Improving Current Practice in Reviews of the Built Environment and Physical Activity

Sports Medicine, Oct 2014

Over the last decade, there has been a marked increase in studies about built environments and physical activity. As the number of publications is growing rapidly, literature reviews play an important role in identifying primary studies and in synthesizing their findings. However, many of the reviews of effectiveness in this field demonstrate methodological limitations that might lead to inaccurate portrayals of the evidence. Some literature reviews a priori excluded intervention studies even though they provide the strongest level of evidence. The label ‘systematic review’ has mostly been used inappropriately. One of the major criteria of a systematic review that is hardly ever met is that the quality of the primary studies needs to be assessed and this should be reflected in the synthesis, presentation and interpretation of results. With few exceptions, ‘systematic’ reviews about environments and physical activity did not refer to or follow the QUORUM or PRISMA statements. This commentary points out the usefulness of the PRISMA statement to standardize the reporting of methodology of reviews and provides additional guidance to limit sources of bias in them. The findings and recommendations from this article can help in moving forward the synthesis of evidence of effectiveness not only in built environments and physical activity, but also more broadly in exercise science and public health.

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Improving Current Practice in Reviews of the Built Environment and Physical Activity

Klaus Gebel 0 1 2 3 Ding Ding 0 1 2 3 Charlie Foster 0 1 2 3 Adrian E. Bauman 0 1 2 3 James F. Sallis 0 1 2 3 0 C. Foster British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford , Oxford, UK 1 K. Gebel D. Ding A. E. Bauman Prevention Research Collaboration, Sydney School of Public Health, University of Sydney , Sydney, NSW, Australia 2 K. Gebel (&) Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University , Cairns, QLD, Australia 3 J. F. Sallis Active Living Research, Department of Family and Preventive Medicine, University of California San Diego , La Jolla, CA, USA Over the last decade, there has been a marked increase in studies about built environments and physical activity. As the number of publications is growing rapidly, literature reviews play an important role in identifying primary studies and in synthesizing their findings. However, many of the reviews of effectiveness in this field demonstrate methodological limitations that might lead to inaccurate portrayals of the evidence. Some literature reviews a priori excluded intervention studies even though they provide the strongest level of evidence. The label 'systematic review' has mostly been used inappropriately. One of the major criteria of a systematic review that is hardly ever met is that the quality of the primary studies needs to be assessed and this should be reflected in the synthesis, presentation and interpretation of results. With few exceptions, 'systematic' reviews about environments and physical activity did not refer to or follow the QUORUM or PRISMA statements. This commentary points out the usefulness of the PRISMA statement to standardize the reporting of methodology of reviews and provides additional guidance to limit sources of bias in them. The findings and recommendations from this article can help in moving forward the synthesis of evidence of effectiveness not only in built environments and physical activity, but also more broadly in exercise science and public health. 1 Introduction Over the last decade there has been a marked increase in publications about built environments and physical activity [1]. There has also been a substantial policy response with governmental and non-governmental agencies recommending environmental strategies to counter the epidemics of low physical activity, sedentariness and obesity while addressing common cross-sectoral goals including traffic congestion and safety, air pollution and climate change [25]. As the number of publications in this field is growing rapidly, it is becoming increasingly challenging for researchers and policy makers to keep track of the evidence base. Literature reviews play an important role in identifying primary studies and in summarizing and synthesizing their findings. Moreover, the rapidly growing evidence base requires that reviews be regularly updated [6]. Just as the quality of primary studies can vary, the methodological quality of review articles can vary substantially and affect their conclusions [7, 8]. A 2007 article critically appraised methodological aspects of literature reviews about built environments and physical activity. The main findings were that reviews inappropriately claimed to be systematic, did not provide important methodological information, omitted large numbers of relevant studies, and reported some study results incorrectly [9]. Since then, hundreds of primary studies and dozens of literature reviews about environments and physical activity have been published [1016]. Many of the new literature reviews continue to demonstrate methodological limitations that might lead to an inaccurate summary of the evidence. This commentary re-emphasizes the importance of methodological rigor in literature reviews of effectiveness by (i) describing common problems in recent literature reviews, and (ii) providing guidance for future reviews on environments and physical activity. 2 Strength of Evidence It is increasingly accepted that reviews of the effectiveness of public health interventions should start with a categorization of the evidence, ranking studies based on the strength of the evidence, starting with the strongest research designs and studies that minimized selection, measurement and confounding bias [17]. So far, only a few studies on the health effects of built environments managed to randomly assign individuals [1820] or settings [21]. As randomization is virtually impossible to achieve in this research field, there have been calls for more opportunistic evaluations of environmental interventions [22, 23]. In a framework for evidence-based public health regarding built environments and physical activity, controlled prospective evaluations of environmental interventions and evaluations of peoples activity level before and after they relocate between neighborhoods of different urban forms provide the highest level of evid (...truncated)


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Klaus Gebel, Ding Ding, Charlie Foster, Adrian E. Bauman, James F. Sallis. Improving Current Practice in Reviews of the Built Environment and Physical Activity, Sports Medicine, 2015, pp. 297-302, Volume 45, Issue 3, DOI: 10.1007/s40279-014-0273-8