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2015;13(3) 61 - 78
Barriers and motivators for physical activity in community dwelling adults: a comprehensive systematic review protocol
Lyndsay Alexander Kay Cooper
1,2
1,2,3
1 School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom 2 The Scottish Centre for Evidence-based, Multi-professional Practice: a Collaborating Centre of the Joanna Briggs Institute; Robert Gordon University, Aberdeen, United Kingdom 3 Institute for Health and Wellbeing Research, Robert Gordon University, Aberdeen, United Kingdom
Corresponding author: Lyndsay Alexander [email protected]
Review question/objective The quantitative objective is to identify the barriers and motivators for the participation of community dwelling adults in physical activity. The qualitative objective is to identify the perceptions and experiences of community dwelling adults on the barriers and motivators to physical activity. The textual objective is to identify the issues related to barriers and motivators for the participation of community dwelling adults in physical activity.
Background The individual, health, economic and societal benefits of a physically active lifestyle are widely acknowledged. Benefits of a physically active lifestyle include an increase in physical, social and mental health and wellbeing, and a significantly reduced risk of developing non-communicable conditions including cardiovascular disease, diabetes and obesity. However, despite these benefits, 1,2
not all individuals meet the current UK or international guidelines for physical activity (PA).
Although
3
Scottish PA levels have been reported as greater than other home countries, the Scottish Health 4
Survey has reported that only 62% of adults have met the UK PA guidelines. The reported values for home countries are thought to be an over-estimation due to the acknowledged limitations of self3
report survey design.
A recent review of the Scottish Physical Activity Strategy “Let’s Make Scotland More Active” has concluded that there has been insufficient action at local levels in Scotland to impact on population 5,6
PA levels.
The authors of this review have identified a need for commitment, resources and robust
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evaluation at local levels to address continued PA inequities. The Scottish Government has identified a number of targets for population participation in physical activity by 2022 and therefore it is important to understand what encourages people to participate in physical activity and what prevents 7
participation at a more local level.
In order to address this need, it is important to identify any barriers or motivators to PA in a community setting so that local agencies can target and plan appropriate interventions and services. Some 3
barriers to physical activity have been identified to be related to safety, culture and access, with the 8,9
majority of published systematic reviews focused on environmental effects, 10,11,12
minorities or disabilities.
or effects within ethnic
A search of the literature has failed to identify any comprehensive
systematic reviews that identified barriers and motivators to physical activity in the community other than a systematic review protocol registered within PROSPERO for barriers and facilitators in physical 13
activity among Muslim adolescents.
This review will therefore systematically evaluate all evidence
around barriers and motivators to physical activity in community dwelling adults. The results of this systematic review will be used to inform the planning and development of community interventions in the Scottish context, as well as identifying areas for future research.
Keywords physical activity; motivators; facilitators; barriers; inhibitors
Inclusion criteria Types of participants The quantitative and qualitative components of this review will consider studies that include community dwelling adults in developed countries aged 19 to 64 years without any medical conditions. As this review is concerned with barriers and motivators to physical activity within usual daily life, this review will not include adults within hospital environments including out-patients or any community programs led by a healthcare professional. Adults from developed countries as defined by the 2013 Human Development Index will be included in this review.
14
Adults that are identified to be
living in developing countries will not be included. Adults aged 19 to 64 will be included in this review 1,15
as this age range has specific physical activity guidelines published.
There are other specific
guidelines available for those aged 18 and under and aged 65 years and over. The textual component of this review will consider the same participants as the quantitative and qualitative components. Types of intervention(s)/phenomena of interest The quantitative component of the review will consider studies that identify barriers and motivators to physical activity for community dwelling adults. Studies on the effectiveness of individual or combined interventions will not be included as this review is concerned only with the identification of the barriers and motivators and not the effectiveness or efficacy of interventions themselves. Studies relating to the development and psychometric properties of questionnaires used to measure barriers and motivators to physical activity are not the focus of this systematic review. Studies which focus on psychological theory and models that explain barriers and motivators are not the focus of this systematic review. Such studies will therefore be excluded.
