Increasing Physical Activity in a Population Requires Changing Physical Environment Comments from
Virpi Kuvaja-Köllner and her team:
Project manager, teacher, M.Sc. (Health Economics), PhD Student
University of Eastern Finland
Faculty of Social Sciences and Business Studies
Department of Health and Social Management

Medical Research: What is the background for this study?

Response: As we all know insufficient physical activity (PA) is associated with an increased risk of various chronic diseases and increases in health care expenditure. However, there are some economic evaluation studies related to physical activity interventions that have proved some of those interventions can offer “good value for money”. Unfortunately, most of these studies have focused on interventions at the individual or patient group level. It is easy to notice that there is a lack of studies related to cost-effectiveness of physical activity interventions at the population level. Somehow this is controversial because the need to increase physical activity in the population is urgent and the public funding for health care and other services is tighter than ever. We should remember that if we can increase physical activity among large population groups, especially among those whoare physically inactive, it might also have an impact on our healthcare costs.

Medical Research:  What are the main findings?

Response: The main finding of this review was the fact that the number of relevant studies related to the cost-effectiveness of population-level physical activity studies is limited. Only 14 studies on the cost-effectiveness of population-level physical activity interventions allowed proper comparative cost-effectiveness analysis between different types of interventions. According to our findings, the most cost-effective way for increasing physical activity among large populations is changing the built environment. For example, the creation of better opportunities for physical activity by offering the use of pedestrian ways or providing Fitness Zones in public parks in densely populated areas. The construction of new pedestrian ways might be costly interventions, but they have long and useful lifespans. Also the use of pedometers and school-based interventions increased physical activity cost-effectively.

Medical Research: What should clinicians and patients take away from your report?

Response: This review did not include studies which were secondary interventions such as primary healthcare interventions or interventions targeting some selected population groups. Also interventions focusing on single individuals were also excluded. So perhaps this study does not necessarily offer so much information specifically for clinicians. Our focus was in primary and preventive interventions for all populations, which were aiming to increase physical activity among wide population groups.However, this study might draw attention among clinicians for a new attitude for promoting physical activity by encouraging patients to walk or travel by bike instead always using cars, for example. As people get used to using bicycles, they start to advocate for better opportunities for walking and biking. Who knows? Perhaps, this is a new start for real active living innovation.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The quality analysis of included studies proved that costs were more highly valued than changes in PA levels, and there is clearly a need for future studies promoting PA to take into account both costs and effects. Although the costs of interventions are mostly assessed and valued appropriately, such information as duration, intensity, and frequency of physical activity may be inaccurate. Objective measurements are seldom done in these studies, but it would definitely increase the validity of the results.   It is impossible to do proper cost-effectiveness analysis without proper cost data and estimates of effectiveness. We also hope that this study encourages researches to do more study in this challenging area. For example, the next time when a new subway line/station is built and hopefully, good options for bicycle storage are organized, the situation would be attractive for this kind of study – conducting a survey about physical activity habits of commuters and other people living in that area before and after this construction work. Also the same kind of analysis could be done when a new disc golfcourse. is built. The possibility of objective measurements would be a great bonus but even a questionnaire before and after could produce some information about the impact of these kinds of investments in relation to physical activity.


Johanna Laine, Virpi Kuvaja-Köllner, Eija Pietilä, Mikko Koivuneva, Hannu Valtonen, and Eila Kankaanpää (2014) Cost-Effectiveness of Population-Level Physical Activity Interventions: A Systematic Review. American Journal of Health Promotion: November/December 2014, Vol. 29, No. 2, pp. 71-80