International Journal of Behavioral Medicine

, Volume 23, Issue 5, pp 527–538 | Cite as

Systematic Review and Meta-Analysis of Peer-Led Self-Management Programs for Increasing Physical Activity

  • Krista L Best
  • William C MillerEmail author
  • Janice J Eng
  • Francois Routhier



Approximately 85 % of Canadians are not physically active enough to achieve health benefits. Peer-led self-management programs are becoming an increasingly popular strategy for modifying health behaviors, including physical activity. The purpose of this study was to systematically review and meta-analyze the effect of peer-led self-management interventions on physical activity.


PubMed, MEDLINE, PsycINFO, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews databases were systematically searched to identify all relevant randomized controlled trials that evaluated the effect of peer-led self-management on physical activity. The studies were described and effect size data were included in meta-analyses. Subgroup analyses were performed according to type of physical activity outcome (i.e., duration, frequency, other).


Twenty-one studies were included in the review and 14 reported statistically significant improvements in physical activity. A meta-analysis of 17 studies showed a statistically significant moderate pooled effect (standardized mean difference (SMD) = 0.4, p < 0.001) of peer-led self-management programs on physical activity immediately post-intervention. The intervention had a large statistically significant effect based on the four studies that included follow-up measures (SMD = 1.5, p = 0.03). Meta-analysis of nine studies that used similar outcomes (i.e., minutes of physical activity) revealed a statistically significant small effect (SMD = 0.2, p < 0.001).


Peer-led self-management programs appear to be effective at increasing weekly duration of physical activity in various populations, but the effect size is small. Training peers to encourage increased physical activity may provide an effective method for reaching various clinical and non-clinical populations. More research is needed using validated and consistent physical activity outcomes.


Meta-analysis Physical activity Peer group Self-efficacy Self-management programs 



The authors would like to thank Jason Tong for his assistance with the systematic review. We would also like to thank the Rehab Research Lab productivity club for research and clinical input when editing the manuscript.


