A 2025 Cochrane Review examined whether interventions delivered through sports organisations were effective at changing behavior.
The review included 20 randomised controlled trials (RCT) aimed at improving health behaviors such as the consumption of tobacco, alcohol, healthy foods or increasing physical activity. It included as 8179 participants who were either players, members, coaches, or supporters.
Interventions run by sporting organisations probably increased daily moderate‐to‐vigorous physical activity by around 7.4 minutes for participants. They may also increase fruit and vegetable consumption. However, the evidence for reductions in sugary drink, alcohol and tobacco consumption was low.
The reviewers identified problems
The reviewers wanted to examine intervention effectiveness broadly. However, in practice interventions targeted specific populations, such as adults, or men with health-related issues. In some studies participants knew which treatment they were receiving, meaning it was not a ‘blinded’ RCT. The reviewers also found results inconsistent between studies and that some studies were small.
But what were they missing?
My research revealed that there are more community sport-based interventions than can be readily identified, but they may avoid using sport terminology, lest it deter participation.
RCTs are expensive, usually target small, specific populations to study medicines and therapies, and are rarely run through sports organisations. Most community sport-based interventions are not run as RCTs, but still achieve good outcomes. However they were not eligible for consideration.
In health settings randomising people to not receive a treatment that is known to prologue life can be unethical. We know enough about the benefits of physical activity that running community sport-based interventions as RCTs could face the same issues. Ethical alternatives include population studies,[1] natural experiments,[2] and step wedge trials,[3] which this Cochrane Review was not looking at. Unfortunately, my research also revealed that community sport-based programs have limited funding, and lack the resources to gather the right data for long enough in order to learn how well these programs work.
Community sport-based interventions may serve as rehabilitation from surgery or a major health event, or for therapeutic purposes other than the behavior change outcomes sought. They also run using a wide range of different methods and program components, and there is no single prescriptive methodology or dose. All of this indicates a need for better study of these interventions, rather than attempting to study a version of them uses an experimental model rarely seen in practice.
[1] Examining health data for large numbers of ordinary people, not experimental subjects
[2] Studying situations where similar cohorts unintentionally get different treatment for example comparing the outcomes of people who have heart attacks when all the cardiologists are away for a weekend conference, and ordinary patients- As explained by Dr Anupam B. Jena on Freakonomics MD these patients often do better
[3] Where all participants start being monitored together, but some are randomised to receive the treatment before others
