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Mosteiro Miguéns DG, Rodríguez Fernández A, Zapata Cachafeiro M, Vieito Pérez N, Represas Carrera FJ, Novío Mallón S. Community Activities in Primary Care: A Literature Review. J Prim Care Community Health 2024; 15:21501319231223362. [PMID: 38197384 PMCID: PMC10785739 DOI: 10.1177/21501319231223362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.
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Affiliation(s)
| | - Almudena Rodríguez Fernández
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maruxa Zapata Cachafeiro
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Natalia Vieito Pérez
- University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Jabardo-Camprubí G, Puig-Ribera A, Donat-Roca R, Farrés-Godayol P, Nazar-Gonzalez S, Sitjà-Rabert M, Espelt A, Bort-Roig J. Assessing the Feasibility and Acceptability of a Primary Care Socio-Ecological Approach to Improve Physical Activity Adherence among People with Type 2 Diabetes: The SENWI Project. Healthcare (Basel) 2023; 11:1815. [PMID: 37444649 DOI: 10.3390/healthcare11131815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69-74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention's expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program's effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term.
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Affiliation(s)
- Guillem Jabardo-Camprubí
- Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Av. Universitaria 4-6, 08242 Manresa, Spain
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC), Ctra. De Roda Núm. 70, 08500 Vic, Spain
| | - Anna Puig-Ribera
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC), Ctra. De Roda Núm. 70, 08500 Vic, Spain
| | - Rafel Donat-Roca
- Sport Exercise and Human Movement (SEaMH), Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Av. Universitaria 4-6, 08242 Manresa, Spain
| | - Pau Farrés-Godayol
- Research Group on Methodology, Methods, Models and Outcome of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, Sagrada Familia 7, 08500 Vic, Spain
| | - Sebastian Nazar-Gonzalez
- Department of Physical Therapy, Faculty of Health Science Blanquerna, Ramon Llul University, Padilla, 326-332, 08022 Barcelona, Spain
| | - Mercè Sitjà-Rabert
- Faculty of Health Science Blanquerna, Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Padilla, 326-332, 08022 Barcelona, Spain
| | - Albert Espelt
- Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Av. Universitaria 4-6, 08242 Manresa, Spain
- Departament de Psicologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, CIBER de Epidemiologia i Salud Pública, 08193 Barcelona, Spain
| | - Judit Bort-Roig
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC), Ctra. De Roda Núm. 70, 08500 Vic, Spain
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García-Ortún F, Jaén A, Solá L, González-Gil L, Garreta R, de la Sierra A. Physical training program for people at risk of cardiovascular disorders in the primary care setting: A randomized clinical trial. Med Clin (Barc) 2022; 159:475-482. [DOI: 10.1016/j.medcli.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
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Represas-Carrera F, Couso-Viana S, Méndez-López F, Masluk B, Magallón-Botaya R, Recio-Rodríguez JI, Pombo H, Leiva-Rus A, Gil-Girbau M, Motrico E, Martí-Lluch R, Gude F, Clavería A. Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5788. [PMID: 34071171 PMCID: PMC8198299 DOI: 10.3390/ijerph18115788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.
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Affiliation(s)
- Francisco Represas-Carrera
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
| | - Sabela Couso-Viana
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
| | - Fátima Méndez-López
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Bárbara Masluk
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Rosa Magallón-Botaya
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Jose I. Recio-Rodríguez
- San Juan Health Centre, Salamanca Primary Care Research Unit (APISAL), Institute of Biomedical Research of Salamanca (IBSAL), Department of Nursing and Physiotherapy (University of Salamanca), Avenue Portugal 83, 2 Floor, 37005 Salamanca, Spain;
| | - Haizea Pombo
- Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation, Biocruces Bizkaia Health Research Institute Innovation Unit, Plaza de Cruces s/n, 48903 Barakaldo, Spain;
| | - Alfonso Leiva-Rus
- Balearic Islands Health Research Institute (IdISBa), Highway Valldemosa 79, 07120 Palma, Spain;
| | - Montserrat Gil-Girbau
- Research Group in Health Technology Assessment in Primary Care and Mental Health (PRISMA), Research and Development Unit, Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Street Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain;
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucía, Avenue of the Universities, s/n, 41704 Dos Hermanas, Spain;
| | - Ruth Martí-Lluch
- Girona Research Support Unit, Jordi Gol i Gurina University Institute for Research in Primary Health Care Foundation (IDIAPJGol), Street Maluquer Salvador 11, 17002 Girona, Spain;
| | - Francisco Gude
- Clinical Epidemiology Unit, Research Methods Group, Santiago Institute of Sanitary Research (IDIS), Complejo Hospitalario Universitario de Santiago, Travesía da Choupana, s/n, 157056 Santiago de Compostela, Spain;
| | - Ana Clavería
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
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Barreira E, Novo A, Vaz JA, Pereira AMG. Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review. Aten Primaria 2018; 50:590-610. [PMID: 29061310 PMCID: PMC6836882 DOI: 10.1016/j.aprim.2017.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Evaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over. DESIGN Systematic review. DATA SOURCE PubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included. STUDY SELECTION A total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over. RESULTS The selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes. CONCLUSIONS Physical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus.
