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Páez DC, Flórez J, Gómez MT, García D, Arango-Paternina CM, Duperly J. Curricular and pedagogical approaches for physical activity prescription training: a mixed-methods study of the "Exercise is Medicine" workshops in Colombia. BMC MEDICAL EDUCATION 2024; 24:79. [PMID: 38254169 PMCID: PMC10804704 DOI: 10.1186/s12909-023-04999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The physical activity (PA) prescription workshop for physicians, through the global health initiative "Exercise is Medicine" (EIM), has trained more than 4000 health care professionals (HCPs) in Latin America. It has shown to be effective in increasing PA prescription knowledge and awareness among HCPs. The purpose of this paper is to evaluate the curricular and pedagogical approach used by EIM Colombia at the PA prescription workshops implemented between 2014 and 2015. METHODS A mixed methods study, with a sequential explanatory design was implemented among a convenience sample of HCPs attending twenty-six PA prescription workshops. HCPs health status, PA personal habits, and medical practices were collected using a questionnaire at baseline among 795 participants (pre-test measurement), and subsequently quantitatively analyzed. A workshop satisfaction survey was administered after the completion of the workshop among 602 HCPs. The curricular and pedagogical approach of the workshop, the designers' and students' contextual factors, and perceptions about the workshop were measured using qualitative methods (analysis of the procedures manual, two workshop observations, three semi-structured interviews, and one focus group including 8 HCPs). RESULTS The workshop is student-centered and guided by an expert with an academic and clinical background. Learning was achieved with theoretical and practical components using authentic performance and collaborative learning. An active teaching and learning approach was used with strategies such as interactive lectures, hands-on elements, and role-playing (patient-counselor). The workshop emphasized an individual approach when prescribing PA integrating in clinical practice not only health benefits but also patient´s beliefs, motivations, needs, and barriers. CONCLUSIONS Evidence-based practices and authentic performance were the most salient pedagogical elements used by EIM Colombia at the PA prescription workshop. A knowledge assessment that includes the practical aspect is suggested for future workshops. The curricular and pedagogical approach of the PA prescription workshop implemented in Colombia is well received by the medical community and a useful continuing medical education intervention with a potential contribution to current, and future health promotion needs.
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Affiliation(s)
- Diana C Páez
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia.
| | - Johanna Flórez
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
| | - María Teresa Gómez
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
- Centro de Investigación y Formación en Educación, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
| | - Daniel García
- Centro de Investigación y Formación en Educación, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
| | - Carlos M Arango-Paternina
- Instituto Universitario de Educación Física y Deporte, Universidad de Antioquia, Calle 74 # 70 - 59, Medellín, Colombia
| | - John Duperly
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
- Institute of Exercise Medicine and Rehabilitation, Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia
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Wattanapisit A, Lapmanee S, Chaovalit S, Lektip C, Chotsiri P. Prevalence of physical activity counseling in primary care: A systematic review and meta-analysis. Health Promot Perspect 2023; 13:254-266. [PMID: 38235006 PMCID: PMC10790122 DOI: 10.34172/hpp.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 01/19/2024] Open
Abstract
Background This systematic review aimed to summarize and evaluate the prevalence of physical activity (PA) counseling in primary care. Methods Five databases (CINAHL Complete, Embase, Medline, PsycInfo, and Web of Science) were searched. Primary epidemiological studies on PA counseling in primary care were included. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to assess the quality of studies. The review protocol was registered with PROSPERO (CRD42021284570). Results After duplicate removal, 4990 articles were screened, and 120 full-text articles were then assessed. Forty studies were included, with quality assessment scores ranging from 5/9 to 9/9. The pooled prevalence of PA counseling based on 35 studies (199830 participants) was 37.9% (95% CI 31.2 to 44.6). The subgroup analyses showed that the prevalence of PA counseling was 33.1% (95% CI: 22.6 to 43.7) in females (10 studies), 32.1% (95% CI: 22.6 to 41.7) in males (10 studies), 65.5% (95% CI: 5.70 to 74.1) in people with diabetes mellitus (6 studies), 41.6% (95% CI: 34.9 to 48.3) in people with hypertension (5 studies), and 56.8% (95% CI: 31.7 to 82.0) in people with overweight or obesity (5 studies). All meta-analyses showed high levels of heterogeneity (I2=93% to 100%). Conclusion The overall prevalence of PA counseling in primary care was low. The high levels of heterogeneity suggest variability in the perspectives and practices of PA counseling in primary care. PA counseling should be standardized to ensure its optimum effectiveness in primary care.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Sarawut Lapmanee
- Department of Basic Medical Sciences, Faculty of Medicine, Siam University, Bangkok, Thailand
| | - Sirawee Chaovalit
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Charupa Lektip
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Palang Chotsiri
- Department of Clinical Pharmacology, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Znyk M, Kaleta D. Healthy lifestyle counseling, and barriers perceived by general practitioners in Poland. Front Public Health 2023; 11:1256505. [PMID: 37829088 PMCID: PMC10565007 DOI: 10.3389/fpubh.2023.1256505] [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: 07/10/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The aim of the study was to determine the influence of the personal factors, such as body mass index (BMI), of general practitioners (GPs), and their counseling on weight management, healthy lifestyle, and their perceived barriers. Materials and methods The cross-sectional study was conducted from January 2020 to December 2021 among 161 GPs in the city of Lodz. Results Only 3.7% of physicians always advised their patients on diet and physical activity (p < 0.05). Most of the GPs (54%) provide counseling occasionally. GPs gave general advice more often to patients with chronic diseases than to patients who did not. The study showed that the chance of providing advice on eating habits or physical activity was significantly higher for the GPs who practiced physical activity (OR = 2.64; 95%Cl: 1.01-6.91, p < 0.05) and measured patient weight, height, and BMI (OR = 4.86; 95%Cl: 1.86-12.67, p < 0.001). GPs who were overweight (OR = 3.55; 95%Cl: 1.49-8.41, p < 0.01) and measured patient weight, height, and BMI (OR = 3.61; 95%Cl: 1.58-8.25, p < 0.01) were more likely to advise on nutrition or physical activity to "healthy" patients. Doctors who measured patient weight, height, and BMI advised patients with chronic diseases (OR = 6.45; 95%Cl: 2.54-16.34, p < 0.001). Over 40% of GPs believe that they are not effective in counseling. Lack of time turned out to be the main barrier to counseling for 73.3% of GPs, which was associated with heavy workload (>100 visits per week). Conclusion As many GPs doubt their effectiveness, it is recommended that GPs attend more training activities regarding counseling. In addition, organizational changes are needed to reduce patient numbers, and financial incentives are needed to improve counseling and patient measurement.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Lodz, Poland
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Rocha JQS, Dutra RP, Vieira YP, Duro SMS, de Oliveira Saes M. Inequalities in the receipt of healthcare practitioner counseling for adults after COVID-19 in southern Brazil. BMC Public Health 2023; 23:1101. [PMID: 37286989 DOI: 10.1186/s12889-023-15914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
Health counseling is a prevention and health promotion action, especially in the context of a pandemic, for both preventing disease and maintaining health. Inequalities may affect receipt of health counseling. The aim was to provide an overview of the prevalence of receiving counseling and to analyze income inequality in the receipt of health counseling. METHODS This was a cross-sectional telephone survey study with individuals aged 18 years or older with diagnosis of symptomatic COVID-19 using RT-PCR testing between December 2020 and March 2021. They were asked about receipt of health counseling. Inequalities were assessed using the Slope Index of Inequality (SII) and Concentration Index (CIX) measures. We used the Chi-square test to assess the distribution of outcomes according to income. Adjusted analyses were performed using Poisson regression with robust variance adjustment. RESULTS A total of 2919 individuals were interviewed. Low prevalence of health counseling by healthcare practitioner was found. Participants with higher incomes were 30% more likely to receive more counseling. CONCLUSIONS These results serve as a basis for aggregating public health promotion policies, in addition to reinforcing health counseling as a multidisciplinary team mission to promote greater health equity.
