Self-Regulation for Health Behavior Change: An Overview of Physical Activity Intervention Literature, 2006-2018

Background. Given the multitude of health behavior change interventions for physical activity, and evidence of success for many, there is a need to understand specific mechanisms of action leading to lasting behavior change. Self-regulation, the ability to control one’s behavior, is a key target component of many of these interventions as physical activity is a health habit that an individual must actively choose to engage in, often times in the context of competing demands or daily stressors that might get in the way. Thousands of primary studies and reviews map intervention effectiveness, but often focus on specific populations or intervention types rather than specific components leading to behavior change. The aim of this paper is to present a systematic overview – a review of reviews – that have systematically gathered intervention studies to quantitatively assess the impact of specific self-regulation mechanisms associated with health behavior change.

Methods. Following our protocol registration, we conducted a systematic search for literature in multiple databases with no language or publication type limits (2006-2018), and engaged in double and independent screening, data extraction, and risk of bias assessment (AMSTAR2).

Results. 21 meta-analyses (k=1245 primary studies) addressed both physical activity outcomes and self-regulation mechanisms or specific behavior change taxonomy intervention components that aim to improve self-regulation (e.g., self-monitoring and goal setting) and were included in our overview. Reviews were of variable quality (mean AMSTAR2=45%). The 4 highest quality reviews (AMSTAR2>70%) demonstrated increased physical activity when the following components were included in interventions: personalized feedback, goal setting, and self-monitoring for overweight and obese adults; personalized feedback for older adults; and goal setting among the general population. Only one high quality review addressed the presence of high versus low self-regulation techniques (among coronary heart disease patients): at immediate post-test (k = 14), but not follow-up (k = 7), interventions with high self-regulation techniques significantly increased exercise among their participants. These reviews also tested review of goals, action planning, and barrier identification and found null results for interventions with these components.

Discussion. Few rigorous reviews test intervention mechanisms. There is strong evidence of some components (self-monitoring, personalized feedback, and goal setting) for physical activity behaviors, but less rigorous reviews of other self-regulation intervention components such as stress or time management, self-talk, and coping planning indicating areas for future synthesis work to address.