Implementation and Scalability of Physical Activity Interventions Delivered Within Primary Care: A Narrative Review

Abstract

Primary Aim

To describe the features of implementation in the setting of primary care (PC) for physical activity (PA) interventions that improved total and moderate to vigorous PA (MVPA).

Secondary Aim

To assess the scalability potential of effective PC PA interventions.

Method

A comprehensive search was conducted across multiple electronic databases to identify relevant studies published between 2012 and 2023. Implementation-related features were extracted, and the scalability potential of effective PC PA interventions was assessed using the Intervention Scalability Tool (ISAT) as a framework.

Results

Twenty-six studies met the inclusion criteria after screening. Analysis of the implementation-related features revealed that effective PC PA interventions showed promising reach with a mean participation rate of 43%. Effective PC PA interventions that increased PA were mostly delivered by nurses and were underpinned by the behavioural change techniques (BCTs) of goal setting, feedback and self-monitoring. The scalability assessment revealed that remote-based interventions and those delivered by nurses had moderate to high scores in the scalability domains of fidelity, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability.

Conclusion

PC PA interventions, whether delivered remotely or face-to-face, show promise for increasing PA, especially when incorporating BCTs like goal setting and feedback. Using the ISAT, most interventions displayed promise for implementation at scale, but further examination is needed concerning the delivery setting, implementation infrastructure and sustainability of these interventions. Remote-based (automated PA advice and mailed instructions) PA interventions and those delivered in contact with a nurse showed high scalability potential. Further work that examines the acceptability and effectiveness of other healthcare professionals in intervention delivery would be worthwhile, and more work is needed to assess the utility and effectiveness of remote-based PA interventions in PC.