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Affiliation(s)
- Juliana Quadros Santos Rocha
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Visconde de Paranaguá, 102, bairro Centro, Rio Grande, Rio Grande do Sul, 96203-900, Brazil.
| | - Rinelly Pazinato Dutra
- Postgraduate Programme in Public Health, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Yohana Pereira Vieira
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Visconde de Paranaguá, 102, bairro Centro, Rio Grande, Rio Grande do Sul, 96203-900, Brazil
| | | | - Mirelle de Oliveira Saes
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Visconde de Paranaguá, 102, bairro Centro, Rio Grande, Rio Grande do Sul, 96203-900, Brazil
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Guerra PH, Sposito LAC, da Costa FF, Fermino RC, Papini CB, Rech CR. Effectiveness of the 5A Counseling Model-Based Interventions on Physical Activity Indicators in Adults: A Systematic Review. Behav Sci (Basel) 2023; 13:476. [PMID: 37366729 DOI: 10.3390/bs13060476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND To identify and appraise the effectiveness of the 5A-counseling-model-based interventions on indicators of physical activity in adults. METHODS A systematic review was conducted from systematic searches in Embase, Lilacs, Pubmed, Scielo, Scopus, Sportdiscus and Web of Science, involving studies published from its inception until May 2022. To avoid potential losses, searches also were made in Google Scholar and in reference lists. The assessment of studies, data extraction, and synthesis were carried out independently by two researchers. RESULTS Four studies composed the synthesis, which involved people with an average age between 40 and 55 years, most of the samples being women. It was observed that counseling was carried out in conjunction with other strategies, such as drawing up an action plan, sending text messages, and offering educational material. Only one study showed a statistically significant difference between the intervention and control groups in the "daily number of steps" indicator. CONCLUSIONS Based on available studies, 5A-counseling-model-based interventions did not reflect significant findings in relation to physical activity. However, given the potential of the model, future studies are recommended with a better description of the strategies, as well as a more robust methodology, to strengthen the evidence.
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Affiliation(s)
| | | | - Filipe Ferreira da Costa
- Associated Post-Graduation Program in Physical Education, University of Pernambuco/Federal University of Paraíba, João Pessoa 58051-900, Brazil
| | - Rogério César Fermino
- Postgraduate Program in Physical Education, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
| | - Camila Bosquiero Papini
- Department of Sports Sciences, Federal University of Triângulo Mineiro, Uberaba 38025-180, Brazil
| | - Cassiano Ricardo Rech
- Post-Graduation Program in Physical Education, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
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Hu R, Hui SSC, Lee EKP, Stoutenberg M, Wong SYS, Yang YJ. Factors associated with physical activity promotion efforts in individuals with chronic diseases: A systematic review from the perspective of patients. PATIENT EDUCATION AND COUNSELING 2023; 109:107641. [PMID: 36724581 DOI: 10.1016/j.pec.2023.107641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To determine factors associated with healthcare provider physical activity (PA) promotion in individuals with chronic diseases from the perspective of patients. METHODS A systematic review of literature was conducted between March and April 2022 by searching five databases. Studies were included if they used survey data, published in English or Chinese, and investigated factors influencing healthcare provider PA promotion in chronic diseases from the perspective of adult patients. Retrieved factors were extracted and mapped to Anderson's Behavioral Model of Health Services Use. Quality of each study was assessed using the NIH Quality Assessment Tool. RESULTS Thirteen articles were included for final analysis. The quality of the included studies ranged from fair to good. A series of factors were positively related to healthcare provider PA promotion (e.g., having emotional support or public programs for PA). Conflicting results were found for other factors (e.g., age and gender). CONCLUSIONS A series of factors may impact the incorporation of PA promotion into clinical care. More studies with well-designed surveys using primary data collection are suggested to confirm these findings. PRACTICE IMPLICATIONS Factors identified from this review provide insights for developing of strategies related to healthcare provider PA promotion for individuals with chronic diseases.
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Affiliation(s)
- Rui Hu
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region
| | - Stanley Sai-Chuen Hui
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region.
| | - Eric Kam-Pui Lee
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region
| | - Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Samuel Yeung-Shan Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region
| | - Yi-Jian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region
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Bhandari S, Watkinson E, Fawkner S. Are doctors and nurses engaging in physical activity and its promotion? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:144-149. [PMID: 36763484 DOI: 10.12968/bjon.2023.32.3.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Physical activity counselling in health care is inadequate but the reasons for this are not well understood. AIMS To evaluate physical activity participation and counselling perceptions and practices among doctors and nurses in the UK. METHODS This study used two anonymised online questionnaires distributed at different times to doctors and nurses throughout the UK. FINDINGS 629 responses were obtained; 78.3% of doctors and 73.4% of nurses met the UK guideline for aerobic physical activity. Perceived importance of counselling on physical activity was high but less than 50% of participants were actually providing counselling. Counselling was more likely in primary care and doctors were marginally more likely than nurses to counsel. CONCLUSION Doctors and nurses are an active cohort and view counselling on physical activity as important. Despite this, counselling levels are low especially in secondary care. Efforts should be made to improve knowledge and opportunity for physical activity counselling.
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Affiliation(s)
- Sara Bhandari
- Time of writing was medical student, University of Edinburgh
| | - Emma Watkinson
- Time of writing was medical student, University of Edinburgh
| | - Samantha Fawkner
- Senior Lecturer, Physical Activity for Health Research Centre, University of Edinburgh
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The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors. PLoS One 2022; 17:e0276868. [PMID: 36315564 PMCID: PMC9621409 DOI: 10.1371/journal.pone.0276868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients' PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare. METHODS This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27-85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes. RESULTS The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary. CONCLUSION This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.
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Bouma A, van Nassau F, Nauta J, Krops L, van der Ploeg H, Verhagen E, van der Woude L, van Keeken H, Dekker R. Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals. BMC Med Inform Decis Mak 2022; 22:250. [PMID: 36138451 PMCID: PMC9494771 DOI: 10.1186/s12911-022-01993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as ‘Exercise is Medicine’ (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care. Methods A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide. Results An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients’ electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care. Conclusions This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01993-5.
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Affiliation(s)
- Adrie Bouma
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joske Nauta
- Department of Public and Occupational Health, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie Krops
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hidde van der Ploeg
- Department of Public and Occupational Health, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Evert Verhagen
- Department of Public and Occupational Health, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lucas van der Woude
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Helco van Keeken
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Reid H, Smith R, Williamson W, Baldock J, Caterson J, Kluzek S, Jones N, Copeland R. Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare. BMC Public Health 2022; 22:1784. [PMID: 36127688 PMCID: PMC9487060 DOI: 10.1186/s12889-022-14178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background An implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap. Methods The BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus. Results The behavioural diagnosis identified healthcare professionals’ initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies. Conclusions This study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals’ frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport and Exercise Medicine, 6 Hill Square, Edinburgh, UK. .,Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Ralph Smith
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Wilby Williamson
- School of Medicine, Trinity College Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - James Baldock
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Jessica Caterson
- Imperial College Healthcare NHS Trust, Praed Street, London, GB, W2 1NY, UK
| | - Stefan Kluzek
- School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2UH, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport and Exercise Medicine, 6 Hill Square, Edinburgh, UK.,Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
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de Souza ALK, dos Santos LP, Rech CR, Rodriguez-Añez CR, Alberico C, Borges LJ, Fermino RC. Barriers to physical activity among adults in primary healthcare units in the National Health System: a cross-sectional study in Brazil. SAO PAULO MED J 2022; 140:658-667. [PMID: 36043670 PMCID: PMC9514869 DOI: 10.1590/1516-3180.2021.0757.r1.20122021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many factors may negatively impact physical activity (PA), but studies lack evidence of individual predictors of perceived barriers to PA among adults in primary healthcare units. OBJECTIVE To analyze associations between sociodemographic characteristics, health conditions, leisure-time physical activity (LTPA), PA counseling and perceived barriers to LTPA among adult patients in primary healthcare units of the National Health System in Brazil. DESIGN AND SETTING Cross-sectional study on a representative sample of adults in primary healthcare units in São José dos Pinhais, Paraná, Brazil. METHODS This study was conducted in 2019, among 779 adults (70% women). Barriers to LTPA, sociodemographic characteristics (sex, age, marital status, skin color, education and income), health conditions (body mass index, hypertension, diabetes, dyslipidemia, coronary disease and medications), LTPA level and PA counseling received were measured using validated, standardized procedures. The data were analyzed using chi-square and Mann-Whitney U tests. RESULTS The most prevalent barriers were "feeling too tired" (53%) and "lack of time" (52%). PA counseling was inversely associated with "lack of time" (45% versus 57%; P < 0.001) but positively associated with "injury or disease" (38% versus 29%; P = 0.008). There was an inverse linear trend between the number of barriers and LTPA (walking and total) (P < 0.001). Most barriers differed in comparisons of sociodemographic characteristics, health conditions, LTPA and counseling (P < 0.05). CONCLUSIONS The barriers vary according to the individual predictors. Counseling strategies need to be specific for each barrier and may be promising for promoting LTPA within primary healthcare.
