TY - JOUR
T1 - The Effectiveness of Interventions and Intervention Components for Increasing Physical Activity and Reducing Sedentary Behaviour in People With Persistent Musculoskeletal Pain
T2 - A Systematic Review and Meta-Analysis
AU - Booth, Gregory
AU - Howarth, Ana
AU - Stubbs, Brendon
AU - Ussher, Michael
N1 - Funding Information:
Brendon Stubbs holds an NIHR Advanced fellowship (NIHR301206; Using data science to understand & improve pain in mental illness informing the development and testing of a feasibility trial, 2021-2026). Brendon is also a lead/co-investigator the following active grants 1) NIHR program grant: Supporting Physical and Activity through Co-production in people with Severe Mental Illness (SPACES,2021-2027); 2) TB multimorbidity with the Medical Research Council (GCRF call (2020-2022); 3) Determinants of MLTCs among young adults with mental disorders: a data-linkage study, Guy's & St Thomas' Charity (2020-2022); 4) Mechanisms underlying the role of gut-microbiota in exercise-induced changes in cognitive function in middle-age, Reta Lila Weston Trust For Medical Research (2021-2024); 5) Improving Outcomes in Mental and Physical Multi-morbidity and Developing Research Capacity (IMPACT) in South Asia, NIHR Global Research program grant (2017-2022).
Funding Information:
Gregory Booth undertook the majority of this work during an ICA Pre-doctoral Clinical Academic Fellowship supported by Health Education England and the National Institute for Health Research [Grant number: NIHR300342]. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. Brendon Stubbs holds an NIHR Advanced fellowship (NIHR301206; Using data science to understand & improve pain in mental illness informing the development and testing of a feasibility trial, 2021-2026). Brendon is also a lead/co-investigator the following active grants 1) NIHR program grant: Supporting Physical and Activity through Co-production in people with Severe Mental Illness (SPACES,2021-2027); 2) TB multimorbidity with the Medical Research Council (GCRF call (2020-2022); 3) Determinants of MLTCs among young adults with mental disorders: a data-linkage study, Guy's & St Thomas' Charity (2020-2022); 4) Mechanisms underlying the role of gut-microbiota in exercise-induced changes in cognitive function in middle-age, Reta Lila Weston Trust For Medical Research (2021-2024); 5) Improving Outcomes in Mental and Physical Multi-morbidity and Developing Research Capacity (IMPACT) in South Asia, NIHR Global Research program grant (2017-2022). Brendon Stubbs has published a book on exercise and mental illness and is on the Editorial board of Ageing Research Reviews, Mental Health and Physical Activity, The Journal of Evidence Based Medicine and The Brazilian Journal of Psychiatry. Brendon Stubbs has received honorarium for advisory work from ASICS Europe BV & Parachute for unrelated work. The views expressed are those of the author(s) and not necessarily those of mentioned above, the NHS, the NIHR, the Department of Health and Social Care, the MRC or GSTT. Author contributions: G. Booth and M. Ussher conceptualized the study. G. Booth, M. Ussher and B. Stubbs finalised the design and protocol. G. Booth conducted the search. G. Booth, A. Howarth and M. Ussher completed the screening and study selection, data extraction and risk-of-bias assessments. G. Booth and B. Stubbs conducted the data analysis, which was reviewed and confirmed by A. Howarth and M. Ussher. G. Booth and M. Ussher performed the GRADE assessments. All authors contributed to interpretation of the results. G. Booth wrote each version of the manuscript, which was reviewed by M. Ussher, A. Howarth and B. Stubbs. All authors approved the final version of the manuscript. The authors would also like to thank Stephen Reid, NHS Liaison Support Librarian at St. George's, University of London for assistance with the search strategy.
Funding Information:
Gregory Booth undertook the majority of this work during an ICA Pre-doctoral Clinical Academic Fellowship supported by Health Education England and the National Institute for Health Research [Grant number: NIHR300342]. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.
Publisher Copyright:
© 2021 United States Association for the Study of Pain, Inc.
