A new model of exercise referral scheme in primary care: is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial

Abstract

IntroductionStudies had not yet overcome the most relevant barriers to physical activity (PA) adherence. An exercise referral scheme (ERS) with mechanisms to promote social support might enhance adherence to PA in the long term.SettingA randomised controlled trial in 10 primary care centres in Spain.ObjectiveTo assess the effectiveness of a primary care-based ERS linked to municipal resources and enhancing social support and social participation in establishing adherence to PA among adults over a 15-month period.Participants422 insufficiently active participants suffering from at least one chronic condition were included. 220 patients (69.5 (8.4) years; 136 women) were randomly allocated to the intervention group (IG) and 202 (68.2 (8.9) years; 121 women) to the control group (CG).InterventionsThe IG went through a 12-week standardised ERS linked to community resources and with inclusion of mechanisms to enhance social support. The CG received usual care from their primary care practice.OutcomesThe main outcome measure was self-report PA with the International Physical Activity Questionnaire and secondary outcomes included stages of change and social support to PA practice.Data collectionParticipant-level data were collected via questionnaires at baseline, and at months 3, 9 and 15.BlindingThe study statistician and research assessors were blinded to group allocation.ResultsCompared with usual care, follow-up data at month 15 for the ERS group showed a significant increase of self-reported PA (IG: 1373±1845 metabolic equivalents (MET) min/week, n=195; CG: 919±1454 MET min/week, n=144; P=0.009). Higher adherence (in terms of a more active stage of change) was associated with higher PA level at baseline and with social support.ConclusionsPrescription from ordinary primary care centres staff yielded adherence to PA practice in the long term. An innovative ERS linked to community resources and enhancing social support had shown to be sustainable in the long term.Trial registration numberNCT00714831; Results.

Health-related quality of life and physical activity level after a behavior change program at Norwegian healthy life centers: a 15-month follow-up

“…The HLC population comprises a heterogeneous group with multiple health challenges [ 22 , 50 , 51 , 60 ]. Although group-based interventions enhancing social support have been found effective to promote PA [ 61 ], tailoring group-based programs to suit all groups’ requirements is demanding [ 49 ]. Given the substantial psychological challenges among participants attending the HLC program [ 50 , 51 ], the staffs’ competence on how to promote socio-psychological health is of particular importance [ 62 ].…”

Adherence Factors Related to Exercise Prescriptions in Healthcare Settings: A Review of the Scientific Literature

“…2; 3; 5; 6; 7; 8; 9. Norway (Kuehl et al, 2016) 3;5;9;10 3;5 6 2; 6 Germany (Tuakli-Wosornu et al, 2016) 1;3; 5; 10 1;3 1;2;5 2;8;9 EEUU (Martin-Payo et al, 2016) 3; 10. 5.…”

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

“…Thus, a therapeutic approach based on the combination of PNE and PE can improve quality of life and disability, decreasing the pain intensity of patients with CMP and those suffering from chronic spinal pain (CSP). Different clinical trials and reviews have shown promising results combining PNE and PE [45,46,48,[62][63][64][65][66], but there is no consensus on the optimal dose of PNE or PE. These types of interventions, in which the patient is the active part of the treatment, are not performed and have been scarcely evaluated in primary care (PC).…”