Long-term physical activity on prescription intervention for patients with insufficient physical activity level—a randomized controlled trial

Abstract

Background Physical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting. Methods We included 190 patients, 27–77 years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups. Results At the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups. Conclusion During long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies. Trial registration ClinicalTrials.gov NCT03012516. Registered on 30 December 2016—retrospectively registered.

Nonresponders of Physical Activity on Prescription (PAP) Can Increase Their Exercise Capacity with Enhanced Physiotherapist Support

“…Furthermore, the long-term aspect and overall study design did not allow for comprehensive evaluations of performed PA and/or exercise volume. The results presented in Table 4 , as well as the statistically significant increase in self-reported PA presented in the main study [ 29 ], may provide an insight into the performed volume. It is noted that self-reported PA is associated with certain inaccuracy [ 46 , 47 ], which further exacerbate understanding of compliance and PA and/or exercise volume in this study.…”

“…The present study followed a quasi-experimental design, evaluating baseline and two-year follow-up data. It was an observational substudy of a randomized controlled trial (RCT) [ 29 ], which compared a continued ordinary PAP treatment at health care centers (HCC) and PAP treatment with enhanced support from a PT [ 29 ]. The RCT was a direct continuation of a previous study that utilized a prospective, longitudinal observational design; its method has been described in detail elsewhere [ 20 ].…”

“…The RCT was a direct continuation of a previous study that utilized a prospective, longitudinal observational design; its method has been described in detail elsewhere [ 20 ]. The present study provided an observational investigation as part of an ongoing study that evaluated Swedish PAP in the short and long term [ 20 , 29 , 30 ].…”

“…A total of 195 patients were insufficiently physically active [ 31 ] after a six-month PAP treatment [ 20 ]. Five of these patients declined further participation, and hence, 190 patients were randomized to either a continued ordinary PAP treatment at HCC (n = 92) or PAP treatment with enhanced support from a PT, which also included testing of EC (n = 98) [ 29 ]. In accordance with our aim, only the PT group was further handled in the present study since only the PT group performed EC tests.…”

“…In accordance with our aim, only the PT group was further handled in the present study since only the PT group performed EC tests. For detailed information regarding the HCC group and the randomization process, we refer to the RCT [ 29 ].…”