Table 5 Implementation strategies identified
Record | Guideline | RQ1: Strategy | RQ2: Evaluation | RQ3: Outcomes | ROB | Record |
|---|---|---|---|---|---|---|
Type | Description | |||||
IMPLEMENTATION PROCESS STRATEGIES (n = 9) | ||||||
aGainforth et al. (2015) [97] | SCI Exercise Guidelines (2011) [8] | Engaging stakeholders | Partnership created between 3 groups (SCI Action Canada, Centre for Collaboration, Motivation, and Innovation, and SCI Ontario) to develop the Brief Action Planning (BAP) training workshop to promote PA to people with SCI | One arm pre-post using interviews (narrative analysis) and surveys (training satisfaction) | Perceived behavioural control to use BAP increased from baseline to post intervention but was not maintained at follow up (p > 0.05). 1 participant reached the level of competence appropriate to be certified to use BAP. Satisfaction with training was positive (all scored between 5–7/10) | Seriousc |
Latimer-Cheung (n.d.) [130] | Canadian Physical Activity Guidelines for Adults with MS (2013) [10] | Engaging stakeholders | Consumer and HCP feedback on the developed MS PA toolkit | Cross-sectional survey | HCP indicated they would use the toolkit in their practice if given the opportunity (mean score 5.45/10 (± 1.214); consumers indicated the toolkit will motivate (mean score 5.26/10 (± 1.298)) and teach (5.53/10 (± 1.379)) adults with MS how to make smart and informed decisions about PA and felt the guideline well-described the types of activities that can be used to meet guidelines (5.86/10 (± 1.159)); HCP and consumers felt strategies to overcome common barriers to exercise were appropriate (HCP mean 5.64/10 ± 1.027; consumer mean 5.14/0 ± 1.549), and all felt the tool was clear (consumer mean 5.92/10 + / 1.251; HCP mean 5.45 ± 1.695) and comprehensive (consumer mean 5.64/10 ± 1.222; HCP mean 5.27/10 ± 0.786) | Seriousd |
Clark et al. (2017) [52] | Too Fit to Fracture (2014)[11] | Engaging stakeholders | Physicians were interviewed to understand their thoughts, acceptability/usability, current practices, prior knowledge, barriers to using them in practice and what would be needed to use implement the recommendation use | N/A | N/A | N/Ae |
aMa et al. (2019) [98] | Scientific Exercise Guidelines for Adults with SCI (2017) [9] | Engaging stakeholders | Stakeholders (physiotherapists and clients with SCI) were engaged to co-develop an RCT (introductory personal training session followed by eight weekly 15-min PA behavioral coaching sessions per week) | N/A | N/A | N/Ae |
Shirazipour (2013) [43] | Canadian Physical Activity Guidelines for Adults with MS (2013) [10] | Engaging stakeholders | Meeting minutes from consensus panel to develop and disseminate an evidence-based toolkit to inform adults of the guidelines and teach them to make smart, informed choices about PA and goal setting (topics included format and use of photos, etc.) | N/A | N/A | N/Ae |
aSanta Mina et al. (2019) [101] | Exercise for People with Cancer (2015) [6] | Human resources | Registered kinesiologists deliver a hospital-based exercise program | N/A | N/A | N/Ae |
aSanta Mina et al. (2017) [102] | Exercise for People with Cancer (2015) [6] | Human resources | Qualified professionals (physiotherapists, kinesiologists, and exercise physiologists) offer a 30 week community based exercise program | N/A | N/A | N/Ae |
aLatimer-Cheung et al. (2013) [42] | SCI Exercise Guidelines (2011) [8] | Human resources | A certified personal trainer and a peer co-delivered home-based strength training sessions | N/A | N/A | N/Ae |
aParkinson Canada (n.d.-b)[100] | Physical Activity and Parkinson’s Disease (2012) [12] | Human resources | Exercise program (“Dancing with Parkinson’s”) with weekly dance class delivered by studio directors at a local dance school for people with Parkinson’s disease | N/A | N/A | N/Ae |
INTEGRATION STRATEGIES (n = 31) | ||||||