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Affiliation(s)
- Ana Luísa Kuehn de Souza
- BHSc. Student, Multiprofessional Residency Program on Family Health, Sergio Arouca National School of Public Health, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Letícia Pechnicki dos Santos
- MSc. Researcher, Postgraduate Program on Physical Education and Research Group on Environment, Physical Activity and Health, Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (PR), Brazil
| | - Cassiano Ricardo Rech
- PhD. Professor and Researcher, Postgraduate Program on Physical Education and Study Group on Urban Environment and Health, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | - Ciro Romelio Rodriguez-Añez
- PhD. Professor and Researcher, Postgraduate Program on Physical Education and Research Group on Environment, Physical Activity and Health, Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (PR), Brazil
| | - Claudia Alberico
- PhD. Researcher, Biomedical/Biotechnology Research Institute, North Carolina Central University (NCCU), Durham (NC), United States
| | - Lucélia Justino Borges
- PhD. Professor and Researcher, Department of Physical Education, Universidade Federal do Paraná (UFPR), Curitiba (PR), Brazil
| | - Rogério César Fermino
- PhD. Professor and Researcher, Postgraduate Program on Physical Education and Research Group on Environment, Physical Activity and Health, Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (PR), Brazil
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12
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Snége A, da Silva AADP, Mielke GI, Rech CR, Siqueira FCV, Rodriguez-Añez CR, Fermino RC. Sedentary Behavior Counseling Received from Healthcare Professionals: An Exploratory Analysis in Adults at Primary Health Care in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9963. [PMID: 36011594 PMCID: PMC9407836 DOI: 10.3390/ijerph19169963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1-14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10-2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14-2.98), BMI ≥ 30 kg/m2 (PR: 2.60; 95% CI: 1.31-5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06-4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88-6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.
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Affiliation(s)
- André Snége
- Research Group on Environment, Physical Activity and Health, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
| | - Alexandre Augusto de Paula da Silva
- Postgraduate Program in Health Sciences, Research Group on Physical Activity and Quality of Life, Pontifical Catholic University of Paraná, Curitiba 80215-901, Brazil
| | - Grégore Iven Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Cassiano Ricardo Rech
- Research and Study Group in Urban Environment and Health, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
| | | | - Ciro Romelio Rodriguez-Añez
- Research Group on Environment, Physical Activity and Health, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
| | - Rogério César Fermino
- Research Group on Environment, Physical Activity and Health, Federal University of Technology-Paraná, Curitiba 81310-900, Brazil
- Postgraduate Program in Physical Education, Federal University of Paraná, Curitiba 81531-980, Brazil
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Gonçalves L, Moraes MS, Silva DAS. Counseling for Physical Activity in Adults during the COVID-19 Pandemic: A Scope Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148687. [PMID: 35886538 PMCID: PMC9322393 DOI: 10.3390/ijerph19148687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 01/02/2023]
Abstract
Objective: The aim of this scope review was to map the available scientific evidence on physical activity counseling for adults during the COVID-19 pandemic. Methods: The search was performed in PubMed, Web of Science, Scopus, SPORTDiscus, LILACS, SciELO, and CINAHL databases. Studies that described the population of adults over 18 years of age that used physical activity counseling during the COVID-19 pandemic context were selected. Data extracted were author, study location, sample, age group, sex, population characteristics, design, means used for intervention, time of intervention, professionals involved, and intervention or counseling strategy. Results: Physical activity counseling interventions were aimed at participants with insufficient levels of physical activity or with comorbidities; counseling was carried out in the online format; by health professionals, in the highest proportion of coaches, physicians, researchers, and nutritionists; through educational contents regarding the practice of physical activity; and using the transtheoretical model of behavior change as a reference method. Conclusions: The results of this review can provide tools for health professionals to assist in the process of coping with physical inactivity.
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Martiskainen TM, Lamidi ML, Venojärvi M, Tikkanen H, Laatikainen T. Effectiveness of physical activity counselling provided for people with type 2 diabetes mellitus in primary healthcare in North Karelia, Finland: a register-based evaluation study. BMJ Open 2022; 12:e058546. [PMID: 35788078 PMCID: PMC9255411 DOI: 10.1136/bmjopen-2021-058546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Physical activity (PA) plays a significant role in the treatment of type two diabetes (T2D). This study evaluated the effectiveness of PA counselling in primary healthcare (PHC) on clinical outcome measures in patients with T2D, comparing them with a registry-based controls. SETTING The study was carried out in North Karelia, Finland, among PHC clients who have been diagnosed with T2D in 2016-2018. PARTICIPANTS The study population consisted of patients aged 19-87 years diagnosed with T2D (n=1803). Altogether 546 patients were referred to the PA educator of whom 521 participated the counselling. In totally 1382 sex, age, time of diagnosis and intervention time-matched controls were used to see the effect of intervention. INTERVENTIONS Patients with T2D followed up in PHC were offered to participate in PA counselling provided by trained PA educators. The number of counselling sessions and their content were tailored according to patients needs and willingness to participate. To assess the effects of PA to management of T2D clinical outcome measures such as weight and Haemoglobin A1c (HbA1c) and lipid levels were assessed using data from electronic patient records. Each patient was followed up from records at least for a year. RESULTS Weight and body mass index (BMI) decreased in both groups and mean yearly changes did not differ between the groups. HbA1c levels declined in the intervention and increased in the control group with statistically significant difference in the mean yearly change between the groups (p=0.001). The low-density lipoprotein declined in both groups. The decline was bigger in the intervention group, but the difference did not quite reach the statistical significance (p=0.096). CONCLUSIONS This study shows that PA counselling in PHC offers significant benefits in the treatment outcomes of T2D although no significant declines were not observed in the weight or BMI.