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The qualitative component of this review will consider studies that investigate perceptions and experiences of barriers and motivators to physical activity in community dwelling adults. The textual component of this review will consider publications that describe barriers and/or inhibitors and motivators and/or facilitators to physical activity in community dwelling adults. Types of outcomes This review will consider studies that include the following outcome measures: Identified, detailed, or characterized barriers and motivators to physical activity participation in community dwelling adults. It is anticipated that survey instruments, questionnaires, interviews and focus groups will be the methods employed to identify such barriers and facilitators in the majority of the studies in this review. Types of studies The quantitative component of the review will consider analytical and descriptive epidemiological study designs, including prospective and retrospective cohort studies, case control studies, case series, individual case reports and descriptive cross sectional studies, for inclusion. The qualitative component of the review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. In the absence of research studies, other text such as opinion papers and reports will be considered. The textual component of the review will consider expert opinion, discussion papers, position papers and other text.
Search strategy The search strategy aims to find both published and unpublished studies. A three step search strategy will be utilized in this review. An initial limited search of Medline and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms will then be undertaken across all databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Only studies published in English will be considered for inclusion in this review since translation services are not available to the review team. Due to the number of articles found during initial scoping, and to ensure findings have relevancy, the search will be limited to the past 10 years, from 2004 to 2014. The databases to be searched include: Medline (accessed via EBSCO HOST), CINAHL, AMED, EmBase, Science Direct, SPORTdiscus, PsycINFO, PsycARTICLES, Joanna Briggs Institute Library, and Web of Science. The search for unpublished studies will include: Google, Google Scholar, Conference proceedings, Centre for Reviews and Dissemination, Cochrane Reviews, and EThOS. Initial keywords to be used will be: physical activity; motivators; facilitators; barriers; inhibitors
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Assessment of methodological quality Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBIMAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Textual papers selected for retrieval will be assessed by two independent reviewers for authenticity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Narrative, Opinion and Text Assessment and Review Instrument (JBI-NOTARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data collection Quantitative data will be independently extracted by two reviewers from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Qualitative data will be independently extracted by two reviewers from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Textual data will be extracted from papers included in the review using the standardized data extraction tool from JBI-NOTARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. In the event of missing data or to clarify unclear data, the authors will be contacted by the reviewers where relevant.
Data synthesis Quantitative papers will, where possible be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different quantitative study designs included in this review. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.
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Qualitative research findings will, where possible be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings (Level 1 findings) rated according to their quality, and categorizing these findings on the basis of similarity in meaning (Level 2 findings). These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings (Level 3 findings) that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form. Textual papers will, where possible be pooled using JBI-NOTARI. This will involve the aggregation or synthesis of conclusions to generate a set of statements that represent that aggregation, through assembling and categorizing these conclusions on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the conclusions will be presented in narrative form.
Conflicts of interest The authors have no conflicts of interest to declare.
Acknowledgements The authors would wish to thank Aberdeen City Health Improvement Fund and Aberdeen City Council for funding of this study.
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References 1 Bull FC and the Expert Working Groups. Physical Activity Guidelines in the UK: Review and recommendations. School of Sport, Exercise and Health Sciences, Loughborough University, May 2010. 2 World Health Organisation. Physical Activity Factsheet February 2014 [cited 2014 Feb 25]. Available from: http://www.who.it/mediacentre/Factsheets/fs385/en/. 3 Department of Health. Start Active, Stay Active. A report from the Chief Medical Officer. London, Department of Health Publications,2011. 4 The Scottish Government. The Scottish Health Survey 2012. Volume 1 – main report. Scottish Government, 2012. 5 Scottish Executive. Let's make Scotland more active. Edinburgh: The Scottish Government; 2003 [Updated 2005 Sept 14; cited 2014]. Availlable from: http://www.scotland.gov.uk/Resources/Doc/47032/0017726.pdf.2003 . 6 Halliday E, Mutrie N and Bull F. Getting Scotland on the move? Reflections on a 5-year review of Scotland's national physical activity strategy. British Journal of Sports Medicine.2013; 47(17): 11301132. 7 The Scottish Government. The Scottish Health Survey. Edinburgh: The Scottish Government; 2011. [Updated 2014 Jan 26; cited 28 Jan 2014] Available from: http://www.scotland.gov.uk/Publications/2011/09/27084018/45.. 8 Humpel N, Owen N and Leslie E. Environmental factors associated with adults participation in physical activity: a review. American Journal of Preventative Medicine. 2002; 22(3): 188-199 9 Bauman AE and Bull FC. Environmental correlates of physical activity and walking in adults and children: a review of reviews. [Homepage on the internet]. London: National Institute for Health and Care Excellence; 2007 [cited 2014 Jan 28]. Available from: http://www.nice.org.uk/guidance/ph8/resources/environmental-correlates-of-physical-activity-review2 10 Koshoedo SA, Simkhada P and Van Tiejlingen ER. Review of barriers to engaging black and minority ethnic groups in physical activity in the UK. Global Journal of Health Science, 2009; 1(2): 8596 11 Horne M and Tierney S. What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: A systematic review of qualitative studies. Preventive Medicine, 2012; 55(4): 276-284 12 Hutzler Y and Kersensky O.
