Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta‐analysis

Summary Multicomponent behavior change interventions are typically used in weight management, but results are largely heterogeneous and modest. Determining which techniques (behavior change technique [BCTs]) are more effective in changing behavior is thus required. This study aimed to identify the most effective BCTs for increasing physical activity (PA) in digital and face‐to‐face behavior change interventions in adults with overweight/obesity. Four databases were searched for eligible studies until October 2019. BCTs were coded using BCTTv1 and MBCT taxonomies. Sixty‐two RCTs were included. Meta‐regressions were performed to explore BCTs' moderating role. Five BCTs showed significant moderator effects on PA in digital interventions: goal setting behavior, goal setting outcome, graded tasks, social incentive, and self‐monitoring of behavior (adjusted R 2's = 0.15–0.51). One BCT showed significant moderator effects on PA in face‐to‐face interventions, behavioral practice and rehearsal (adjusted R 2 = 0.22). Multivariate and sensitivity analysis generally led to similar findings. Effective BCTs for increasing PA in adults with overweight/obesity in digital and face‐to‐face interventions seem to differ. Evidence suggests that using goal setting, social incentive, and graded tasks might help improve PA in digital interventions while avoiding inconsistent self‐monitoring of behavior. In face‐to‐face interventions, prompting behavioral practice and rehearsal might lead to better PA outcomes. Still, further studies are needed. Implications of the current findings are discussed.

At baseline and 16 weeks The ALED-I intervention produced a significant increase in PA, but there were no significant between-group differences. The gamification arm had the highest mean step count, but there were no significant differences between each of the intervention arms and control.

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During the 24-week intervention, the proportion of participant days where the goal of 10,000 steps was achieved was 15.5% in control, 17.0% in IG1, and 12.4% in IG2. These declined to 11.4, 12.9, and 10.3%, respectively, during the follow-up period. At baseline and weeks 1, 2, 3, 4, 5, and 6

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The intervention group showed on average higher activity levels over the 6 weeks compared with the comparison group.
There were no betweengroup differences in changes for steps or minutes of PA by intensity level. At baseline, 3, 6, 9 12, and 24 months Among those in pre-action stages for exercise at baseline, there was a significant group effect beginning at 6 months that was maintained over time.

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More participants from the IG progressed to action/maintenance phase than from the CG. At baseline, 6, 12 and 18 months During the extended therapy phase (i.e., months 7 to 12), participants in both conditions reported significant increases in their weekly amounts of walking and no significant betweengroup differences were found.
No significant changes in energy expenditure over time for either group, and no between-group differences at any of the assessments. At baseline and 12 months for all, and at 24 months for the IG The intervention group walked more after the 12 months, both genders, than at the beginning of the program, and significant group-by-time interactions were seen in both sexes. Group-by-time interactions at follow-up remained significant although the number of steps decreased in both genders. At baseline, end of treatment, and 6and 12-month follow-ups.

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There was a significant increase in reported physical activity, but no group by time interaction. BMI, 32.7 ± 3.9 kg/m 2 IG: Consisted of 12 sessions, once a week for the first eight weeks and then every two weeks until the 16th week. There were three main components of the intervention conducted including (1) tailored nutrition counseling using motivational interviewing, (2) health education aimed at increasing the severity, susceptibility and threats regarding obesity and health, understanding benefits and barriers relating to weight loss, increasing individual's ability regarding diet and exercise and stimulating cues to lose weight, and (3) an exercise training session to increase individual's ability in performing exercise.

Health belief model
Goal setting (behaviour) (IG) Goal setting (outcome) (IG) Self-monitoring of behaviour (IG) Self-monitoring of outcomes of behaviour (IG) Social support (unspecified) (IG) Information about health consequences (IG) Demonstration of behaviour (IG) Social comparison (IG) Behavioural practice/rehearsal (IG) Pros and cons (IG) Social reward (IG) Face-to Face 16 weeks Self-reported PA. Each participant kept a physical activity record log with a specific time of 1 week. The average physical activity in METs was estimated.
At the program completion, the mean score of physical activity for the intervention group showed statistically greater improvement than the control group.