The use of sequential multiple assignment randomized trials (SMARTs) in physical activity interventions: a systematic...

Area of Science:

• Physical Activity Interventions
• Adaptive Trial Designs
• Personalized Medicine

Background:

• Physical activity (PA) is crucial for chronic disease management.
• Evaluating complex PA interventions requires adaptive study designs.
• Sequential Multiple Assignment Randomized Trials (SMARTs) are novel designs for building adaptive interventions.

Approach:

• Systematic review of PA SMARTs published up to May 2023.
• Searched PubMed, Embase, PsychINFO, CENTRAL, and CinAHL.
• Assessed methodological quality using the Cochrane Risk of Bias 2 Tool.

Key Points:

• Twenty PA SMART studies were reviewed across diverse populations (e.g., obesity, chronic pain).
• Interventions commonly featured aerobic exercise, goal setting, and wearable technology.
• Analysis methods included linear mixed models and Q-learning; high risk of bias was noted.

Conclusions:

• Aerobic exercise, behavior change techniques, and wearable tech are key for future PA SMARTs.
• Improved rationale for tailoring variables and timing is essential for advancing PA SMART designs.
• Collaboration is needed to link adaptive designs with personalized clinical practice.