Motivational correlates of physical activity in persons with an
intellectual disability. Journal of Intellectual Disability Research, 2010; 54(9): 767-786 13 Ekawati FF, Ntoumanis N and Thøgersen-Ntoumani C. Barriers and facilitators in physical activity among Muslim adolescents living in Western societies. PROSPERO 2014:CRD42014007126 [cited 2014 July]. Available from: http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42014007126
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14 United Nations Development Fund. Human Development Index and its components. United Nations, New York; 2013. [cited 2014 Jan 28]. Available from: http://data.undp.org/dataset/Table-1Human-Development-Index-and-its-components/wxub-qc5k. . 15 NHS Choices. Physical Activity Guidelines for adults aged 19-64 years. National Health Service; 2013. [cited 2014 Feb 25]. Available from: http://www.nhs.uk/livewell/fitness/pages/physical-activityguidelines-for-adults.aspx
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Appendix I: Appraisal instruments QARI appraisal instrument
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NOTARI appraisal instrument
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Appendix II: Data extraction instruments QARI data extraction instrument
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Barriers and motivators for physical activity in community dwelling adults: a comprehensive systematic review protocol
Lyndsay Alexander Kay Cooper
1,2
1,2,3
1 School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom 2 The Scottish Centre for Evidence-based, Multi-professional Practice: a Collaborating Centre of the Joanna Briggs Institute; Robert Gordon University, Aberdeen, United Kingdom 3 Institute for Health and Wellbeing Research, Robert Gordon University, Aberdeen, United Kingdom
Corresponding author: Lyndsay Alexander [email protected]
Review question/objective The quantitative objective is to identify the barriers and motivators for the participation of community dwelling adults in physical activity. The qualitative objective is to identify the perceptions and experiences of community dwelling adults on the barriers and motivators to physical activity. The textual objective is to identify the issues related to barriers and motivators for the participation of community dwelling adults in physical activity.
Background The individual, health, economic and societal benefits of a physically active lifestyle are widely acknowledged. Benefits of a physically active lifestyle include an increase in physical, social and mental health and wellbeing, and a significantly reduced risk of developing non-communicable conditions including cardiovascular disease, diabetes and obesity. However, despite these benefits, 1,2
not all individuals meet the current UK or international guidelines for physical activity (PA).
Although
3
Scottish PA levels have been reported as greater than other home countries, the Scottish Health 4
Survey has reported that only 62% of adults have met the UK PA guidelines. The reported values for home countries are thought to be an over-estimation due to the acknowledged limitations of self3
report survey design.
A recent review of the Scottish Physical Activity Strategy “Let’s Make Scotland More Active” has concluded that there has been insufficient action at local levels in Scotland to impact on population 5,6
PA levels.
The authors of this review have identified a need for commitment, resources and robust
doi: 10.11124/jbisrir-2015-1830 .
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evaluation at local levels to address continued PA inequities. The Scottish Government has identified a number of targets for population participation in physical activity by 2022 and therefore it is important to understand what encourages people to participate in physical activity and what prevents 7
participation at a more local level.
