title: Exploring equity in primary-care-based physical activity interventions using PROGRESS-Plus: a systematic review and evidence synthesis.
abstract: BACKGROUND
  Little is known about equity effects in primary care based physical activity interventions. This review explored whether differences in intervention effects are evident across indicators of social disadvantage, specified under the acronym PROGRESS-Plus (place of residence, race/ethnicity, occupation, gender, religion, education, social capital, socioeconomic status, plus age, disability and sexual orientation).
  
  
  METHODS
  Six bibliographic databases were systematically searched for randomised controlled trials (RCTs) of physical activity interventions conducted in primary care. Harvest plots were used to synthesize findings from RCTs reporting subgroup or interaction analyses examining differences in intervention effects across levels of at least one PROGRESS-Plus factor.
  
  
  RESULTS
  The search yielded 9052 articles, from which 173 eligible RCTs were identified. Despite PROGRESS-Plus factors being commonly measured (N = 171 RCTs), differential effect analyses were infrequently reported (N = 24 RCTs). Where reported, results of equity analyses suggest no differences in effect across levels or categories of place of residence (N = 1RCT), race (N = 4 RCTs), education (N = 3 RCTs), socioeconomic status (N = 3 RCTs), age (N = 16 RCTs) or disability (N = 2 RCTs). Mixed findings were observed for gender (N = 22 RCTs), with some interventions showing greater effect in men than women and others vice versa. Three RCTs examined indicators of social capital, with larger post-intervention differences in physical activity levels between trial arms found in those with higher baseline social support for exercise in one trial only. No RCTs examined differential effects by participant occupation, religion or sexual orientation.
  
  
  CONCLUSIONS
  The majority of RCTs of physical activity interventions in primary care record sufficient information on PROGRESS-Plus factors to allow differential effects to be studied. However, very few actually report details of relevant analyses to determine which population subgroups may stand to benefit or be further disadvantaged by intervention efforts.
authors.affiliation: Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Sciences, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. ska32@cam.ac.uk.|Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK. ska32@cam.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Attwood
authors.affiliation: Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Sciences, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
authors.forename: E
authors.initials: E
authors.lastname: van Sluijs
authors.affiliation: Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sutton
mesh_terms: D015444:Exercise; D005260:Female; D000069576:Health Equity; D006293:Health Promotion; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012959:Socioeconomic Factors
keywords: Equity; Intervention; Non-communicable diseases; Physical activity; Socio-economic inequalities; Trials