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Affiliation(s)
- Tuula Marketta Martiskainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heikki Tikkanen
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Reid H, Caterson J, Smith R, Baldock J, Jones N, Copeland R. What do healthcare professionals want from a resource to support person-centred conversations on physical activity? A mixed-methods, user-centric approach to developing educational resources. BMJ Open Sport Exerc Med 2022; 8:e001280. [PMID: 35813130 PMCID: PMC9226873 DOI: 10.1136/bmjsem-2021-001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES Healthcare is a fundamental action area in population efforts to address the global disease burden from physical inactivity. However, healthcare professionals lack the knowledge, skills and confidence to have regular conversations about physical activity. This study aimed to: (1) understand the requirements of healthcare professionals and patients from a resource to support routine physical activity conversations in clinical consultations and (2) develop such a resource. METHODS This study used codesign principles across two phases, actively involving relevant stakeholders in an iterative development process. The preparatory phase included a scoping literature review and workshops with multidisciplinary healthcare professionals and patients. The Delphi phase included the development of a draft resource, a three-stage modified online Delphi study and an external review. RESULTS The scoping review highlighted the importance of addressing time restrictions, a behaviour change skill deficit, the need for resources to fit into existing systems and meeting patient expectations. Consultation included 69 participants across two clinical workshops. They recommended using the internet, valued guidance on all aspects of physical activity conversations and were concerned about how to use a person-centred approach. The Delphi phase, including 15 expert participants, met agreement criteria in two stages to develop the resource. CONCLUSION This mixed-methods study delivered an online resource that was codesigned with and based on the requirements of healthcare professionals and patients. The resource presents condition-specific '1-minute', '5-minute' and 'more minute' person-centred and evidence-based conversation templates on physical activity in an accessible and usable format to meet the needs of real-life clinical practice.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, UK
| | | | - Ralph Smith
- Oxsport, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - James Baldock
- Oxsport, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Oxsport, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, UK
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16
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Worley V, Fraser P, Allender S, Bolton KA. Describing workplace interventions aimed to improve health of staff in hospital settings - a systematic review. BMC Health Serv Res 2022; 22:459. [PMID: 35392894 PMCID: PMC8991835 DOI: 10.1186/s12913-021-07418-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/15/2021] [Indexed: 12/11/2022] Open
Abstract
Background A large proportion of staff working in hospital settings are overweight or obese, have poor dietary habits and low physical activity levels. The workplace is a priority setting for health promotion. This systematic review will describe dietary and physical activity workplace interventions that have aimed to improve the health of staff in hospital settings; and the barriers and enablers of implementing these interventions. Methods A systematic search retrieved 551 studies from 2004 to 2020 using the following databases CINAHL Complete, MEDLINE Complete, Academic Search Complete, Global Health, Health Source Nursing/Academic Edition and PsycINFO. Studies were included if they: (1) took place in a hospital setting; (2) employed a physical activity or dietary intervention to improve the well-being of staff; (3) the intervention duration was 12 weeks or over; (4) used a control group. The Integrated quality Criteria for the Review of Multiple Study designs (ICROMS) and National Institute of Health’s National Heart Lung and Blood Institute Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies tools were used to assess quality of included studies. A narrative review was conducted. Results Quality analysis identified six studies of high quality, nine moderate quality, and three low quality. Of these 18 studies, 15 reported at least one positive health outcome. The evidence revealed that multi-component strategies, financial incentives and motivational strategies were the most effective approaches to improve health behaviours of hospital staff. Conclusion Hospital-based dietary and physical activity workplace interventions show promise as an effective strategy for improving health behaviours of hospital staff. Methodological limitations highlight the need for more research from high-quality, randomised control trials, to gain further insight into the benefits of workplace interventions in hospital settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07418-9.
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Affiliation(s)
- Verity Worley
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Penny Fraser
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Kristy A Bolton
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia. .,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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17
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von Sommoggy J, Grepmeier EM, Curbach J. Health Literacy-Sensitive Counselling on Early Childhood Allergy Prevention: Results of a Qualitative Study on German Midwives' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074182. [PMID: 35409865 PMCID: PMC8998819 DOI: 10.3390/ijerph19074182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/06/2023]
Abstract
In Germany, midwives are involved in extensive antenatal and postnatal care. As health professionals, they can play a key role in strengthening health literacy (HL) of parents on how to prevent chronic allergic diseases in their children. The objective of this study is to explore midwives' perspectives regarding HL-sensitive counselling in early childhood allergy prevention (ECAP). Twenty-four qualitative semi-structured interviews were conducted with midwives, and data were analyzed using qualitative content analysis. Only a small number of study participants were aware of HL as a concept. However, most of these use screening and counselling strategies which consider individual information needs and which support parental HL. HL sensitivity in counselling is largely based on the midwives' "gut feelings" and counselling experience, rather than on formal education. The midwives were largely aware of evidence-based ECAP recommendations; however, allergy prevention was not seen as a stand-alone topic but as part of their general counselling on infant feeding and hygiene. They found parents to be more open to receiving complex prevention information during antenatal counselling. In order to strengthen midwives' roles in HL-sensitive ECAP counselling, their formal education should provide them with explicit HL knowledge and counselling skills. ECAP should be an inherent part of antenatal care.
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Affiliation(s)
- Julia von Sommoggy
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, 93051 Regensburg, Germany
- Correspondence:
| | - Eva-Maria Grepmeier
- Medical Faculty, Institute of Social Medicine & Health Systems Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany;
| | - Janina Curbach
- Department of Business Studies, Ostbayerische Technische Hochschule Regensburg, 93053 Regensburg, Germany;
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18
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Grogg KA, Giacobbi PR, Blair EK, Haggerty TS, Lilly CL, Winters CS, Kelley GA. Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review. Am J Health Promot 2022; 36:714-737. [PMID: 35224998 DOI: 10.1177/08901171211051840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States. DATA SOURCES A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019. INCLUSION AND EXCLUSION CRITERIA Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature. DATA EXTRACTION Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders. DATA SYNTHESIS Data were synthesized using qualitative and descriptive methods. RESULTS Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions. CONCLUSION The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.
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Affiliation(s)
- Kristin A Grogg
- West Virginia Clinical and Translational Science Institute, 5631West Virginia University School of Medicine and Honors College, Morgantown, WV, USA
| | - Peter R Giacobbi
- Department of Sport Sciences, Joint Appointment in Department of Social & Behavioral Sciences, 5631West Virginia University College of Physical Activity & Sport Sciences, School of Public Health, Morgantown, WV, USA
| | - Emma K Blair
- Department of Exercise Physiology, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Treah S Haggerty
- Department of Family Medicine, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Carena S Winters
- Department of Kinesiology, 4121Jacksonville University, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville, FL, USA
| | - George A Kelley
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
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Guerra PH, Soares HF, Mafra AB, Czarnobai I, Cruz GA, Weber WV, Farias JCH, Loch MR, Ribeiro EHC. Educational interventions for physical activity among Brazilian adults: systematic review. Rev Saude Publica 2021; 55:110. [PMID: 34932699 PMCID: PMC8664058 DOI: 10.11606/s1518-8787.2021055003236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To summarize the main evidence from educational interventions designed to increase levels of physical activity (PA) among Brazilian adults. METHODS Systematic review of intervention studies carried out in Brazil that implemented educational components aimed at promoting increased levels of PA among adult populations (18 to 65 years old). In October 2020, systematic searches were conducted in six databases, and in the reference lists of the assessed studies. RESULTS Of the initial 2,511 studies, nine were included in the synthesis. Samples with specific characteristics (such as social vulnerability, physical inactivity, and overweight or obesity) were observed, with a greater number of women. Five interventions (55.6%) occurred in primary healthcare settings (PHC) of the Brazilian Unified Health System (SUS). Only four studies (44.4%) described the pedagogical frameworks structuring the educational approaches, among which counseling was the most used strategy, such as those carried out through face-to-face meetings, home visits, lectures, and phone calls (n = 8; 88.9%). Positive results were observed in three different indicators: increase in weekly PA volume (n = 4); increase in leisure-time PA rate (n = 1); and increase in the proportion of women classified as “very active/active” (n = 1). Given the sampling specificities, the domain “participant selection” showed a high number of interventions with high risk of bias. CONCLUSIONS Educational approaches engendered some positive effects on different PA indicators, notably counseling as the main strategy used and approaches involving other health themes, such as nutrition and stress. However, considering the several determinants of PA in Brazil, future interventions should be conducted in different locations of Brazil in order to evaluate, in a broader way, their implementation processes and articulation with the many professionals working in PHC.
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Affiliation(s)
- Paulo Henrique Guerra
- Universidade Federal da Fronteira Sul. Curso de Medicina. Chapecó, SC, Brasil.,Universidade de São Paulo. Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde da São Paulo, SP, Brasil
| | - Hugo Falqueto Soares
- Universidade Federal da Fronteira Sul. Curso de Medicina. Chapecó, SC, Brasil.,Universidade Federal da Fronteira Sul. Programa de Pós-Graduação em Ciências Biomédicas. Chapecó, SC, Brasil
| | - Ana Beatriz Mafra
- Universidade Federal da Fronteira Sul. Curso de Medicina. Chapecó, SC, Brasil
| | - Izadora Czarnobai
- Universidade Federal da Fronteira Sul. Curso de Medicina. Chapecó, SC, Brasil
| | | | | | | | - Mathias Roberto Loch
- Universidade Estadual de Londrina. Programa de Pós-Graduação em Saúde Coletiva. Londrina, PR, Brasil
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20
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Curbach J, Lander J, Dierks ML, Grepmeier EM, von Sommoggy J. How do health professionals translate evidence on early childhood allergy prevention into health literacy-responsive practice? A protocol for a mixed-method study on the views of German health professionals. BMJ Open 2021; 11:e047733. [PMID: 34785543 PMCID: PMC8596052 DOI: 10.1136/bmjopen-2020-047733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Paediatricians, general practitioners (GPs) and midwives in primary care are important sources of information for parents on early childhood allergy prevention (ECAP). Research has shown that preventive counselling by health professionals can be effective in improving patients' health literacy (HL) and health behaviour. Providing effective advice relies on two factors. First, health professionals need be up-to-date with research evidence on ECAP, to consider popular misconceptions and fears and to translate this knowledge into clear recommendations for parents (knowledge translation). Second, they need to know and apply counselling techniques and create a practice setting which accommodates parental HL needs (health literacy-responsive care). The objective of this study is to explore and assess how German health professionals take up and translate ECAP evidence into appropriate recommendations for parents, how they consider HL in counselling and practice organisation and what barriers and enablers they find in their performance of HL-responsive ECAP. METHODS AND ANALYSIS The study has a sequential mixed-method design, in two phases. In the first phase, qualitative semi-structured expert interviews will be conducted with health professionals (paediatricians, GPs and midwives) at primary care level and professional policy level. Data collection is ongoing until January 2022. In the second phase, based on the qualitative results, a standardised questionnaire will be developed, and pilot-tested in a wider population of German health professionals. The findings of both phases will be integrated. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethics Committee of the University of Regensburg (18-1205-101). The results will be published in international peer-reviewed open access journals and via presentations at scientific conferences. The results will also be shared with German health professionals, decision-makers and potential funders of interventions.