In order to address this need, it is important to identify any barriers or motivators to PA in a community setting so that local agencies can target and plan appropriate interventions and services. Some 3
barriers to physical activity have been identified to be related to safety, culture and access, with the 8,9
majority of published systematic reviews focused on environmental effects, 10,11,12
minorities or disabilities.
or effects within ethnic
A search of the literature has failed to identify any comprehensive
systematic reviews that identified barriers and motivators to physical activity in the community other than a systematic review protocol registered within PROSPERO for barriers and facilitators in physical 13
activity among Muslim adolescents.
This review will therefore systematically evaluate all evidence
around barriers and motivators to physical activity in community dwelling adults. The results of this systematic review will be used to inform the planning and development of community interventions in the Scottish context, as well as identifying areas for future research.
Keywords physical activity; motivators; facilitators; barriers; inhibitors
Inclusion criteria Types of participants The quantitative and qualitative components of this review will consider studies that include community dwelling adults in developed countries aged 19 to 64 years without any medical conditions. As this review is concerned with barriers and motivators to physical activity within usual daily life, this review will not include adults within hospital environments including out-patients or any community programs led by a healthcare professional. Adults from developed countries as defined by the 2013 Human Development Index will be included in this review.
14
Adults that are identified to be
living in developing countries will not be included. Adults aged 19 to 64 will be included in this review 1,15
as this age range has specific physical activity guidelines published.
There are other specific
guidelines available for those aged 18 and under and aged 65 years and over. The textual component of this review will consider the same participants as the quantitative and qualitative components. Types of intervention(s)/phenomena of interest The quantitative component of the review will consider studies that identify barriers and motivators to physical activity for community dwelling adults. Studies on the effectiveness of individual or combined interventions will not be included as this review is concerned only with the identification of the barriers and motivators and not the effectiveness or efficacy of interventions themselves. Studies relating to the development and psychometric properties of questionnaires used to measure barriers and motivators to physical activity are not the focus of this systematic review. Studies which focus on psychological theory and models that explain barriers and motivators are not the focus of this systematic review. Such studies will therefore be excluded.
doi: 10.11124/jbisrir-2015-1830 .
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The qualitative component of this review will consider studies that investigate perceptions and experiences of barriers and motivators to physical activity in community dwelling adults. The textual component of this review will consider publications that describe barriers and/or inhibitors and motivators and/or facilitators to physical activity in community dwelling adults. Types of outcomes This review will consider studies that include the following outcome measures: Identified, detailed, or characterized barriers and motivators to physical activity participation in community dwelling adults. It is anticipated that survey instruments, questionnaires, interviews and focus groups will be the methods employed to identify such barriers and facilitators in the majority of the studies in this review. Types of studies The quantitative component of the review will consider analytical and descriptive epidemiological study designs, including prospective and retrospective cohort studies, case control studies, case series, individual case reports and descriptive cross sectional studies, for inclusion. The qualitative component of the review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. In the absence of research studies, other text such as opinion papers and reports will be considered. The textual component of the review will consider expert opinion, discussion papers, position papers and other text.
Search strategy The search strategy aims to find both published and unpublished studies. A three step search strategy will be utilized in this review. An initial limited search of Medline and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms will then be undertaken across all databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Only studies published in English will be considered for inclusion in this review since translation services are not available to the review team. Due to the number of articles found during initial scoping, and to ensure findings have relevancy, the search will be limited to the past 10 years, from 2004 to 2014. The databases to be searched include: Medline (accessed via EBSCO HOST), CINAHL, AMED, EmBase, Science Direct, SPORTdiscus, PsycINFO, PsycARTICLES, Joanna Briggs Institute Library, and Web of Science. The search for unpublished studies will include: Google, Google Scholar, Conference proceedings, Centre for Reviews and Dissemination, Cochrane Reviews, and EThOS. Initial keywords to be used will be: physical activity; motivators; facilitators; barriers; inhibitors
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Assessment of methodological quality Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBIMAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Textual papers selected for retrieval will be assessed by two independent reviewers for authenticity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Narrative, Opinion and Text Assessment and Review Instrument (JBI-NOTARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data collection Quantitative data will be independently extracted by two reviewers from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Qualitative data will be independently extracted by two reviewers from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Textual data will be extracted from papers included in the review using the standardized data extraction tool from JBI-NOTARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. In the event of missing data or to clarify unclear data, the authors will be contacted by the reviewers where relevant.