PY - 2022/6
Y1 - 2022/6
N2 - This systematic review and meta-analysis investigated the effectiveness of physical activity (PA) and sedentary behavior (SB) interventions on PA and SB levels in people with persistent musculoskeletal pain. We explored the effectiveness of behavior change techniques (BCTs), the use of behavior change theory and non-PA/SB outcomes. Randomized controlled trials of PA or SB interventions for people with persistent musculoskeletal pain were eligible. Twenty-three studies were included. Quality of evidence was assessed using the GRADE approach. Meta-analysis demonstrated a small effect for PA post-intervention (Hedge's g =.321, CI.136–.507, P =.001, very low-quality evidence). There was no effect for longer-term follow-up PA (low quality evidence) or SB outcomes (very low-quality evidence). There was a small effect for studies with low risk-of-bias at longer-term follow-up PA. Self-report PA outcomes, PA and education interventions, non-self-selected PA, a combination of supervised and unsupervised PA and a combination of individual and group-based interventions had larger effects. Heterogeneity was moderate to considerable. Risk-of-bias, assessed using Cochrane risk-of-bias tool (version two), was generally low. Five promising BCTs were identified: “adding objects to the environment,” “goal setting (outcome),” “action planning,” “monitoring outcome(s) of behaviour by others without feedback” and “feedback on outcome(s) of behaviour.” In conclusion, there is evidence for a modest benefit for PA interventions immediately post-intervention, however the quality of evidence is very low. There was no evidence for longer-term follow-up PA or SB. Higher quality studies of PA and SB interventions that use objective measures are needed. PROSPERO registration: CRD42020180260. Perspective: This review investigated the effects of physical activity and sedentary behavior interventions on physical activity and sedentary behavior levels in people with persistent musculoskeletal pain. Current evidence shows a modest benefit for interventions on physical activity post-intervention but not at longer-term follow-up or on sedentary behavior at any time-point, however quality of evidence is low to very low.
AB - This systematic review and meta-analysis investigated the effectiveness of physical activity (PA) and sedentary behavior (SB) interventions on PA and SB levels in people with persistent musculoskeletal pain. We explored the effectiveness of behavior change techniques (BCTs), the use of behavior change theory and non-PA/SB outcomes. Randomized controlled trials of PA or SB interventions for people with persistent musculoskeletal pain were eligible. Twenty-three studies were included. Quality of evidence was assessed using the GRADE approach. Meta-analysis demonstrated a small effect for PA post-intervention (Hedge's g =.321, CI.136–.507, P =.001, very low-quality evidence). There was no effect for longer-term follow-up PA (low quality evidence) or SB outcomes (very low-quality evidence). There was a small effect for studies with low risk-of-bias at longer-term follow-up PA. Self-report PA outcomes, PA and education interventions, non-self-selected PA, a combination of supervised and unsupervised PA and a combination of individual and group-based interventions had larger effects. Heterogeneity was moderate to considerable. Risk-of-bias, assessed using Cochrane risk-of-bias tool (version two), was generally low. Five promising BCTs were identified: “adding objects to the environment,” “goal setting (outcome),” “action planning,” “monitoring outcome(s) of behaviour by others without feedback” and “feedback on outcome(s) of behaviour.” In conclusion, there is evidence for a modest benefit for PA interventions immediately post-intervention, however the quality of evidence is very low. There was no evidence for longer-term follow-up PA or SB. Higher quality studies of PA and SB interventions that use objective measures are needed. PROSPERO registration: CRD42020180260. Perspective: This review investigated the effects of physical activity and sedentary behavior interventions on physical activity and sedentary behavior levels in people with persistent musculoskeletal pain. Current evidence shows a modest benefit for interventions on physical activity post-intervention but not at longer-term follow-up or on sedentary behavior at any time-point, however quality of evidence is low to very low.
KW - meta-analysis
KW - persistent musculoskeletal pain
KW - physical activity
KW - sedentary behavior
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85122218162&partnerID=8YFLogxK
U2 - 10.1016/j.jpain.2021.11.004
DO - 10.1016/j.jpain.2021.11.004
M3 - Review article
AN - SCOPUS:85122218162
SN - 1526-5900
VL - 23
SP - 929
EP - 957
JO - JOURNAL OF PAIN
JF - JOURNAL OF PAIN
IS - 6
ER -