This scoping review maps the economic evidence of physical activity interventions that could be commissioned by UK local authorities as public health measures and identifies which of those interventions could be led by physiotherapists (PTs).
Ten databases were searched between August and October 2023 in addition to citation searching and searching of key websites. The search had three facets: physical activity, economic evaluation, and the UK. Studies were screened independently by two reviewers using pre-defined criteria. Data were extracted on study characteristics, methods, and results expressed as cost per outcome, incremental cost-effectiveness ratio, benefit-cost ratio, or return on investment. The risk of bias was assessed using the ECOBIAS checklist and an evidence gap map was produced.
We screened 6,256 unique tiles and abstracts, 428 full-text studies of which 36 economic evaluations were deemed eligible. Most (28 studies) were conducted in England and some studies were specifically targeted at children (11 studies). PTs could potentially be involved in exercise classes (14 studies); however, only one RCT used PTs for delivering a fall prevention intervention. Eight studies delivered tailored exercises classes in the community for different age groups and five provided free access to a leisure centre. None of these interventions included PTs. The same is applicable for multifaceted interventions – often a combination of exercise and behaviour change techniques (11 studies), infrastructure projects such as cycle or footpaths (7 studies), active travel (2 studies), advice and education (2 studies). There were notable gaps in the economic evidence for some interventions, such as play streets and active travel for children, and improving urban green space, sports provision, and public transport. Sixteen studies reported either a benefit-cost ratio (BCR), incremental net monetary benefits (INMB), or return on investment (ROI), while 18 reported an incremental cost-effectiveness ratio (ICER). Exercise classes were often reported to be cost-effective for older adults whilst there was mixed evidence for adults and children. Multifaceted interventions in children were generally not cost-effective whereas infrastructure projects frequently had favourable benefit-cost ratios. There was substantial heterogeneity in the interventions and methods of analysis used.
This review found mixed evidence on the cost-effectiveness of interventions to promote physical activity. Despite the role that PTs could play in promoting, guiding, and prescribing physical activity, these were seldom involved in the delivery of the intervention.
Further research should focus on the evidence gaps identified as well as using the evidence available to choose the most cost-effective interventions to increase physical activity as a public health measure. PTs should advocate to become the first choice for promoting and prescribing physical activity, and delivering behaviour change interventions to increase regular physical activity.
Scoping review
cost-effectiveness