Data synthesis Quantitative papers will, where possible be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different quantitative study designs included in this review. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.
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Qualitative research findings will, where possible be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings (Level 1 findings) rated according to their quality, and categorizing these findings on the basis of similarity in meaning (Level 2 findings). These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings (Level 3 findings) that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form. Textual papers will, where possible be pooled using JBI-NOTARI. This will involve the aggregation or synthesis of conclusions to generate a set of statements that represent that aggregation, through assembling and categorizing these conclusions on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the conclusions will be presented in narrative form.
Conflicts of interest The authors have no conflicts of interest to declare.
Acknowledgements The authors would wish to thank Aberdeen City Health Improvement Fund and Aberdeen City Council for funding of this study.
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References 1 Bull FC and the Expert Working Groups. Physical Activity Guidelines in the UK: Review and recommendations. School of Sport, Exercise and Health Sciences, Loughborough University, May 2010. 2 World Health Organisation. Physical Activity Factsheet February 2014 [cited 2014 Feb 25]. Available from: http://www.who.it/mediacentre/Factsheets/fs385/en/. 3 Department of Health. Start Active, Stay Active. A report from the Chief Medical Officer. London, Department of Health Publications,2011. 4 The Scottish Government. The Scottish Health Survey 2012. Volume 1 – main report. Scottish Government, 2012. 5 Scottish Executive. Let's make Scotland more active. Edinburgh: The Scottish Government; 2003 [Updated 2005 Sept 14; cited 2014]. Availlable from: http://www.scotland.gov.uk/Resources/Doc/47032/0017726.pdf.2003 . 6 Halliday E, Mutrie N and Bull F. Getting Scotland on the move? Reflections on a 5-year review of Scotland's national physical activity strategy. British Journal of Sports Medicine.2013; 47(17): 11301132. 7 The Scottish Government. The Scottish Health Survey. Edinburgh: The Scottish Government; 2011. [Updated 2014 Jan 26; cited 28 Jan 2014] Available from: http://www.scotland.gov.uk/Publications/2011/09/27084018/45.. 8 Humpel N, Owen N and Leslie E. Environmental factors associated with adults participation in physical activity: a review. American Journal of Preventative Medicine. 2002; 22(3): 188-199 9 Bauman AE and Bull FC. Environmental correlates of physical activity and walking in adults and children: a review of reviews. [Homepage on the internet]. London: National Institute for Health and Care Excellence; 2007 [cited 2014 Jan 28]. Available from: http://www.nice.org.uk/guidance/ph8/resources/environmental-correlates-of-physical-activity-review2 10 Koshoedo SA, Simkhada P and Van Tiejlingen ER. Review of barriers to engaging black and minority ethnic groups in physical activity in the UK. Global Journal of Health Science, 2009; 1(2): 8596 11 Horne M and Tierney S. What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: A systematic review of qualitative studies. Preventive Medicine, 2012; 55(4): 276-284 12 Hutzler Y and Kersensky O.
Motivational correlates of physical activity in persons with an
intellectual disability. Journal of Intellectual Disability Research, 2010; 54(9): 767-786 13 Ekawati FF, Ntoumanis N and Thøgersen-Ntoumani C. Barriers and facilitators in physical activity among Muslim adolescents living in Western societies. PROSPERO 2014:CRD42014007126 [cited 2014 July]. Available from: http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42014007126
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14 United Nations Development Fund. Human Development Index and its components. United Nations, New York; 2013. [cited 2014 Jan 28]. Available from: http://data.undp.org/dataset/Table-1Human-Development-Index-and-its-components/wxub-qc5k. . 15 NHS Choices. Physical Activity Guidelines for adults aged 19-64 years. National Health Service; 2013. [cited 2014 Feb 25]. Available from: http://www.nhs.uk/livewell/fitness/pages/physical-activityguidelines-for-adults.aspx
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Appendix I: Appraisal instruments QARI appraisal instrument
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MAStARI appraisal instrument this is a test message
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NOTARI appraisal instrument
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Appendix II: Data extraction instruments QARI data extraction instrument
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