Objective To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions. Design Systematic review with meta-analysis. Data sources Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. Study selection Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included. Study appraisal and synthesis Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals. Results 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of −1.56 kg (95% confidence interval −2.27 to −0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a −1.80 kg (−2.54 to −1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (−2.34 kg, −3.03 to −1.65) compared with 60 mg and 30 mg three times a day (−0.70 kg, 95% confidence interval −1.92 to 0.52), P=0.02. Conclusions Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.

Objective Physical activity (PA) is associated with a decreased incidence of dementia, but much of the evidence comes from short follow-ups prone to reverse causation. This meta-analysis investigates the effect of study length on the association. Design A systematic review and meta-analysis. Pooled effect sizes, dose–response analysis and funnel plots were used to synthesise the results. Data sources CINAHL (last search 19 October 2021), PsycInfo, Scopus, PubMed, Web of Science (21 October 2021) and SPORTDiscus (26 October 2021). Eligibility criteria Studies of adults with a prospective follow-up of at least 1 year, a valid cognitive measure or cohort in mid-life at baseline and an estimate of the association between baseline PA and follow-up all-cause dementia, Alzheimer’s disease or vascular dementia were included (n=58). Results PA was associated with a decreased risk of all-cause dementia (pooled relative risk 0.80, 95% CI 0.77 to 0.84, n=257 983), Alzheimer’s disease (0.86, 95% CI 0.80 to 0.93, n=128 261) and vascular dementia (0.79, 95% CI 0.66 to 0.95, n=33 870), even in longer follow-ups (≥20 years) for all-cause dementia and Alzheimer’s disease. Neither baseline age, follow-up length nor study quality significantly moderated the associations. Dose–response meta-analyses revealed significant linear, spline and quadratic trends within estimates for all-cause dementia incidence, but only a significant spline trend for Alzheimer’s disease. Funnel plots showed possible publication bias for all-cause dementia and Alzheimer’s disease. Conclusion PA was associated with lower incidence of all-cause dementia and Alzheimer’s disease, even in longer follow-ups, supporting PA as a modifiable protective lifestyle factor, even after reducing the effects of reverse causation.

Motivation is a proximal determinant of behaviour, and increasing motivation is central to most health behaviour change interventions. This systematic review and meta-analysis sought to identify features of physical activity interventions associated with favourable changes in three prominent motivational constructs: intention, stage of change and autonomous motivation. A systematic literature search identified 89 intervention studies (k = 200; N = 19,212) which assessed changes in these motivational constructs for physical activity. Intervention descriptions were coded for potential moderators, including behaviour change techniques (BCTs), modes of delivery and theory use. Random effects comparative subgroup analyses identified 18 BCTs and 10 modes of delivery independently associated with changes in at least one motivational outcome (effect sizes ranged from d = 0.12 to d = 0.74). Interventions delivered face-to-face or in gym settings, or which included the BCTs ‘behavioural goal setting’, ‘self-monitoring (behaviour)’ or ‘behavioural practice/rehearsal’, or which combined self-monitoring (behaviour) with any other BCT derived from control theory, were all associated with beneficial changes in multiple motivational constructs (effect sizes ranged from d = 0.12 to d = 0.46). Meta-regression analyses indicated that increases in intention and stage of change, but not autonomous motivation, were significantly related to increases in physical activity. The intervention characteristics associated with changes in motivation seemed to form clusters related to behavioural experience and self-regulation, which have previously been linked to changes in physical activity behaviour. These BCTs and modes of delivery merit further systematic study, and can be used as a foundation for improving interventions targeting increases in motivation for physical activity.

Methodological guidelines for intervention reporting emphasise describing intervention content in detail. Despite this, systematic reviews of quality improvement (QI) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated. We aimed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 (BCTTv1) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients. Three psychologists independently coded a random sample of 23 trials of healthcare system, provider- and/or patient-focused implementation interventions from a systematic review that included 142 such studies. Intervention content was coded using the BCTTv1, which describes 93 behaviour change techniques (BCTs) grouped within 16 categories. We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature. Less than a quarter of possible BCTs within the BCTTv1 were identified. For implementation interventions targeting providers, the most commonly identified BCTs included the following: adding objects to the environment, prompts/cues, instruction on how to perform the behaviour, credible source, goal setting (outcome), feedback on outcome of behaviour, and social support (practical). For implementation interventions also targeting patients, the most commonly identified BCTs included the following: prompts/cues, instruction on how to perform the behaviour, information about health consequences, restructuring the social environment, adding objects to the environment, social support (practical), and goal setting (behaviour). The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour. The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels. Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions, which may help to better inform replication efforts. In addition, prospective use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions.

Behaviour change techniques describe the content of behaviour change interventions, but do not adequately account for the actions that people must themselves undertake to successfully change or self-manage motivation or behaviour. This paper describes the development of a compendium of self-enactable techniques, combining behaviour- and motivation-regulation techniques across six existing classifications of behaviour change techniques and three scoping reviews. The compendium includes 123 techniques, each of which is labelled, defined and presented with instructive examples to facilitate self-enactment. Qualitative feedback was gathered from intervention developers and the general public to improve the utility, congruence and ease of self-enactability of the techniques. This integrative index of self-enactable techniques can assist intervention developers in selecting appropriate self-directed techniques to help people self-manage their motivation and behaviour. Future research with this compendium can expand on the number of behaviours covered by the instructive examples and link techniques with their potential impacts on factors that influence behaviours.