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Affiliation(s)
- Eduarda Barreira
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal.
| | - André Novo
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal; CINTESIS-Research Center on Health Technologies and Services, Porto, Portugal
| | - Josiana A Vaz
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal; CIMO-Mountain Research Centre, Polytechnic Institute of Bragança, Campus de Santa Apolónia, Bragança, Portugal
| | - Ana M G Pereira
- Health School, Polytechnic Institute of Bragança, Bragança, Portugal
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Gorina M, Limonero JT, Álvarez M. Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus, hypertension and hypercholesterolemia: A systematic review. Int J Nurs Stud 2018; 86:139-150. [PMID: 30007585 DOI: 10.1016/j.ijnurstu.2018.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes. OBJECTIVES To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia. METHODS The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia. RESULTS Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.
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Affiliation(s)
- Marta Gorina
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Carrer de la Riba, 90, 08221 Terrassa, Barcelona, Spain.
| | - Joaquín T Limonero
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - María Álvarez
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
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[Influence of a programme of therapeutic exercise on different clinical indicators related to dyslipidaemia in adult subjects aged between 26 to 73 years with a cardiovascular risk factor]. HIPERTENSION Y RIESGO VASCULAR 2018; 36:21-27. [PMID: 29636229 DOI: 10.1016/j.hipert.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A sedentary lifestyle is indicated in the international literature as one of the main causes for the onset of some cardiovascular risk factors. OBJECTIVE To assess the effect of a therapeutic physical exercise programme on different clinical indicators related to dyslipidaemia (total cholesterol, HDL and LDL) in sedentary subjects with a cardiovascular risk factor. METHOD Intervention study with before-and-after evaluation of a sample of 340 patients (132 males and 208 females) referred from the 2 primary care centres of the municipality of Molina de Segura (Murcia), and who participated in a 30-week programme of physical exercise combining muscle-conditioning work circuits with other cardio-respiratory resistance workouts. Regarding the clinical indicators, the health professionals collected in the medical history the health indicators corresponding to the biological evolution of the process for which the subjects studied had started the physical exercise programme. RESULTS The statistical analyses showed a significant improvement (p<.005) in the LDL indicator and a non-significant improvement in total and HDL cholesterol indicators after a 3-month exercise programme of 3 weekly sessions. CONCLUSIONS The prescription of physical exercise in dyslipidaemic subjects from primary care centre should be evaluated as a resource for improving the clinical indicators specific to their pathology.
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Muñoz Flórez A, Cortés Ferreira OL. Impacto de la Entrevista Motivacional en la Adherencia de Pacientes Diabéticos Inactivos a la Actividad Física: Estudio Piloto de un Ensayo Clínico EMOACTIF – DM. REVISTA COLOMBIANA DE PSICOLOGÍA 2017. [DOI: 10.15446/rcp.v26n2.59963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Este artículo investiga la factibilidad y aceptabilidad de un ensayo clínico para evaluar el impacto de la entrevista motivacional (EM) en la adherencia a la actividad física (AF) de pacientes inactivos con diabetes mellitus. En este ensayo se incluyeron treinta participantes; dieciséis recibieron em con refuerzo telefónico durante 4 semanas, los restantes recibieron cuidado convencional. Se evaluó AF, índice de masa corporal, nivel de glucosa en la sangre y autoeficacia hacia la AF. El grupo de intervención mostró mejoría significativa en la AF (p<.05) y el nivel de glucosa en la sangre (p<.05). Al tener en cuenta el cambio en imc para un estudio a gran escala, el cálculo de la muestra oscila entre 710 y 950 pacientes. Para estudios de menor escala, si se tiene en cuenta el cambio en METS, glucemia y autoeficacia, el cálculo de la muestra oscila entre 34 y 272 pacientes.