aTrinh et al. (2018) [103] | Exercise for People with Cancer (2015) [6] | Feedback | Participants wore activity trackers that provided information on their daily step count and overall progress | Pre-post intervention using Jawbone activity tracker and surveys (Functional Assessment of Cancer Therapy – General) | Significant reduction in sedentary time (455.4 min/week) and increase in MVPA (44.1 min/week) at post treatment but NS differences from baseline to 12 week follow up. NS changes in light intensity PA. Significant increase in step count from baseline to post intervention (1535 average step increase). At phase 1, 59% of participants met target step count (1000 above baseline) but by phase 3 only 39% met the rising target (3000 above baseline). Significant improvements seen in emotional wellbeing (average 1.2 point increase on a scale from 0–28) | Seriousc |
aTrinh et al. (2018) [103] | Exercise for People with Cancer (2015) [6] | Alerts | Participants wore activity trackers that provided sensory alerts to stand after ≥ 30 min of sedentary time | Pre-post intervention using Jawbone activity tracker and surveys (functional assessment of cancer therapy – general) | Significant reduction in sedentary time (455.4 min/week) and increase in MVPA (44.1 min/week) at post treatment but NS differences from baseline to 12 week follow up. NS changes in light intensity PA. Significant increase in step count from baseline to post intervention (1535 average step increase). At phase 1, 59% of participants met target step count (1000 above baseline) but by phase 3 only 39% met the rising target (3000 above baseline). Significant improvements seen in emotional wellbeing (average 1.2 point increase on a scale from 0–28) | Seriousc |
aTrinh et al. (2018) [103] | Exercise for People with Cancer (2015) [6] | Financial incentives | Participants were awarded points to encourage engagement with the intervention, which could be redeemed for a maximum of $50 CAD | Pre-post intervention using Jawbone activity tracker and surveys (functional assessment of cancer therapy – general) | Significant reduction in sedentary time (455.4 min/week) and increase in MVPA (44.1 min/week) at post treatment but NS differences from baseline to 12 week follow up. NS changes in light intensity PA. Significant increase in step count from baseline to post intervention (1535 average step increase). At phase 1, 59% of participants met target step count (1000 above baseline) but by phase 3 only 39% met the rising target (3000 above baseline). Significant improvements seen in emotional wellbeing (average 1.2 point increase on a scale from 0–28) | Seriousc |
aSanta Mina et al. (2019) [101] | Exercise for People with Cancer (2015) [6] | Skills training | Hospital based exercise program delivered by registered kinesiologists with prescribed at home component | Prospective cohort using surveys (IPAQ, SF-36), 6 min walk test | All participants were meeting PA guidelines at all time-points of the intervention. Improvements in the 6 min walk test from baseline to 48 weeks were seen (+ 72 m). Improvements in SF36 measures of general health (+ 4.4 points) and physical (+ 3.6 points) were seen at 48 weeks | Seriousc |
aSanta Mina et al. (2017) [102] | Exercise for People with Cancer (2015) [6] | Skills training | Qualified professionals (physiotherapists, kinesiologists, and exercise physiologists) offering a 30 week community based exercise program | Prospective cohort using surveys (GLTEQ, FACIT-F and G, self-rated health), 6 min walk test, grip strength, HR, BP, BMI, WC and functional reach | NS increase in MVPA minutes/week (+ 47); significant increase in LTPA from baseline to 10 weeks; significant increase in MET hours/week (4.46). Statistically significant increase from baseline to 10 weeks in fatigue, social wellbeing, 6 min walk test, RHR, SBP and functional reach | Seriousc |
aLatimer-Cheung et al. (2013) [42] | SCI Exercise Guidelines (2011) [8] | Skills training | Study 2/2: One home-based strength training session co-delivered by a certified personal trainer and a peer, paired with a 1-week action plan | One arm pre-post intervention using surveys (intention to be active, modified LTPAQ-SCI, health care climate questionnaire) | Significant increase in intentions to be active (d = 0.6) and action planning (d = -1.14) over the intervention. Significant increase in number of bouts of strength training, duration, and total min/week at the 4 week follow up (p < 0.024). Significant increase in task frequency self efficacy and barrier self-efficacy (d = 0.52; d = 0.87) | Seriousc |
