; we included controls without intervention, waitlist controls and controls with an alternative intervention.
- Outcome: we included sedentary behavior across different domains of sitting or sedentary time.
- Setting: at least part of the intervention needed to have been implemented in Germany and results had to have been reported separately for Germany.
2.2. Search Strategy
2.3. Study Selection Process and Data Extraction
2.4. Data Synthesis
2.5. Risk of Bias Assessment
3. Results
3.1. Study Selection
3.2. Risk of Bias Assessment
3.3. Study Characteristics
Authors, Year, Funding Source, Trial Registry | Study Design, Health Promotion Program | Population | Intervention Duration, Follow-Up | Intervention Setting, Type of Intervention, Intervention Focus | Intervention Description | Control Condition | Assessment of Outcome, SB Outcomes |
---|---|---|---|---|---|---|---|
Children | |||||||
Brandes et al., 2020 [88] Steenbock et al., 2017 [90] “ German health insurance AOK DRKS00011065 | Cluster non-RCT JolinchenKids (JOKITA; fit and healthy in daycare) | Preschoolers, n = 144, age range: 3–6 y IG: n = 67, mean age: 4.1 y, gender: 46.8% male, 53.2% female CG: n = 77, mean age: 4.3 y, gender: 49.4% male, 50.6% female | 1 year 1 year | Daycare based Multicomponent intervention PA | Five modules: three focused on children (one on PA, nutrition and mental well-being each), one on parents, one on DF staff PA module: instructions for PA games, aim to create movement-friendly areas in DF, additionally: parents received newsletter once yearly and participated in joint activities twice yearly | Wait list | Quantitative (GENEActiv device) Domain SB: total sedentary behavior (min/day) |
De Bock et al., 2013 [75] Grant from Baden-Württemberg Stiftung * NCT00987532 | Cluster RCT Ene mene fit | Preschoolers, n = 528, age range: 4–6 y mean age: 5.05 y, gender: 52% boys, 48% girls IG: n = 248 CG: n = 280 | IG: 9 months CG: 6 months 6 months, 12 months | Daycare community based Multicomponent intervention PA | Non-participatory PA program: one-hour gym class (twice weekly over 6 months), one meeting of parents and gym class trainer Additionally: participatory intervention, incorporating parents, teachers and other preschool community members, website (www.ene-mene-fit.de (accessed on 2 July 2021)), introductory video, book with project ideas, gym trainers provided support to parents and preschool communities in implementing own interventions | Only non-participatory PA program | Quantitatve (Actiheart) Domain SB: total sedentary behavior (min/day) |
Verbestel et al., 2015 [89] ** Ahrens et al., 2011 [91] “ n/a | Cluster non-RCT Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) | Toddlers, preschoolers, school children, n = 1097, age range: 2–9.9 y | 2 years 2 years | Community, school and family based Multicomponent intervention SB/PA | Ten intervention modules:
| No intervention | Quantitative (ActiGraphTM GT1 M and ActiTrainerTM) Domain SB: total sedentary time (% of time) |
Kobel et al., 2020 [78] Funded by Baden-Württemberg Foundation DRKS00000494 | Cluster RCT Join the Healthy Boat | School children, n = 154, age range: 5–8 y IG: n = 102, mean age: 7 y, gender: 48% male, 52% female CG: n = 52, mean age: 7 y, gender: 42.3% male, 57.7% female | 1 year 1 year | School based Multicomponent intervention PA/SB | Primary school teachers trained to conduct change towards movement-friendly school environment and to promote healthy and active lifestyle in lessons, implemented short exercises twice daily to break up SB, held teaching units once weekly (containing 20 lessons dealing with health-related topics, 13 focused on PA and SB). To encourage parental involvement: six family homework assignments, two parents´ nights, additionally: parents received five letters (three were dealing with PA and SB) | No intervention, continued usual school curriculum | Quantitative (Actiheart) Domain SB: total sedentary time total week (min/day) Sedentary time weekdays (min/day) Sedentary time weekend (min/day) |
Sprengeler et al., 2020 [87] City of Ludwigsburg: height-adjustable standing desks, publication of article funded * | Cross-over RCT n/a | School children, n = 37, Age range: 8–10 y mean age: 8.4 y, gender: 38.5% boys, 61.5% girls G1: n = 19 G2: n = 18 | 2 weeks (each for G1, G2) 2 weeks, 9.43 weeks | School based Physical environment SB | First G1 received height-adjustable standing desks and G2 served as control. After washout period, G2 used height-adjustable standing desks and G1 served as control | Respective group serving as control used traditional working desks | Quantitative (activPAL inclinometer) Domain SB: total, school, leisure time Sitting time (min/day) Sitting time (% of total time during lessons, % of total time during breaks, % of total time during leisure time) |