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Affiliation(s)
- Janina Curbach
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
- Faculty of Businesss Studies, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany
| | - Jonas Lander
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Marie Luise Dierks
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Eva-Maria Grepmeier
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
| | - Julia von Sommoggy
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
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21
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Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med 2021; 56:427-438. [PMID: 34649919 PMCID: PMC8995821 DOI: 10.1136/bjsports-2021-104281] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
Introduction The benefits of physical activity for people living with long-term conditions (LTCs) are well established. However, the risks of physical activity are less well documented. The fear of exacerbating symptoms and causing adverse events is a persuasive barrier to physical activity in this population. This work aimed to agree clear statements for use by healthcare professionals about medical risks of physical activity for people living with LTCs through expert consensus. These statements addressed the following questions: (1) Is increasing physical activity safe for people living with one or more LTC? (2) Are the symptoms and clinical syndromes associated with common LTCs aggravated in the short or long term by increasing physical activity levels? (3) What specific risks should healthcare professionals consider when advising symptomatic people with one or more LTCs to increase their physical activity levels? Methods Statements were developed in a multistage process, guided by the Appraisal of Guidelines for Research and Evaluation tool. A patient and clinician involvement process, a rapid literature review and a steering group workshop informed the development of draft symptom and syndrome-based statements. We then tested and refined the draft statements and supporting evidence using a three-stage modified online Delphi study, incorporating a multidisciplinary expert panel with a broad range of clinical specialties. Results Twenty-eight experts completed the Delphi process. All statements achieved consensus with a final agreement between 88.5%–96.5%. Five ‘impact statements’ conclude that (1) for people living with LTCs, the benefits of physical activity far outweigh the risks, (2) despite the risks being very low, perceived risk is high, (3) person-centred conversations are essential for addressing perceived risk, (4) everybody has their own starting point and (5) people should stop and seek medical attention if they experience a dramatic increase in symptoms. In addition, eight symptom/syndrome-based statements discuss specific risks for musculoskeletal pain, fatigue, shortness of breath, cardiac chest pain, palpitations, dysglycaemia, cognitive impairment and falls and frailty. Conclusion Clear, consistent messaging on risk across healthcare will improve people living with LTCs confidence to be physically active. Addressing the fear of adverse events on an individual level will help healthcare professionals affect meaningful behavioural change in day-to-day practice. Evidence does not support routine preparticipation medical clearance for people with stable LTCs if they build up gradually from their current level. The need for medical guidance, as opposed to clearance, should be determined by individuals with specific concerns about active symptoms. As part of a system-wide approach, consistent messaging from healthcare professionals around risk will also help reduce cross-sector barriers to engagement for this population.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK.,Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Ashley Jane Ridout
- Sport and Exercise Medicine, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Simone Annabella Tomaz
- Stirling Physical Activity Research Knowledge and Learning Exchange (SPARKLE), University of Stirling, Stirling, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport Physical Education and Health Sciences, Edinburgh, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK .,Sport and Exercise Medicine, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
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22
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Rossen J, Hagströmer M, Yngve A, Brismar K, Ainsworth B, Johansson UB. Process evaluation of the Sophia Step Study- a primary care based three-armed randomized controlled trial using self-monitoring of steps with and without counseling in prediabetes and type 2 diabetes. BMC Public Health 2021; 21:1191. [PMID: 34157994 PMCID: PMC8220758 DOI: 10.1186/s12889-021-11222-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Describing implementation features of an intervention is required to compare interventions and to inform policy and best practice. The aim of this study was to conduct a process evaluation of the first 12 months of the Sophia Step Study: a primary care based RCT evaluating a multicomponent (self-monitoring of daily steps plus counseling) and a single component (self-monitoring of steps only) physical activity intervention to standard care on cardiometabolic health. Methods The evaluation was guided by the Medical Research Council Guidance for complex interventions. To describe the implementation communication with the health professionals implementing the interventions, attendance records and tracking of days with self-monitored pedometer-determined steps were used. Change in physical activity behaviour was measured at baseline, 6 and 12 months as daily steps by accelerometry. Results During April 2013 to January 2018 188 participants were randomized and intervened directly after inclusion. Response rate was 49% and drop out was 10%. A majority, 78%, had type 2 diabetes and 22% were diagnosed with prediabetes. Mean [Standard deviation (SD)] body mass index was 30.4 (4.4) kg/m2 and steps per day was 6566 (3086). The interventions were delivered as intended with minor deviation from the protocol and dose received was satisfying for both the multicomponent and single component group. The mean [95% Confidence Interval (CI)] change in daily steps from baseline to 6 months was 941(227, 1655) steps/day for the multicomponent intervention group, 990 (145, 1836) step/day for the single component group and − 506 (− 1118, 107) for the control group. The mean (95% CI) change in daily steps from baseline to 12 months was 31(− 507, 570) steps/day for the multicomponent intervention group, 144 (− 566, 853) step/day for the single component group and − 890 (− 1485, − 294) for the control group. There was a large individual variation in daily steps at baseline as well as in step change in all three groups. Conclusions Applying self-monitoring of steps is a feasible method to implement as support for physical activity in the primary care setting both with and without counseling support. Trial registration ClinicalTrials.gov, NCT02374788. Registered 2 March 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11222-9.
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Affiliation(s)
- Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Box 5605, 114 86, Stockholm, Sweden.
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Box 5605, 114 86, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Agneta Yngve
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Ainsworth
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Box 5605, 114 86, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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dos Santos LP, da Silva AT, Rech CR, Fermino RC. Physical Activity Counseling among Adults in Primary Health Care Centers in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5079. [PMID: 34064953 PMCID: PMC8151541 DOI: 10.3390/ijerph18105079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
Physical activity (PA) counseling by health professionals has promising results in behavior change. However, few studies have evaluated its prevalence in Primary Health Care in Latin American countries. This study aimed to describe the prevalence and analyze the associated factors of PA counseling in adults in Primary Health Care in Brazil. This is a cross-sectional study with a representative sample of 779 adults (70% women). Counseling was identified among those who reported having received PA counseling during a health professional consultation in the last 12 months. Sociodemographic factors, health conditions, and leisure-time PA were analyzed with Poisson regression. The prevalence of counseling was 43% (95% Confidence Interval [CI]: 39.5-46.4%), higher in people aged ≥40 years (Prevalence Ratio [PR]: 1.44; 95% CI: 1.19-1.75], who are married (PR: 1.27; 95% CI: 1.07-1.59), obese (PR: 1.53; 95% CI: 1.23-1.90), take prescription medication (PR: 1.83; 95% CI: 1.47-2.27), and walk for leisure (PR: 1.28; 95% CI: 1.06-1.54). People with more education were less likely to receive PA counseling (PR: 0.82; 95% CI: 0.68-0.99). In conclusion, 4 out of 10 users reported receiving PA counseling and this was associated with sociodemographic factors, health conditions, and walking for leisure. These results can guide PA promotion in Primary Health Care.