aMa et al. (2019) [98] | Scientific Exercise Guidelines for Adults with SCI (2017) [9] | Skills training | Introductory personal training session followed by 8 behavioural coaching sessions delivered by an exercise professional (weekly 15-min sessions) | RCT using surveys (LTPAQ-SCI, measures of health action process, self-efficacy), wrist accelerometer | Increases in all but 1 participant in MVPA from baseline to post-intervention (+ 236 min/week); larger effect size when self-reported vs when looking at accelerometer. Increase in total LTPA from baseline to 6 month follow up (+ 348 min/week). Increase in task self-efficacy for all participants for engaging in strength exercise, with a significantly greater increase in intervention vs control group (p < 0.05) | Highb |
aParkinson Canada (n.d.-b)[100] | Physical Activity and Parkinson’s Disease (2012) [12] | Skills training | Exercise program (“Dance with Parkinson’s”) with weekly dance class delivered by studio directors at a local dance school for people with Parkinson’s disease | N/A | N/A | N/Ae |
Vallerand et al. (2019) [110] | Exercise for People with Cancer (2015) [6] | Counselling | 12-week theory-based telephone counselling (1 session/week) intervention to encourage cancer survivors to increase their PA by 60 min/week | RCT using surveys (affective attitude, action planning, instrumental attitude, modified GLTEQ, perceived capability and opportunity) | Significantly greater increases in instrumental attitude in intervention group vs control (MBGD = 0.5). Small between group difference noted for action planning (MBGD = 0.3) and medium between group differences in affective attitude were observed (MBGD = 0.06). Intervention group increased exercise behaviour by 281 min (versus 93 min in the control). Small between group differences (MBGD = 0.2) at the end of intervention in perceived capability to increase aerobic exercise and medium between group difference seen in having the opportunity to increase weekly aerobic exercise (MBGD = 0.4) | Highb |
aArbour-Nicitopoulos et al. (2014) [106] | SCI Exercise Guidelines (2011) [8] | Counselling | 6 month telephone counselling with trained counsellor delivered with a Welcome Package (resistance bands, an instruction guide, tip sheets, and goal-achievement strategies) to develop and strengthen social cognitions for engaging in LTPA | Prospective cohort using surveys (LTPA intentions, LTPAQ-SCI) | Intentions to engage in LTPA started high (average 4.54/7) and remained high (p = 0.44). More clients engaged in moderate-high intensity LTPA at 6 months vs baseline (p = 0.09). NS increase in % of clients regularly active at baseline vs 4 (p = 0.13) or 6 (p = 0.09) months | Seriousc |
Chemtob et al. (2019) [109] | Scientific Exercise Guidelines for Adults with SCI (2017) [9] | Counselling | One counselling session per week for 8 weeks with a trained registered kinesiologist to motivate participants to engage in LTPA | RCT using surveys (treatment self-regulation questionnaire, LTPAQ-SCI, series assessing social cognitive predictors) | Intervention group reported greater autonomous motivation (Hedge’s g = 0.91) and controlled motivation at 6 (Hedges' g = − 0.24) and 10 weeks (Hedges' g = 0.02). They reported greater total LTPA at 6 (Hedges' g = 0.87) and 10 (Hedge’s g = 0.85) weeks and showed a greater change from baseline to 6 (dppc = 1.14) and 10 (dppc = 1.28) weeks | Highb |
aLatimer-Cheung et al. (2013)[42] | SCI Exercise Guidelines (2011) [8] | Counselling | Study 1/2: One 30 min telephone-based counselling session on self-regulation and action plans | One arm pre-post intervention using surveys (intention to be active, modified LTPAQ-SCI, health care climate questionnaire) | Significant increase in intentions to be active (d = 0.6) and action planning (d = -1.14) over the intervention. Significant increase in number of bouts of strength training, duration, and total min/week at the 4 week follow up (p < 0.024). Significant increase in task frequency self efficacy and barrier self-efficacy (d = 0.52; d = 0.87) | Seriousc |
