Plotnikoff et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:45 DOI 10.1186/s12966-015-0203-7 REVIEW Open Access Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis Ronald C Plotnikoff1,2*, Sarah A Costigan1,2, Rebecca L Williams1,3, Melinda J Hutchesson1,3, Sarah G Kennedy1,2, Sara L Robards1,2, Jennifer Allen2, Clare E Collins1,3, Robin Callister1,4 and John Germov5 Abstract To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies. Keywords: University, College, Tertiary education institutions, University students, Health promotion, Health behavior, Healthy universities, Physical activity, Exercise, Diet, Nutrition, Weight loss Introduction The health benefits of engaging in regular physical ac- Physical inactivity and poor dietary-intake are related be- tivity are well established for adults [3]. Strategies to haviors that impact on health and wellbeing and the promote physical activity have become an important maintenance of a healthy weight. These behaviors under- public health approach for the prevention of chronic dis- pin risk of lifestyle related non-communicable conditions eases [4]. The prevalence of achieving physical activity rec- [1]. Risk for ischaemic heart disease, stroke, type two dia- ommendations declines rapidly between the ages of 18 betes, osteoporosis, various cancers and depression are and 24 [5] when many young people are undertaking ter- linked by behavioral and biomedical health determinants tiary education [6-8]. For instance, in the United States such as physical inactivity, poor dietary behaviors and nearly half of all university students are not achieving rec- overweight/obesity [2]. ommended levels of physical activity [9]. Australian data in the ≥18 year age group indicate 66.9% are sedentary or have low levels of physical activity during 2011-2012 [10]. Similarly in the United Kingdom, 73% of male and 79% of * Correspondence: [email protected] 1Priority Research Centre for Physical Activity and Nutrition, University of female university students do not meet physical activity Newcastle, Callaghan Campus, Newcastle, NSW, Australia guidelines [6]. Further, Irwin [8] suggests that students liv- 2 School of Education, Faculty of Education and Arts, University of Newcastle, ing on campus are less likely to be active, and thus may be Callaghan Campus, Newcastle, NSW, Australia Full list of author information is available at the end of the article at greater risk of poor health. © 2015 Plotnikoff et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Plotnikoff et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:45 Page 2 of 10 Dietary intake patterns that align with national dietary education worldwide will reach 262 million by 2025, a guidelines are associated with reduced risk of developing marked increase from 178 million in 2010 [26]. Second, chronic conditions [11,12], however recent research sug- higher education institutions have access to a large propor- gests tertiary students do not achieve these guidelines tion of students living away from home for the first time, [13-15]. For instance, in the United States, university and and have the capacity to provide support and establish college students have sub-optimal dietary habits compared healthy behavioral patterns that may continue throughout to such recommendations [16]. Similarly, Australian ter- the lifespan. Third, universities and colleges are regarded tiary students fail to consume the recommended daily as organizations that follow high standards of practice servings of fruit (50%) and vegetables (90%) [2]. While stu- which can establish research-based examples for sur- dents from the UK fail to consume the recommended rounding communities to follow. This allows for the op- daily intake of fruit and vegetables (88.7% and 83.5%, re- portunity and responsibility to develop and implement the spectively) [17]. best available research evidence, and to set a benchmark Commencing college/university is often associated with for other groups to follow [27]. Universities and colleges students having more autonomy over their dietary choices have a range of facilities, resources and qualified staff, com- (e.g., food purchasing and preparation). Due to life stage, monly including health professionals, ideal for implement- students may not consider the risk of developing chronic ing initiatives to target lifestyle-related health issues. Finally, diseases when making food choices [18]. Specifically, fac- the possibility that exists for students to deliver initiatives tors such as cost, skipping meals, inadequate variety of as a part of their study/training to become health profes- foods, snacking, and frequent consumption of fast foods sionalsaddstothepromisefortertiary education institu- may increase students’ risk of poor health [19]. Indeed, tions as ideal settings for promoting healthy lifestyles. studies have reported that considerable weight gain occurs Evidence suggests that intervention strategies have during college/university [20,21]. The associated food se- been successful for students in the higher educational lection skills and habits have long-term health impacts setting [1,5], particularly interventions that seek to em- [22]. Further, within US institutions a great proportion of power individuals to achieve their full potential through freshmen (first year) live in college resident halls, which creating learning and support to improve health, well- provide commercially prepared food, take-away and pre- being and sustainability within the community [28]. In prepared meals. This environment may further contribute addition, whilst the primary advantage of implementing to subsequent poor food purchasing and preparation be- health promotion programs is to reduce individuals’ health haviors. Along with these dietary behaviors, physical activity risks, the benefits to higher education institutions in attri- participation also declines inuniversityandcollegestu- tion, retention and academic performance are also poten- dents, which may be due to increased sedentary time when tial gains [29]. Although a recent review examining the studying and during examination periods [23]. effectiveness of interventions targeting health behaviors Given the lack of physical activity and healthy eating it (physical activity, nutrition and healthy weight) amongst is not surprising that the prevalence of overweight/obesity university staff has been conducted [22], it appears that a has reached epidemic proportions in young adults. In the review investigating the effectiveness of health behavior USA, the age range of greatest increase in obesity (7.1% to interventions on these health behaviors/issues for univer- 12.1%) is among young adults aged 18–29 years [7]. In- sity students has not yet been performed. deed, late adolescence and early adulthood appear to be significant periods of transition, highlighting the import- Objective ance of understanding factors such as attitudes towards The objective of this paper is to systematically review the and knowledge of health benefits, as these may be associ- best available evidence regarding the impact of health be- ated with physical activity levels, dietary behavior and obes- havior interventions to improve physical activity, diet and/ ity prevalence [24]. Improvements to lifestyle behaviors can or weight outcomes and targeted at students enrolled in reduce or prevent the occurrence of non-communicable tertiary education institutions. diseases; therefore strategies to foster healthier lifestyles in the working age population are essential. Review Higher education institutions are an appropriate set- Methods ting to promote healthy lifestyles.