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Affiliation(s)
- Letícia Pechnicki dos Santos
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
| | - Alice Tatiane da Silva
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
- Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil
| | - Cassiano Ricardo Rech
- Physical Education Department, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil;
| | - Rogério César Fermino
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
- Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil
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24
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Brand C, Ward F, MacDonagh N, Cunningham S, Timulak L. A national evaluation of the Irish public health counselling in primary care service- examination of initial effectiveness data. BMC Psychiatry 2021; 21:227. [PMID: 33941127 PMCID: PMC8091479 DOI: 10.1186/s12888-021-03226-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Counselling in Primary Care service (CIPC) is the first and only nationally available public counselling service in the Republic of Ireland. This study provides initial data for the effectiveness of short-term psychotherapy delivered in a primary care setting in Ireland for the first time. METHOD A practice-based observational research approach was employed to examine outcome data from 2806 clients receiving therapy from 130 therapists spread over 150 primary care locations throughout Ireland. Pre-post outcomes were assessed using the CORE-OM and reliable and clinically significant change proportions. Binary logistic regression examined the effect of pre therapy symptom severity on the log odds of recovering. Six and 12 month follow up data from a subsample of 276 clients were also analysed using growth curve analysis. RESULTS Of 14,156 referred clients, 5356 presented for assessment and 52.3% (N = 2806) consented to participate. Between assessment and post-therapy a large reduction in severity of symptoms was observed- Cohen's d = 0.98. Furthermore, 47% of clients achieved recovery,a further 15.5% reliably improved, 2.7% reliably deteriorated and34.7% showed no reliable improvement. Higher initial severity was associated with less chance of recovering at post-therapy. Significant gains were maintained between assessment and12 months after therapy- Cohen's d = 0.50. CONCLUSIONS Outcomes for clients in the CIPC service compared favourably with large scale counselling and psychotherapy services in jurisdictions in the U.K., the U.S.A., Norway and Sweden. This study expands the international primary care psychotherapy research base to include the entire Republic of Ireland jurisdiction.
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Affiliation(s)
- Charles Brand
- School of Psychology, Trinity College, Dublin 2, Ireland. .,Health Service Executive, Counselling in Primary Care National Evaluation, 19 Upper Ormond Quay, Dublin 2, Ireland.
| | - Fiona Ward
- Health Service Executive, 34 Brew’s Hill, Navan, Co, Meath, Ireland
| | - Niamh MacDonagh
- Health Service Executive, 1st Floor Junction House, Primary Care Centre, Airton Rd., Tallagh, Co, Dublin, Ireland
| | - Sharon Cunningham
- Health Service Executive, Unit 8A Brulington Business Park, Srah Avenue, Tullamore, Co, Offaly, Ireland
| | - Ladislav Timulak
- School of Psychology, Trinity College, Dublin 2, Ireland ,Health Service Executive, Counselling in Primary Care National Evaluation, 19 Upper Ormond Quay, Dublin 2, Ireland
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25
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Kyei-Frimpong J, Blood-Siegfried J, Wijetilaka R, Gendler A. Exercise as medicine: Providing practitioner guidance on exercise prescription. Prev Med Rep 2021; 22:101323. [PMID: 33659155 PMCID: PMC7895835 DOI: 10.1016/j.pmedr.2021.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 10/26/2022] Open
Abstract
The purpose of this study was to examine the effect of a practitioner education program (consisting of education on exercise guidelines and exercise prescription) on practitioner (i) confidence in prescribing exercise and (ii) rate of prescribing exercise. A pre-post study design was utilized. A two-session practitioner education and a toolbox of resources was developed and implemented in January 2020, targeting 12 eligible practitioners at a large primary care and functional medicine office in New York City. A three-question confidence survey was given pre and post. Fifty randomly selected charts were reviewed at baseline (pre), and 25 charts were reviewed monthly for 3 months (February - April 2020) post. There were significant increases and a large effect size in both confidence in prescribing exercise (30% to 89% [p = .020, Phi = 0.596]) and individualizing an exercise prescription between pre- and post-education sessions (20% to 78% [p = .023, Phi = 0.578]). There was also a sustained and significant increase (24% to 63% [p < .001, Phi = 0.379]) in exercise prescription over the three-month period following the education sessions. No statistically significant data was obtained regarding increasing the rate of physical activity among patients. The evidence from this study demonstrates the effectiveness of increasing practitioner confidence and uptake of exercise prescription through education sessions that provide them with the knowledge and tools to properly assess patients' activity level and offer individualized exercise recommendations.
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Affiliation(s)
| | | | | | - Abigail Gendler
- Parsley Health, 126 5th Ave, 2nd Fl, New York, NY 10011, USA
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26
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Klepac Pogrmilovic B, Linke S, Craike M. Blending an implementation science framework with principles of proportionate universalism to support physical activity promotion in primary healthcare while addressing health inequities. Health Res Policy Syst 2021; 19:6. [PMID: 33461584 PMCID: PMC7813166 DOI: 10.1186/s12961-020-00672-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/16/2020] [Indexed: 01/01/2023] Open
Abstract
Globally, insufficient physical activity (PA) is one of the main risk factors for premature mortality. Although insufficient PA is prevalent in nearly every demographic, people with socio-economic disadvantage participate in lower levels of PA than those who are more affluent, and this contributes to widening health inequities. PA promotion interventions in primary healthcare are effective and cost effective, however they are not widely implemented in practice. Further, current approaches that adopt a ‘universal’ approach to PA promotion do not consider or address the additional barriers experienced by people who experience socioeconomic disadvantages. To address the research to policy and practice gap, and taking Australia as a case study, this commentary proposes a novel model which blends an implementation science framework with the principles of proportionate universalism. Proportionate universalism is a principle suggesting that health interventions and policies need to be universal, not targeted, but with intensity and scale proportionate to the level of social need and/or disadvantage. Within this model, we propose interrelated and multi-level evidence-based policies and strategies to support PA promotion in primary healthcare while addressing health inequities. The principles outlined in the new model which blends proportionate (Pro) universalism principles and Practical, Robust Implementation and Sustainability Model (PRISM), ‘ProPRISM’ can be applied to the implementation of PA promotion interventions in health care settings in other high-income countries. Future studies should test the model and provide evidence of its effectiveness in improving implementation and patient health outcomes and cost-effectiveness. There is potential to expand the proposed model to other health sectors (e.g., secondary and tertiary care) and to address other chronic disease risk factors such as unhealthy diet, smoking, and alcohol consumption. Therefore, this approach has the potential to transform the delivery of health care to a prevention-focused health service model, which could reduce the prevalence and burden of chronic disease and health care costs in high-income countries.
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Affiliation(s)
| | - Sarah Linke
- Family Medicine and Public Health, University of California, San Diego, USA
| | - Melinda Craike
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Australia. .,Institute for Health and Sport (IHES), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
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27
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Bowen PG, Opoku-Agyeman W, Clay OJ, Gina M, Mixon V, Sen BP, Pisu M, Martin MY. Promoting Physical Activity Through Policy at a Single Safety-Net Clinic: A Pilot Study. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021; 6. [PMID: 34169150 DOI: 10.1249/tjx.0000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Physical inactivity is a major issue for African Americans that contributes to increased risk for chronic conditions including obesity, heart disease, diabetes, and cognitive decline. The purpose of this single-clinic pilot study aimed to determine if a physical activity policy would increase primary-care provider discussions of physical activity during clinic visits using the Exercise is Medicine initiative as a guide. Methods The study design involved data collection at three time points. Participants were recruited from a single clinic providing high quality healthcare without regard to ability to pay. Participants included 109 African American patients between the ages of 24 and 81 (39 pre-intervention, 40 at 6 weeks post-intervention, and 30 at 12-months post-intervention). The primary outcome measure was participants' answers related to whether a physical activity discussion occurred with their primary-care provider. Results At baseline, 13% of participants reported a physical activity discussion with their provider, this increased to 33% at 6 weeks post-intervention. However, at 12-months post-intervention, the percentage of participants who reported a physical activity discussion decreased to 23%. Conclusion Exercise is an underused evidence-based strategy that should be prescribed as a medicine to prevent and manage many chronic health conditions. This pilot study demonstrated the feasibility of improving provider-patient communications related to the importance of daily physical activity behaviors. Further research is needed to determine how to employ and sustain a clinic level policy that will encourage physical activity discussions at every visit.