Suchert et al., 2015 [76] German Cancer Aid: Primary Prevention of Cancer ISRCTN49482118 | Cluster RCT läuft | Teenagers, n = 1162, age range: 12–17 y IG: n = 702, mean age: 13.7 y, gender: 52.7% male, 47.3% female CG: n = 460, mean age: 13.79 y, gender: 50.9% male, 49.1% female | 12 weeks 12 weeks | School based Multicomponent intervention PA | Pedometers, could record and compare their steps on “läuft” homepage Classes participated in two competitions, attended educational lessons, schools and parents received information material | Regular education | Qualitative (survey) Domain SB: total sedentary behavior (h/day) |
Adults | |||||||
Voigt et al., 2018 [70] Federal Ministry of Education and Research NCT02990039 | RCT n/a | Adults, n = 138, age range: 40–65 y, mean age: 54.5, gender: 35.9% male, 64.1% female IG1: n = 69 IG2: n = 69 | 4 months (after split of IG1 and IG2) 1 month, 6 months, 12 months | Home based Personal behavior PA/SB | During first month, IG1 and IG2 were not split up, had an assessment only After separation: IG1 received letters at month 1, 3, 4 (letters were tailored via self-report assessing personal PA and SB behavior) | After separation, participants in IG2 received no letters (only assessed their PA and SB behavior via self-report) | Qualitative (IPAQ) Domain SB: total overall sedentary time (hours/week and sqrt min/week) |
Livingstone et al., 2020 [72] ** Work supported by European Commission under the Food, Agriculture, Fisheries and Biotechnology Theme * NCT01530139 | RCT Food4Me | Adults IG: n = 63 | 6 months 6 months | Web based Personal behavior PA | Participants randomized to intervention groups L1–L3, all participants received personalized dietary and PA advice but based on different sources (tailored feedback reports at baseline, month three, month six) L1: advised based on current PA and diet L2: additionally advised based on phenotypic data L3: additionally advice based on phenotypic and genotypic data | General (non-personalized) dietary and PA advice | Quantitative (triaxial accelerometer (Tracmor D)) Domain SB: total % of participants benefiting from the intervention (>5% reduction concerning sedentary time from baseline to month 6) |
Ellegast et al., 2012 [85] German Social Accident Insurance (DGUV) | RCT n/a | Office workers, n = 25, gender: 76% male, 24% female IG: n = 13 CG: n = 12 | 12 weeks 12 weeks | Work based Multicomponent intervention PA/SB | Intervention at the workplace (office), intervention included sit–stand tables, pedometers, face-to-face motivation for, e.g., lunch walks, incentives for bicycle commuting/sports activities | No intervention | Qualitative (activity log), quantitative (CUELA Activity System) Domain SB: office sitting time (min/day) Tasks carried out sitting (%) |
Pischke et al., 2022 [77] Federal Ministry of Education and Research (project 01EL1822A, 01EL1822F, 01EL1822l and 01EL1822C) DRKS00016073 | Cross-over randomized trial PROMOTE II | Older adults, n = 160, age range: 60–82y IG1 (WEB): n = 59, mean age: 67.9 y, gender: 36% male, 64% female IG2 (WEB+): n = 22, mean age: 70.5 y, gender: 53% male, 47% female IG3 (PRINT): n = 79, mean age: 67.6 y, gender: 24% male, 76% female | 9 months 3 months 9 months | Web and community based Personal behavior PA | WEB intervention group: online WHO PA recommendations, online brochures with instructions for exercises, online PA diary with weekly feedback, smartphone app with additional access to PA diary and exercises, additionally: 90 min weekly group session for 10 weeks After 10 weeks, participants had the option to cross over to another group, then group sessions continued once per month for 6 months WEB+ intervention group: same intervention and intervention materials online as participants in WEB group, additionally: PA tracker | PRINT group: same intervention and intervention materials as participants in WEB and WEB+ group but in printed form, did not receive PA tracker | Quantitative (GT3 x+) Domain SB: total sedentary time (min/day) Sedentary time in 30 min bouts (min/week) |
