Community-wide promotion of physical activity in middle-aged and older Japanese: a 3-year evaluation of a cluster randomized trial

Int J Behav Nutr Phys Act. 2015 Jun 23:12:82. doi: 10.1186/s12966-015-0242-0.


Background: Promotion of physical activity (PA) is a key strategy to prevent non-communicable diseases. However, evidence on the effectiveness of community-wide interventions (CWIs) for promoting PA is limited.

Purpose: To evaluate the effectiveness of a 3-year CWI for promoting PA in middle-aged and older adults compared with usual public health services. This study is an extension to an original 1-year investigation study.

Design: Cluster randomized controlled trial with community as unit of randomization and individual as unit of analysis.

Setting/participants: 12 communities in Unnan, Japan were randomly allocated to the intervention (9) or the control (3). Additionally intervention communities were randomly allocated to aerobic activity promotion (Group A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening activities promotion (Group AFM), each consisting of three communities. Randomly-sampled 4414 residents aged 40 to 79 years responded to the baseline survey (74%), and were analyzed in 2013-2014.

Intervention: A 3-year CWI based on social marketing, to promote PA from 2009 to 2012.

Main outcome measures: The primary outcome was a change in regular aerobic, flexibility, and/or muscle-strengthening activities, defined by (1) engaging in 150 mins/week or more of walking, (2) engaging in daily flexibility activity, or (3) engaging 2 or more days/week in muscle-strengthening activities, evaluated at the individual level. Secondary outcomes were changes in specific types of PA and musculoskeletal pain. Outcomes were measured at baseline and at 1 and 3 years (2009, 2010, and 2012).

Results: The CWI did not significantly increase the proportion of adults who reached recommended levels of aerobic, flexibility, and/or muscle-strengthening activities (adjusted change difference = 1.6% [95% CI: -3.5, 6.6]). In the subgroup analysis, compared to the controls, adults doing flexibility activity daily significantly increased in Group FM (6.3% [95% CI: 1.9, 10.7]). In Group A and AFM for PA outcomes and in all groups for pain outcomes, there was no significant change compared to controls.

Conclusions: The CWI did not achieve significant increase in the proportion of adults who reached recommended PA levels. However, it might be effective in promoting flexibility activity in middle-aged and older Japanese.

Trial registration: UMIN-CTR UMIN000002683 .

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cluster Analysis
  • Exercise / physiology
  • Exercise / psychology
  • Exercise Therapy / methods*
  • Female
  • Health Promotion / methods*
  • Health Promotion / statistics & numerical data
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Motor Activity*
  • Muscle Strength / physiology
  • Musculoskeletal Pain / therapy
  • Outcome Assessment, Health Care / methods
  • Pliability
  • Residence Characteristics* / statistics & numerical data
  • Resistance Training / methods
  • Time Factors

Associated data

  • JPRN/UMIN000002683