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Affiliation(s)
- Pamela G Bowen
- Department of Acute, Chronic and Continuing Care, School of Nursing, The University of Alabama at Birmingham, NB 470B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences/ College of Health and Human Services, University of North Carolina Wilmington, Wilmington, NC
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - McCaskill Gina
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Veronica Mixon
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Bisakha Pia Sen
- Department of Health Care Organization & Policy, University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Huntington J, Dwyer JJM, Shama S, Brauer P. Registered dietitians' beliefs and behaviours related to counselling patients on physical activity and sedentary behaviour from a theory of planned behaviour perspective. BMC Nutr 2020; 6:66. [PMID: 33292838 PMCID: PMC7702673 DOI: 10.1186/s40795-020-00392-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Registered dietitians working in team-based primary care settings (e.g., family health teams [FHTs]) are positioned to counsel on physical activity and sedentary behaviour when providing nutrition-related services to promote health and prevent disease. This qualitative study explored FHT registered dietitians’ beliefs and behaviours related to counselling patients on physical activity and sedentary behaviour. Methods Twenty registered dietitians in FHTs in Ontario, Canada were interviewed in person. Theory of planned behaviour guided the development of this cross-sectional, descriptive study. Thematic analysis was used to identify themes within each of the following theoretical constructs (topics): registered dietitians’ behaviour (practice), behavioural intention, attitude, subjective norm, and perceived behavioural control related to physical activity and sedentary behaviour counselling. Results All participants counselled patients on physical activity, using some motivational interviewing strategies, and most counselled on sedentary behaviour. Many participants intended to continue their current physical activity counselling practices and increase sedentary behaviour counselling. Some participants had a positive attitude about the effectiveness of counselling on physical activity and sedentary behaviour, but their belief about effectiveness was dependent on factors such as time frame for behaviour change. Many participants felt that other health care professionals expected them to counsel on physical activity and they believed that other registered dietitians counsel on physical activity and sedentary behaviour. Facilitators to counselling included FHT dynamics and time with patients. In terms of barriers, almost all participants were confident in basic PA counselling only and contended that only this is within their scope of practice. Many participants posited that exercise prescription is outside their scope of practice. Other barriers included registered dietitians’ lack of knowledge and not having a physical activity expert on the team. Conclusions The results suggest that strategies are warranted to improve FHT registered dietitians’ knowledge, attitude, and counselling skills related to physical activity and sedentary behaviour. This study provides a strong foundation to develop a theory-based, quantitative measure to assess physical activity and sedentary behaviour counselling practices and determinants among registered dietitians. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-020-00392-1.
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Affiliation(s)
- Jessica Huntington
- Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute Building, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - John J M Dwyer
- Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute Building, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Sara Shama
- Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute Building, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute Building, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
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29
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Crisford P, Aitken D, Winzenberg T, Venn A, Cleland V. What factors are associated with physical activity promotion in the podiatry setting? A cross-sectional study. J Sci Med Sport 2020; 24:60-66. [PMID: 32896459 DOI: 10.1016/j.jsams.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the status of and identify factors associated with physical activity promotion by podiatrists. DESIGN Cross sectional survey. METHOD In 2016-17 Australian podiatrists were invited to complete an online survey. Items assessed by Likert scale included; frequency of assessing and promoting physical activity and podiatrists' intentions, attitudes, social norms, confidence, barriers, role beliefs and perceived knowledge and skills regarding the promotion of physical activity. Data were analysed using descriptive statistics, exploratory factor analysis and structural equation modelling. RESULTS Of 316 respondents, 62% reported always/or often giving general and 39% specific physical activity advice. Attitudes to physical activity promotion were mostly positive and 83% agreed it was part of their role. Many believed they have the knowledge 62%) and skills to promote physical activity. Most podiatrists were confident to carry out basic physical activity promotion activities (83%), but fewer were confident assessing physical activity levels (54%), providing specific advice (47%), monitoring patient physical activity levels (49%) and carrying out physical activity counselling (41%). Modelling revealed intention to promote physical activity was most strongly influenced by experiential beliefs (β=0.35, 95%CI 0.20-0.51) and instrumental beliefs (β=0.27, 95%CI 0.15-0.40), whereas physical activity promotion was influenced by intention (β=0.45, 95%CI 0.35-0.55) and behavioural control (β=0.43, 95%CI 0.33-0.53). CONCLUSION Physical activity promotion is feasible and regularly practiced in the podiatry setting, however current practice appears suboptimal. Attitudes and behavioural control appear influential in engagement and deserve consideration when designing strategies to improve delivery in podiatric practice.
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Affiliation(s)
- Paul Crisford
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart TAS 7001, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart TAS 7001, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart TAS 7001, Australia; Faculty of Health, University of Tasmania, Medical Science Precinct, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart TAS 7001, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart TAS 7001, Australia.
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Lisón JF, Palomar G, Mensorio MS, Baños RM, Cebolla-Martí A, Botella C, Benavent-Caballer V, Rodilla E. Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial. J Med Internet Res 2020; 22:e14196. [PMID: 32286232 PMCID: PMC7189251 DOI: 10.2196/14196] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 10/31/2019] [Accepted: 02/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background Internet-based interventions are a promising strategy for promoting healthy lifestyle behaviors. These have a tremendous potential for delivering electronic health interventions in scalable and cost-effective ways. There is strong evidence that the use of these programs can lead to weight loss and can lower patients’ average blood pressure (BP) levels. So far, few studies have investigated the effects of internet-based programs on patients who are obese with hypertension (HTN). Objective The aim of this study is to investigate the short- and long-term efficacy, in terms of body composition and BP parameters, of a self-administered internet-based intervention involving different modules and learning techniques aimed at promoting lifestyle changes (both physical activity and healthy eating) in patients who are obese with HTN. Methods A randomized wait-list controlled trial design was used. We recruited 105 adults with HTN who were overweight or obese and randomly assigned them to either a 3-month internet-based intervention group (n=55) or the wait-list control group (n=50). We assessed BMI (primary outcome), body fat mass (BFM), systolic (S)BP and diastolic (D)BP, blood glucose and insulin levels, physical activity levels, and functional capacity for aerobic exercise at Time 0 (preintervention) and Time 1 (postintervention). All the patients in the wait-list control group subsequently received the intervention, and a secondary within-group analysis, which also included these participants, was conducted at Time 2 (12-month follow-up). Results A 2-way mixed analysis of covariance showed a significant decrease in BMI, BFM, and blood glucose at 3 months in the internet-based intervention group; the effect size for the BMI and BFM parameters was moderate to large, and there was also a borderline significant trend for DBP and insulin. These results were either maintained or improved upon at Time 2 and showed significant changes for BMI (mean difference −0.4, 95% CI −0.1 to −0.6; P=.005), BFM (mean difference −2.4, 95% CI −1.1 to −3.6; P<.001), DBP (mean difference −1.8, 95% CI −0.2 to −3.3; P=.03), and blood glucose (mean difference −2, 95% CI 0 to −4; P=.04). Conclusions Implementation of our self-administered internet-based intervention, which involved different learning techniques aimed to promote lifestyle changes, resulted in positive short- and long-term health benefits in patients who are obese with HTN. Trial Registration ClinicalTrials.gov NCT03396302; https://clinicaltrials.gov/ct2/show/NCT03396302
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Affiliation(s)
- Juan Francisco Lisón
- Department of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | | | - Marinna S Mensorio
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Foundation, Brasilia, Brazil.,Department of Personality, Assessment and Psychological Treatment, Facultad de Psicología, Universitat de València, Valencia, Spain
| | - Rosa M Baños
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.,Department of Personality, Assessment and Psychological Treatment, Facultad de Psicología, Universitat de València, Valencia, Spain
| | - Ausiàs Cebolla-Martí
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.,Department of Personality, Assessment and Psychological Treatment, Facultad de Psicología, Universitat de València, Valencia, Spain
| | - Cristina Botella
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.,Universitat Jaume I, Castellón, Spain
| | - Vicent Benavent-Caballer
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Enrique Rodilla
- Department of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Hypertension and Vascular Risk Unit, Hospital de Sagunto, Sagunto, Spain
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Physical Activity Promotion Tools in the Portuguese Primary Health Care: An Implementation Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030815. [PMID: 32012974 PMCID: PMC7038181 DOI: 10.3390/ijerph17030815] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/04/2022]
Abstract
Background: This paper aims to discuss how physical activity (PA) brief assessment, brief counseling, and self-monitoring tools were designed and implemented in the Portuguese National Health Service (NHS), and to report on their current use by health professionals and citizens. Methods: Three digital tools to facilitate PA promotion in primary health care (PHC) were developed: 1) a PA brief assessment tool was incorporated in the electronic health record platform “SClínico Cuidados de Saúde Primários“; 2) a brief counseling tool was developed in the software “PEM—Prescrição Eletrónica Médica” (electronic medical prescription); and 3) a “Physical Activity Card” was incorporated in an official NHS smartphone app called “MySNS Carteira”. Results: From September 2017 to June 2019, 119,386 Portuguese patients had their PA assessed in PHC. Between December 2017 and June 2019, a total of 7957 patients received brief intervention for PA by a medical doctor. Regarding the app “MySNS Carteira”, 93,320 users activated the “Physical Activity Card”, between February 2018 and December 2018. Conclusions: These tools represent key actions to promote PA among Portuguese citizens using PHC as a priority setting. Further initiatives will follow, including proper assessment of their clinical impact and training programs for health care professionals on PA promotion.
