BackgroundWe evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care.Methods and FindingsPragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life.A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p<0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%).ConclusionsGeneral practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention but this effect wears off at 12 and 24 months. Only in the subgroup of patients receiving repeat prescriptions of physical activity is the effect maintained in long-term.Trial Registrationclinicaltrials.gov NCT00131079
Background: Counselling in routine general practice to promote physical activity (PA) is advocated, but inadequate evidence is available to support this intervention, and its sustainable implementation over time is difficult.
BackgroundFurther research is needed to improve the evidence regarding determinants of physical activity (PA) as a crucial step to plan higher effective intervention strategies. The goal of the present study is to identify socio-demographic and clinical characteristics of primary care (PHC) insufficiently active patients that are associated with longitudinal changes in the level of physical activity.MethodsLongitudinal analysis of baseline socio-demographic and clinical predictors of physical activity change in insufficiently active PHC patients who participated in a PA-promoting multi-centre randomized clinical trial conducted from October 2003 through March 2006. The primary outcome measure was the self-reported physical activity assessed with the 7-day Physical Activity Recall (PAR), at baseline, 6, 12 and 24 months. Baseline covariates included sex, age, social class, anthropometric measures and other cardiovascular risk factors or associated diseases (Diabetes, HTA, tobacco use, etc.), and stage of readiness to change PA. Generalized linear mixed models were used to estimate longitudinal association of studied variables on PA change over the three follow-up measurements.ResultsA total of 3691 patients (85% of the 4317 recruited in the trial) with at least one follow-up measurement were included in the longitudinal analysis. At baseline, analysed patients (mean age: 50.6 years; 64.6% women) devoted 34.7 minutes and 2.36 metabolic equivalent hours per week (MET.h/week) to moderate and vigorous physical activity. Older age, male gender, higher social class, lower BMI, diagnosis of diabetes or hypertension, and measurement season were significant predictors of PA longitudinal change. The effect of baseline readiness to change on PA dose was modified by time, showing a positive gradient in favour of those with more readiness to change that increases significantly at 12 and 24 months (p-value interaction < .0001).ConclusionsIdentified baseline characteristics such as readiness to change and risk factors can guide physicians to prioritize time and intervention efforts for maximizing their impact on insufficiently active PHC patients.
Background: It is unclear how returning to physical activity (PA) after long periods of inactivity gives expected health benefits. Aim: To determine whether the inactive primary care population reduce their mortality by increasing PA, even in low doses. Design and setting: Prospective cohort of 3,357 inactive patients attending 11 Spanish public primary healthcare centers. Method: Change in PA was repeatedly measured during their participation in the ‘Experimental Program for Physical Activity Promotion’ clinical trial in 2003-2006, using the ‘7-day PA Recall’. Mortality until December 31, 2018, (312 deaths) has been recorded from national statistics and survival time from the end of the clinical trial analyzed using proportional hazard models. Results: After 46,191 person-years follow-up, compared with individuals that remained completely inactive, the mortality of those who achieved minimal recommendations of 150-300 minutes/week (M/W) of moderate or 75-150 M/W of vigorous intensity, was reduced by 45% (adjusted Hazard Ratio –aHR-= 0.55; 95% confidence interval -95%CI: 0.41 to 0.74); those who did not meet these recommendations but increased PA in low doses, i.e. 50 M/W of moderate PA, showed a 31% reduced mortality (aHR=0.69; 98%CI: 0.51 to 0.93); and those who surpassed the recommendation saw a 49% reduction in mortality (aHR= 0.51; 95%CI: 0.32 to 0.81). The inverse association between increased PA and mortality follows a continuous curvilinear dose-response relationship. Conclusion: Inactive primary care patients reduce mortality by increasing PA even in doses below the recommended. Greater reduction is achieved through meeting PA recommendations or adopting levels of PA higher than recommended.
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