Muellmann et al., 2019 [71] German Federal Ministry of Education and Research DRKS00010052 | RCT PROMOTE study | Older adults, n = 405, age range: 62–79 y IG1: n = 146, mean age: 69.6 y, gender: 46.2% men, 53.8% women IG2: n = 119, mean age: 69.6 y, gender: 41.3% men, 58.7% women CG: n = 140, mean age: 69.8 y, gender: 42.6% men, 57.4% women | 10 weeks, 12 weeks | Web and community based Personal behavior PA | IG1: Access to website, weekly group meetings in their community led by trained staff, additionally: instruction brochures tailored to their PA levels and gender, were instructed to exercise regularly Functions of the website: track PA, weekly feedback on predetermined PA goals, online rewards if goals were reached, option to contact other participants IG2: Same intervention as IG1, additionally: Fitbit Zip | Delayed intervention (access to web-based PA intervention, but did not receive Fitbit or group meetings) | Quantitative (ActiGraph GT3 X+) Domain SB: total sedentary time (min/day) Sedentary time in 30 min bouts (min/week) |
Kleinke et al., 2021 [69] Federal Ministry of Education and Research (funding sign: 81Z7400174) DRKS00010410 | RCT Motivation-Oriented intervention study for the elderly in Greifswald (MOVING-study) | Older adults, n = 166 IG: n = 85, mean age: 70.4 y, gender: 41.2% male, 58.8% female CG: n = 81, mean age: 71.2 y, gender: 42% male, 58% female | 14 weeks 3 months 6 months | Home based Personal behavior PA/SB | Personalized feedback (based on accelerometer data) regarding their PA and SB via mail (after baseline and the 3-month follow-up examination), additionally: WHO PA recommendations | Did not receive any intervention, but received feedback concerning their accelerometer data after end of study | Quantitative (ActiGraph GT3 x-BT) Domain SB: total sedentary time (min/week) |
Salchow et al., 2021 [73] Authors received no funding DRKS00009453 | RCT Motivate Adolescent and Young Adults (MAYA) | Adults, people with chronic diseases (cancer survivors), n = 69, age range: 15–39 y IG: n = 36, mean age: 23.4 y, gender: 36.1% male, 63.9% female CG: n = 33, mean age: 25.3 y, gender: 48.5% male, 51.5% female | 12 weeks 12 weeks 52 weeks | Home based Personal behavior PA | Sixty minutes of personally tailored PA counselling, containing a PA anamnesis and the development of a personalized PA plan, additionally: PA guidelines for cancer survivors and list with local opportunities for PA | Usual care (consisting of the PA guidelines for cancer survivors) | Qualitative (IPAQ) Domain SB: total sitting (hours/day) |
Geidl et al., 2021 [74] German Pension Insurance * NCT02966561 | RCT Stay Active after Rehabilitation (STAR) | Adults, people with chronic diseases (COPD), n = 327 IG: n = 167, mean age: 58.01 y, gender: 68.7% male, 31.3% female CG: n = 160, mean age: 58.03 y, gender: 69.4% male, 30.6% female | 3 weeks 11 weeks 31 weeks | Stationary rehabilitation Personal behavior PA | Three-week stationary pulmonal rehabilitation, additionally, pedometer and two 45 min PA lessons | Same 3-week stationary rehabilitation as intervention group, instead of pedometer and PA lessons: repetition of PA information twice for 45 min | Quantitative (ActiGraph wGT3X) Domain SB: total sedentary time (min/day) |
Wagner et al., 2019 [86] German Social Accident Insurance (DGUV) DRKS00010777 | RCT n/a | Adults, people with chronic diseases (occupational respiratory diseases), n = 137, age range: 45–80 y, mean age: 69.1 y, gender: 95.9% male, 4.1% female IG: n = 67 CG: n = 70 | IG: 7 weeks CG: 4 weeks 4.53 months 8.53 months 14.53 months | Stationary rehabilitation Personal behavior PA | Standardized stationary rehabilitation (similarly to CG) and additional behavior-orientated movement intervention (three weeks, contained three 45 min group sessions per week, tailored work folder with tasks) | Four-week stationary, standardized rehabilitation (included personally tailored interventions and activities) | Quantitative (Actigraph GT3 x) Domain SB: total sedentary behavior (min/day) |
3.4. Description and Effectiveness of Interventions
3.4.1. Adults
3.4.2. Children and Adolescents
3.5. Meta-Analysis
4. Discussion
4.1. Recommendations to Effectively Reduce Sitting Time in Germany
4.2. Strengths and Limitations
4.3. Implications for Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Mugler, N.; Baurecht, H.; Lam, K.; Leitzmann, M.; Jochem, C. The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions. Int. J. Environ. Res. Public Health 2022, 19, 10178. https://doi.org/10.3390/ijerph191610178
Mugler N, Baurecht H, Lam K, Leitzmann M, Jochem C. The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions. International Journal of Environmental Research and Public Health. 2022; 19(16):10178. https://doi.org/10.3390/ijerph191610178
Chicago/Turabian StyleMugler, Nida, Hansjörg Baurecht, Kevin Lam, Michael Leitzmann, and Carmen Jochem. 2022. "The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions" International Journal of Environmental Research and Public Health 19, no. 16: 10178. https://doi.org/10.3390/ijerph191610178