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Galindo Rubio M, Jansà Morató M, Menéndez Torre E. Educación terapéutica y autocuidado: resultados del estudio observacional transversal Diabetes Attitudes, Wishes and Needs 2 (DAWN2) en España. ACTA ACUST UNITED AC 2015; 62:391-9. [DOI: 10.1016/j.endonu.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022]
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Parra-Sánchez J, Moreno-Jiménez M, Nicola CM, Nocua-Rodríguez II, Amegló-Parejo MR, Del Carmen-Peña M, Cordero-Prieto C, Gajardo-Barrena MJ. [Evaluation of a supervised physical exercise program in sedentary patients over 65 years with type 2 diabetes mellitus]. Aten Primaria 2015; 47:555-62. [PMID: 25769195 PMCID: PMC6983777 DOI: 10.1016/j.aprim.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To analyze whether an exercise program can modify glycated hemoglobin (HbA1c), blood pressure (BP), body mass index (BMI), lipids, cardiovascular risk profile (CVR), self-perceived health status (SHS), and pharmaceutical expenditure (PE). DESIGN A randomized, single blind, controlled trial. INTERVENTION program of supervised aerobic physical exercise. Analysis by intention to treat. LOCATION Primary Care: 2 rural health areas. Health Area of Navalmoral. Cáceres. Extremadura. Spain. PARTICIPANTS 100 type 2 diabetic patients, aged 65 to 80 years, sedentary. Distribution: 50% control group (CG) and 50% intervention group (IG). Abandoned 12%. INTERVENTION monitored aerobic exercise: 40minutes, 2 days/week, 3 months. KEY MEASURES HbA1c, BP, BMI, lipid, CVR, SHS, PE. Complications during exercise. RESULTS There were post-intervention differences between groups in HbA1c, BP, BMI, cholesterol and SHS. In the IG, there was a significant decrease in; HbA1c: 0.2±0.4% (95% CI: 0.1 to 0.3), systolic BP: 11.8±8.5mmHg (95% CI: 5.1 to 11.9), BMI: 0.5±1 (95% CI: 0.2 to 0.8), total cholesterol: 14±28.2mg/dl (95% CI: 5.9 to 22.2), LDL: 18.3±28.2mg/dl 95% CI: 10.2 to 26.3), CVR: 6.7±7.7% (95% CI: 4.5 to 8.9), PE: 3.9±10.2 € (95% CI: 0.9 to 6.8), and an increase in SHS; 4.7±5.7 (95% CI: 3 to 6.3). CONCLUSIONS In diabetics over 65 years, a program of monitored aerobic exercise, of easy implementation, improves HbA1c, BP, cholesterol, CVR, PE, and SHS.
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Affiliation(s)
| | | | | | | | | | - Marlen Del Carmen-Peña
- Centro de Salud de Navalmoral de la Mata, Área de Salud de Navalmoral de la Mata, Cáceres, Servicio Extremeño de Salud, España
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Díaz-Rodríguez MI, Sánchez-Morales MC, Aceña-Gutiérrez MT, Carrasco-Flores J, Villarín-Castro A. [Family physician attitudes towards insulinization in type II diabetics]. Semergen 2014; 40:121-7. [PMID: 24503168 DOI: 10.1016/j.semerg.2013.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/13/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022]
Abstract
AIM To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. MATERIALS AND METHODS Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. RESULTS A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). CONCLUSIONS The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy.
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Affiliation(s)
- M I Díaz-Rodríguez
- Centro de Salud de Mota del Cuervo, Gerencia de Atención Integrada de Alcázar de San Juan, Mota del Cuervo, Cuenca, España
| | | | - M T Aceña-Gutiérrez
- Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | | | - A Villarín-Castro
- Unidad Docente de Atención Familiar y Comunitaria de Toledo, Gerencia de Atención Primaria de Toledo, Toledo, España.
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González Pérez J. Ejercicio y diabetes mellitus tipo 2. Aten Primaria 2012; 44:178; author reply 179. [DOI: 10.1016/j.aprim.2011.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/29/2011] [Indexed: 11/26/2022] Open
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Birulés M. [Community clinical trial on type 2 diabetics: Benefits of health education associated with physical exercise]. Aten Primaria 2011; 43:407-8. [PMID: 21722993 DOI: 10.1016/j.aprim.2011.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 11/17/2022] Open
Affiliation(s)
- Martí Birulés
- Centro de Atención Primaria Poblenou, Barcelona, España.
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