• Indicates article was included in systematic review

  1. 1.
    World Health Organization. World report on disability. Geneva, Switzerland, 2011. Available online: [Accessed 14 April 2015].Google Scholar
  2. 2.
    Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;13(9838):219–29.CrossRefGoogle Scholar
  3. 3.
    Janssen I. Health care costs of physical inactivity in Canadian adults. Appl Physiol Nutr Metab. 2012;37(4):803–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol. 2004;29(1):90–115.CrossRefPubMedGoogle Scholar
  5. 5.•
    Warburton DE, Nicol C, Bredin SS. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006;174:801–9.CrossRefGoogle Scholar
  6. 6.
    Warburton DE, Charlesworth S, Ivey A, Nettlefold L, Bredin SS. A systematic review of the evidence for Canada’s physical activity guidelines for adults. Int J Behav Nutr Phys Act. 2010;7:39.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Public Health Agency of Canada, The Strengthened Pan-Canadian Healthy Living Strategy 2010. Available online: Scholar
  8. 8.
    Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Stat Can. 2011. [Accessed 14 April 2015].Google Scholar
  9. 9.
    Lorig K, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behavior Med. 2003;26(1):1–7.CrossRefGoogle Scholar
  10. 10.
    Barlow J, Wright C, Sheasby J, et al. Self-management for people with chronic conditions: a review. Patient Educ Counsel. 2002;48:177–87.CrossRefGoogle Scholar
  11. 11.
    Lorig KR. Stanford self-management programs effectiveness and translation. Institute of Medicine, 2004.Google Scholar
  12. 12.
    Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman and Company; 1997.Google Scholar
  13. 13.
    Medvene L. Self-help groups, peer helping, and social comparison. In: Shirlynn Spacapan SO, editor. Helping and being helped: naturalistic studies. Newbury Park, CA: Sage; 1992. p. 49–77.Google Scholar
  14. 14.
    Bratter B, Freeman E. The maturing of peer counseling. Generations. 1990;14:49.Google Scholar
  15. 15.
    Nuñez DE, Keller C, Ananian CD. A review of the efficacy of the self-management model on health outcomes in community-residing older adults with arthritis. Worldviews Evid Based Nurs. 2009;6(3):130–48.CrossRefPubMedGoogle Scholar
  16. 16.
    Dale JR, Williams SM, Bowyer V. What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabet Med. 2012;29(11):1361–77.CrossRefPubMedGoogle Scholar
  17. 17.
    Jonker AA, Comijs HC, Knipscheer KC, Deeg DJ. Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP). Eur J Ageing. 2009;6(4):303–14.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Webel AR, Okonsky J, Trompeta J, Holzemer WL. A systematic review of the effectiveness of peer-based interventions on health-related behaviours in adults. Am J Pub Health. 2010;100(2):247–53.CrossRefGoogle Scholar
  19. 19.
    Richardson G, Kennedy A, Reeves P, Bower V, Lee E, Middleton C, et al. Cost effectiveness of the expert patients programme (EPP) for patients with chronic conditions. J Epidemiol Community Health. 2008;62:361–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Kennedy A, Reeves D, Bower P, et al. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomized controlled trial. J Epidemiol Comm Health. 2007;61:254–61.CrossRefGoogle Scholar
  21. 21.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. doi: 10.1136/bmj.b2700.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Best KL. Manual wheelchair use: understanding participation and skill development [PhD dissertation]. Vancouver: University of British Columbia; 2015. Available at Scholar
  23. 23.
    Sherrington C, Herbert RD, Maher CG, et al. PEDro. A database of randomized trials and systematic reviews in physical therapy. Man Therapy. 2000;5:223–6.CrossRefGoogle Scholar
  24. 24.
    Foley NC, Teasell RW, Bhogal SK, Speechley MR. Stroke rehabilitation evidence-based review: methodology. Top Stroke Rehabil. 2003;10:1–7.Google Scholar
  25. 25.
    Fu R, Gartlehner G, Grant M, Shamliyan T, Sedrakyan A, Wilt TJ, et al. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the effective health care program. J Clin Epidemiol. 2011;64(11):1187–97.CrossRefPubMedGoogle Scholar
  26. 26.
    Cohen J. Statistical power for the behavioural sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1998.Google Scholar
  27. 27.
    Glasziou PP, Sanders SL. Investigating causes of heterogeneity in systematic reviews. Stat Med. 2002;21:1503–11.CrossRefPubMedGoogle Scholar
  28. 28.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327:557.CrossRefGoogle Scholar
  29. 29.
    Borenstein B, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. UK: John Wiley & Sons, Ltd; 2009.CrossRefGoogle Scholar
  30. 30.
    Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. Br Med J. 2011;342:d4002.CrossRefGoogle Scholar
  31. 31.•
    Barlow J, Turner A, Edwards R, Gilchrist M. A randomised controlled trial of lay-led self-management for people with multiple sclerosis. Patient Educ Couns. 2009;77(1):81–9.CrossRefPubMedGoogle Scholar
  32. 32.•
    Buman MP, Giacobbi PR, Dzierzewski JM, Aiken Morgan A, McCrae CS, Roberts BL, et al. Peer volunteers improve long-term maintenance of physical activity with older adults: a randomized controlled trial. J Phys Act Health. 2011;8 Suppl 2:S257–66.CrossRefPubMedGoogle Scholar
  33. 33.•
    Druss BG, Zhao L, von Esenwein SA, Bona JR, Fricks L, Jenkins-Tucker S, et al. The health and recovery peer (HARP) program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res. 2010;118:264–70.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.•
    Fu D, Fu H, McGowan P, Shen YE, Zhu L, Yang H, et al. Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. Bull World Health Organ. 2003;81(3):174–82.PubMedPubMedCentralGoogle Scholar