aTomasone et al. (2018) [108] | SCI Exercise Guidelines (2011) [8] | Counselling | Telephone-based counselling by a registered kinesiologist paired with the SCI Get Fit Toolkit, gradually progressing to self-regulation (i.e., counselling delivered weekly for months 1 & 2, biweekly for months 3 & 4, and monthly for 5 & 6). Intervention materials included: resistance bands, an instruction guide, tip sheets, and an activity intensity classification chart | One arm pre-post intervention using surveys (LTPA intentions, LTPAQ-SCI | Baseline intentions for engaging in aerobic, strength, and total LTPA were high (6.14/7 ± 1.44) and did not change over the 6 month intervention. Significant effect in time spent strength training and total MVPA over the intervention (all F(2,40) s ≥ 3.679, ps = 0.03). NS change in aerobic activity over the intervention though small increases emerged between baseline and 2 months (d = 0.29), and baseline and 6 months (d = 0.2). Clients had positive perceptions of the information and resources provided (all Ms ≥ 6.00 out of 7) | Seriousc |
aMa et al. (2019) [98] | Scientific Exercise Guidelines for Adults with SCI (2017) [9] | Counselling | Behavioural coaching sessions and personal training by professionals (8 weekly 15-min sessions) | RCT using surveys (LTPAQ-SCI, measures of health action process, self-efficacy), wrist accelerometer | Increases in all but 1 participant in MVPA from baseline to post-intervention (+ 236 min/week); larger effect size when self-reported vs when looking at accelerometer. Increase in total LTPA from baseline to 6 month follow up (+ 348 min/week). Increase in task self-efficacy for all participants for engaging in strength exercise, with a significantly greater increase in intervention vs control group (p < 0.05) | Highb |
aSalci et al. (2016) [107] | SCI Exercise Guidelines (2011) [8] | Counselling | Adults with SCI and exercise professionals trained by the ALLTP online mentorship program offered counselling to promote LTPA to people with SCI | N/A | N/A | N/Ae |
aTrinh et al. (2018) [103] | Exercise for People with Cancer (2015) [6] | Planning tools | Participants were granted access to online action planning resources to help them be more active | Pre-post intervention using Jawbone activity tracker and surveys (functional assessment of cancer therapy – general) | Significant reduction in sedentary time (455.4 min/week) and increase in MVPA (44.1 min/week) at post treatment but NS differences from baseline to 12 week follow up. NS changes in light intensity PA. Significant increase in step count from baseline to post intervention (1535 average step increase). At phase 1, 59% of participants met target step count (1000 above baseline) but by phase 3 only 39% met the rising target (3000 above baseline). Significant improvements seen in emotional wellbeing (average 1.2 point increase on a scale from 0–28) | Seriousc |
aArbour-Nicitopoulos et al. (2014) [106] | SCI Exercise Guidelines (2011) [8] | Planning tools | 6 month telephone counselling with trained counsellor delivered with a Welcome Package (resistance bands, an instruction guide, tip sheets, and goal-achievement strategies) to develop and strengthen social cognitions for engaging in LTPA | Prospective cohort using surveys (LTPA intentions, LTPAQ-SCI) | Intentions to engage in LTPA started high (average 4.54/7) and remained high (p = 0.44). More clients engaged in moderate-high intensity LTPA at 6 months vs baseline (p = 0.09). NS increase in % of clients regularly active at baseline vs 4 (p = 0.13) or 6 (p = 0.09) months | Seriousc |
aLatimer-Cheung et al. (2013) [42] | SCI Exercise Guidelines (2011) [8] | Planning tools | One home based strength training session co-delivered by a certified personal trainer and a peer, paired with a 1-week action plan | One arm pre-post intervention using surveys (intention to be active, modified LTPAQ-SCI, health care climate questionnaire) | Significant increase in intentions to be active (d = 0.6) and action planning (d = -1.14) over the intervention. Significant increase in number of bouts of strength training, duration, and total min/week at the 4 week follow up (p < 0.024). Significant increase in task frequency self efficacy and barrier self-efficacy (d = 0.52; d = 0.87) | Seriousc |
Cancer Care Ontario (n.d.-d)[114] | Exercise for People with Cancer (2015) [6] | Planning tools | Handout sheet for setting PA goals | N/A | N/A | N/Ae |
SCI Action Canada (2011c)[54] | SCI Exercise Guidelines (2011) [8] | Planning tools | SCI Get Fit Toolkit brochure with sample activity plan | N/A | N/A | N/Ae |