  35. 35.•
    Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: managing comorbidity and eliminating health disparities. Arthritis Rheum. 2007;57(6):1081–8.CrossRefPubMedGoogle Scholar
  36. 36.•
    Lorig KR, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized controlled trial. Med Care. 1999;37:5–14.CrossRefPubMedGoogle Scholar
  37. 37.•
    Loriq KR, Ritter PL, Jacquez A. Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes Educ. 2005;31(3):401–9.CrossRefGoogle Scholar
  38. 38.•
    Lorig KR, Villa FJ, Ritter PL, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care. 2008;31(3):408–14.CrossRefPubMedGoogle Scholar
  39. 39.•
    Lorig KR, Ritter PL, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educ. 2009;35(4):641–51.CrossRefPubMedGoogle Scholar
  40. 40.•
    Lorig KR, Ritter PL, González VM. Hispanic chronic disease self-management: a randomized community-based outcome trial. Nurs Res. 2003;52(6):361–9.CrossRefPubMedGoogle Scholar
  41. 41.•
    Lorig KR, Gonzalez VM, Ritter P. Community-based Spanish language arthritis education program: a randomized trial. Med Care. 1999;37(9):957–63.CrossRefPubMedGoogle Scholar
  42. 42.•
    Garrett N, Hageman CM, Sibley SD, Davern M, Berger M, Brunzell C, et al. The effectiveness of an interactive small group diabetes intervention in improving knowledge, feeling of control, and behaviour. Health Promot Pract. 2005;6:320–8.CrossRefPubMedGoogle Scholar
  43. 43.•
    Goldberg RW, Dickerson F, Lucksted A, Brown CH, Weber E, Tenhula WN, et al. Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness. Psychiatr Serv. 2013;64(1):51–7.CrossRefPubMedGoogle Scholar
  44. 44.•
    Robinson-Whelen S, Hughes RB, Taylor HB, Colvard M, Mastel-Smith B, Nosek MA. Improving the health and health behaviours of women aging with physical disabilities: a peer-led health promotion program. Womens Health Issues. 2006;16(6):334–45.CrossRefPubMedGoogle Scholar
  45. 45.•
    Swerissen H, Belfrage J, Weeks A, Jordan L, Walker CC, Furler J, et al. A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Educ Couns. 2006;64:360–8.CrossRefPubMedGoogle Scholar
  46. 46.•
    Williams AM, Bloomfield L, Milthorpe E, Aspinall D, Filocamo K, Wellsmore T, et al. Effectiveness of moving on: an Australian designed generic self-management program for people with a chronic illness. BMC Health Serv Res. 2013;11:13–90.Google Scholar
  47. 47.•
    Barlow JH, Turner AP, Wright CC. A randomized controlled trial of the arthritis self management programme in the UK. Health Edu Res. 2000;15(6):665–80.CrossRefGoogle Scholar
  48. 48.•
    Campbell MC, James A, Hudson MA, Carr C, Jackson E, Oates V, et al. Improving multiple behaviours for colorectal cancer prevention among African American church members. Health Psychol. 2004;23(5):492–502.CrossRefPubMedGoogle Scholar
  49. 49.•
    Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, et al. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos: Latinos en control. Diabetes Care. 2011;34(4):838–44.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.•
    van der Wulp I, de Leeuw JR, Gorter KJ, Rutten GE. Effectiveness of peer-led self-management coaching for patients recently diagnosed with Type 2 diabetes mellitus in primary care: a randomized controlled trial. Diabet Med. 2012;29(10):e390–7.CrossRefPubMedGoogle Scholar
  51. 51.•
    Vincent D, Pasvogel A, Barrera L. A feasibility study of a culturally tailored diabetes intervention for Mexican Americans. Biol Res Nurs. 2007;9(2):130–41.CrossRefPubMedGoogle Scholar
  52. 52.
    Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, et al. A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009;62:464–75.CrossRefPubMedGoogle Scholar
  53. 53.
    Boot WR, Simons DJ, Stothart C, Stutts C. The pervasive problem with placebos in psychology: why active control groups are not sufficient to rule out placebo effects. Perspect Psychol Sci. 2013;8(4):445–54.CrossRefPubMedGoogle Scholar
  54. 54.
    Godin G, Shephard RJ. A simple method to assess exercise behaviour in the community. Can J Appl Sport Sci. 1985;10:141–6.PubMedGoogle Scholar
  55. 55.
    Ashford S, Edmunds J, French DP. What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis. Br J Health Psychol. 2010;15(2):265–88.CrossRefPubMedGoogle Scholar
  56. 56.
    Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioural research: a critical review of the literature and recommended remedies. J App Psychol. 2003;88(5):879–903.CrossRefGoogle Scholar
  57. 57.
    Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behaviour Nutr Phys Act. 2008;5:56.CrossRefGoogle Scholar
  58. 58.
    Williams K, Frei A, Vetsch A, Dobbels F, Puhan MA, Rüdell K. Patient-reported physical activity questionnaires: a systematic review of content and format. Health Qual Life Outcome. 2012;10:28.CrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  • Krista L Best
    • 1
    • 2
  • William C Miller
    • 2
    • 3
    Email author
  • Janice J Eng
    • 2
    • 4
  • Francois Routhier
    • 5
    • 6
  1. 1.Graduate Program in Rehabilitation Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  2. 2.Rehabilitation Research Program, Vancouver Coastal Research InstituteGF Strong Rehabilitation CentreVancouverCanada
  3. 3.Department of Occupational Sciences and Occupational Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Department of Physical Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  5. 5.Department of RehabilitationUniversité LavalQuebec CityCanada
  6. 6.Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)Centre intégré universitaire de santé et de services sociaux de la Capitale-NationaleQuebec CityCanada

Personalised recommendations