SCI Action Canada (n.d.-b)[93] | SCI Exercise Guidelines (2011) [8] | Planning tools | Home strength training guide with planning worksheets | N/A | N/A | N/Ae |
McMaster University (n.d.) [111] | Canadian Physical Activity Guidelines for Adults with MS (2013) [10] | Planning tools | Interactive e-learning module (MS Get Fit Toolkit Online) to provide practical information on how to achieve MS guideline level activity | N/A | N/A | N/Ae |
MS Society of Canada (n.d.-a)[113] | Canadian Physical Activity Guidelines for Adults with MS (2013) [10] | Planning tools | Sub-portion of the MS Get Fit Toolkit including a goal setting template to help people with MS set and achieve exercise goals | N/A | N/A | N/Ae |
MS Society of Canada (n.d.-b)[69] | Canadian Physical Activity Guidelines for Adults with MS (2013) [10] | Planning tools | MS Get Fit Toolkit: sample exercises for different movement levels to help people with MS meet each guideline component and provides common exercise barriers and strategies to overcome them | N/A | N/A | N/Ae |
MS Society of Canada (n.d.-c)[112] | Canadian Physical Activity Guidelines for Adults with MS (2013) [10] | Planning tools | Website containing various resources (toolkit, handouts, guide) for planning exercise, basic exercises and a guide for people to follow if they wish to engage in more activity | N/A | N/A | N/Ae |
Osteoporosis Canada (n.d.-b)[75] | Too Fit to Fracture (2014)[11] | Planning tools | Booklet containing sample exercises, activity planning worksheets, and guide for how to achieve each recommendation (i.e., how to get 30 min aerobic) | N/A | N/A | N/Ae |
Parkinson Society Canada (2012) [12] | Physical Activity and Parkinson’s Disease (2012) [12] | Planning tools | PA progress chart to note daily activity type and duration for one month | N/A | N/A | N/Ae |
Diabetes Canada (n.d.-a) [49] | Physical Activity and Diabetes (2018) [2] | Planning tools | Brochure with a motivation checklist and an interactive exercise to help end-users identify personal barriers to PA and can consider strategies to overcome common barriers | N/A | N/A | N/Ae |
Diabetes Canada (n.d.-c) [86] | Physical Activity and Diabetes (2018) [2] | Planning tools | Brochure explaining how to set SMART (specific, measureable, attainable, realistic, time-oriented) exercise goals, and how to create and maintain an aerobic training program | N/A | N/A | N/Ae |
Diabetes Canada (n.d.-e)[87] | Physical Activity and Diabetes (2018) [2] | Planning tools | Brochure with an activity sheet for considering personal pros and cons of being active/inactive and a template for creating a weekly PA plan | N/A | N/A | N/Ae |
Ontario Brain Institute (2014b) [115] | Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease (2017) [3] | Planning tools | Tracking sheet to write down sources of personal motivation and goals, and to build and plan how to maintain a weekly PA plan | N/A | N/A | N/Ae |
CAPACITY-BUILDING (n = 6) | ||||||
Tomasone et al. (2017) [119] | SCI Exercise Guidelines (2011) [8] | Stakeholder training | Seminars provided to HCP trainees during regular class time to teach how to discuss LTPA among their patients with SCI | One arm pre-post intervention using surveys | Significant linear increase immediately post training in belief that attending a presentation will help discuss PA to future patients (5.62 to 6.2, out of 7), followed by linear decrease over subsequent 6 months (5.59) (αs ≥ .81). Confidence in ability to discuss PA with future patients followed the same trend (4.91 to 5.84 to 5.25; rs ≥ .71). Inclusion of audiovisual presentation aspects predicted positive changes in attitudes pre/post intervention (p < 0.001) | Seriousc |
Tomasone et al. (2015) [118] | SCI Exercise Guidelines (2011) [8] | Stakeholder training | Training sessions for CMCL presenters (i.e., facilitators) how to run the CMCL intervention for people with SCI either face to face or via telephone (the CMCL intervention aims to increase HCPs use of PA guidelines for people with SCI) | One arm pre-post intervention using surveys | NS changes at any time-point in perceptions that the new CMCL curriculum will help presenters implement the CMCL info, strategies, and resources at their next presentation (pre score: 5.89/7). NS changes in % of the new CMCL curriculum presenters intend to use at their next presentation. Significant decrease from post intervention to 6 month follow up in confidence in ability to tell HCP about CMCL info, strategies and resources, persuade HCP to use CMCL resources, teach presenters about CMCL and persuade presenters to use CMCL information (6.2/7 fell to 5.65/7; effect size -0.77) | Seriousc |
Tomasone et al. (2014) [117] | SCI Exercise Guidelines (2011) [8] | Stakeholder training | CMCL seminars delivered to HCPs (e.g., rehabilitation therapists) to enhance their intentions to prescribe PA to patients | One arm pre-post intervention using surveys (self efficacy items adapted from Rhodes and Courneya, intention items adapted from Azjen) | Intentions to discuss PA significantly increased from pre-to-post CMCL training (p < 0.002) but significant decreases were seen between post training and 6 months (p < 0.005) (no decline below baseline). Same trend was seen in confidence in their ability to discuss PA with patients and persuade patients to participate in PA, and in instrumental attitudes towards the usefulness of CMCL | Seriousc |
aGainforth et al. (2015) [97] | SCI Exercise Guidelines (2011) [8] | Stakeholder training | One 4-h workshop offered in 3 regional areas by a certified Brief Action Planning (BAP) trainer to teach peers BAP and motivational interviewing to promote PA to people with SCI | One arm pre-post intervention using interviews (narrative analysis) and surveys (training satisfaction) | Perceived behavioural control to use brief action planning increased from baseline to post intervention but was not maintained at follow up (p > 0.05). 1 participant reached the level of competence appropriate to be certified to use BAP. Satisfaction with training was positive (all scored ranging from 5–7/10) | Seriousc |
aSalci et al. (2016) [107] | SCI Exercise Guidelines (2011) [8] | Stakeholder training | HCP completed the ALLTP program to help them encourage and recommend PA to patients with SCI | Quasi-experimental pre/post intervention using surveys | The ALLTP module left participants feeling their self-efficacy was enhanced to speak about and encourage LTPA. It remained high throughout training and positively correlated with the usefulness of program content (r = 0.41–0.71). At follow up, participants had discussed LTPA with an average of 7 people with disabilities | Seriousc |
Schmitz et al. (2019) [120] | Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) [7] | Stakeholder training | Suggestions for HCP to work toward implementing the guidelines in their practice | N/A | N/A | N/Ae |
SCALE-UP (n = 7) | ||||||
Oncology Nursing Society (n.d.) [123] | Exercise for People with Cancer (2015) [6] | Implementation toolkit | Checklist can be used by any HCP to help recommend PA to cancer patients and identify risk factors | N/A | N/A | N/Ae |
Exercise is Medicine (n.d.-b) [124] | Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) [7] | Implementation toolkit | Online program registry to help patients, families, and HCP find PA programs in their communities | N/A | N/A | N/Ae |
Exercise is Medicine (n.d.-c) [125] | Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) [7] | Implementation toolkit | Fillable handout for HCPs to help make PA recommendations (prescriptions) to patients (including dose, type, etc. for aerobic and strength training) | N/A | N/A | N/Ae |
Ma et al. (2018) [92] | SCI Exercise Guidelines (2011) [8] | Implementation toolkit | Tool helps HCP recommend PA to patients with SCI depending on risk factors, motivation, and resource availability | N/A | N/A | N/Ae |
SCI Action Canada (n.d.-b) [127] | SCI Exercise Guidelines (2011) [8] | Implementation toolkit | Series of online videos to provide HCPs with the latest knowledge, resources, barriers people with SCI face to PA, coping strategies, and tips to lead patients to be more active | N/A | N/A | N/Ae |
Canadian Society for Exercise Physiology (2015) [122] | Canadian Guideline for Physical Activity Throughout Pregnancy (2019) [1] | Implementation toolkit | Screening tool to help HCPs determine if their pregnant patients are ready to safely engage in PA | N/A | N/A | N/Ae |
Diabetes Canada (n.d.-d) [126] | Physical Activity and Diabetes (2018) [2] | Implementation toolkit | Interactive decision-making tool for HCP to easily recommend PA to patients with diabetes | N/A | N/A | N/Ae |