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Chew EJC, Ho YN, Kee GJ, Sirisena D. Scoping review and international multi-centre cohort study investigating teaching, knowledge and beliefs regarding physical activity as a health intervention among medical students: a comparison between Singapore and the UK. Singapore Med J 2019; 60:642-651. [PMID: 31197375 PMCID: PMC7911064 DOI: 10.11622/smedj.2019051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Physical inactivity is a global challenge and physicians must promote physical activity (PA) among their patients. Nevertheless, PA counselling remains inadequate due to limitations in knowledge, education and information availability. This study evaluates the understanding of PA as a health intervention and knowledge of World Health Organization (WHO) guidelines among Singapore and United Kingdom (UK) medical students, the next generation of physicians. METHODS Students from Singapore (Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine) and the UK (Universities of Cardiff, Leicester, Oxford and Birmingham) were invited to complete a 12-item online survey. Questions assessed knowledge of WHO guidelines, understanding of PA in health and illness, personal PA levels and exposure to PA counselling in clinical practice. RESULTS Among 633 Singapore and UK students who completed the questionnaire, 94.8% believed that PA was important in preventing disease, but only 70.9% recognised its importance in treating disease. The majority (85.3%) indicated participation in PA and exercise. General understanding of WHO guidelines for adults was poor, with less than half (46.8%) correctly answering this section. 3 (0.5%) students identified that PA in adults could be accumulated in multiple ways. Understanding of PA in health and familiarity with guidelines did not differ significantly between Singapore and UK students. CONCLUSION There is considerable room for improvement in the knowledge of WHO guidelines and the role of PA in health. Education should begin during the undergraduate phase so that future doctors are better equipped to counsel their patients.
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Affiliation(s)
- Edwin Jun Chen Chew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ying Na Ho
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ga Jing Kee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dinesh Sirisena
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore
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Vetrovsky T, Vetrovska K, Bunc V. A qualitative exploration of the experiences of primary care patients engaged in email counseling meant to increase physical activity. ACTA GYMNICA 2019. [DOI: 10.5507/ag.2019.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wattanapisit A, Thanamee S, Wongsiri S. Physical activity counselling among GPs: a qualitative study from Thailand. BMC FAMILY PRACTICE 2019; 20:72. [PMID: 31142277 PMCID: PMC6540406 DOI: 10.1186/s12875-019-0968-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Physical activity (PA) counselling is an intervention to promote PA among patients in primary care, yet it remains limited in this clinical setting. This study aimed to explore PA counselling practices among general practitioners (GPs), as well as barriers to and recommendations for improving PA counselling. METHODS This qualitative study employed a descriptive approach. Data were collected by in-depth interviews and analysed by thematic analysis. The study was conducted in district hospitals in Nakhon Si Thammarat, Thailand, from February 2017 to February 2018. The study participants were GPs who worked at district hospitals. RESULTS Seventeen GPs (6 males and 11 females, mean age 29.8 ± 3.4 years) from 6 district hospitals were interviewed. Their clinical experience ranged from 2 to 12 years (mean 4.7 ± 2.9). The GPs saw 30-80 outpatients/day (mean 56.2 ± 14.1) and spent 1-8 min (mean 3.8 ± 1.8) with each patient. They emphasised PA in patients with poorly controlled non-communicable diseases (NCDs) using the word 'exercise' in the Thai language as well as discussing time and frequency of exercise. PA was considered a non-pharmacological treatment in the management of NCDs, which improved patient health and quality of life. Barriers to PA counselling among GPs included time constraints, insufficient knowledge, and lack of opportunities to follow-up previously counselled patients. GPs suggested that training in PA counselling was required. CONCLUSIONS GPs concurred that PA counselling is essential in the treatment of NCDs. Physicians' recommendations to improve the quality of PA counselling in primary care include 3 Ts: training in PA counselling, tools for prescribing PA, and teams of healthcare professionals. Implementing use of written PA prescriptions may encourage patients to increase PA. Multidisciplinary teams should be developed to support PA counselling in the clinical setting. Further studies should focus on appropriate techniques to implement PA counselling and overcome existing barriers.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80161, Thailand.
- Walailak University Hospital, Thasala, Nakhon Si Thammarat, 80161, Thailand.
| | | | - Sunton Wongsiri
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Bouma AJ, van Wilgen P, Lemmink KAPM, Stewart R, Dijkstra A, Diercks RL. Barrier-belief lifestyle counseling in primary care: A randomized controlled trial of efficacy. PATIENT EDUCATION AND COUNSELING 2018; 101:2134-2144. [PMID: 30072044 DOI: 10.1016/j.pec.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/14/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Intervening on barrier beliefs (BBs) may inhibit the role of barriers as mediating factors in lifestyle behavior. The aim of this study was to analyze the effects of a barrier-belief counseling intervention (BBCI) on physical activity (PA) and healthy food intake. METHODS An RCT was conducted in a primary care setting among adults (aged 18-70), with two interventions: a BBCI (n = 123) and a standardized lifestyle group intervention (SLI) (n = 122). A non-treated hanging control group (n = 36) received no intervention. Outcomes on PA (accelerometer and SQUASH) and fruit and vegetable intake (self-report) were measured with follow-ups at 6, 12 and 18 months, and analyzed using multiple regression. RESULTS The BBCI was more effective on PA compared with the SLI (p < .01): in the short term all PA outcomes improved (p < .05), in the long term moderate-to-vigorous PA outcomes improved (p < .05), all with small effect sizes. No differences between interventions were found on fruit and vegetable intake. None of the outcomes in the control group changed over time. CONCLUSIONS BBCI in primary care improves PA compared with SLI. PRACTICE IMPLICATIONS The customized BB approach seems promising for implementation in healthcare practice to stimulate PA.
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Affiliation(s)
- Adrie J Bouma
- Hanze University of Applied Sciences Groningen, Institute of Sports Studies, Zernikeplein 17, 9766 AS Groningen, The Netherlands.
| | - Paul van Wilgen
- Transcare, Transdisciplinary Pain Management Centre, Barkmolenstraat 196, 9723 DM Groningen, The Netherlands.
| | - Koen A P M Lemmink
- Center for Human Movement Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Roy Stewart
- Faculty of Medical Sciences, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Arie Dijkstra
- Faculty of Behavioral and Society Sciences, Grote Kruisstraat 2/1, 9712 TS, University of Groningen, Groningen, The Netherlands.
| | - Ron L Diercks
- Department of Sports Medicine and Orthopedic Surgery, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Gonzalez-Viana A, Violan Fors M, Castell Abat C, Rubinat Masot M, Oliveras L, Garcia-Gil J, Plasencia A, Cabezas Peña C. Promoting physical activity through primary health care: the case of Catalonia. BMC Public Health 2018; 18:968. [PMID: 30075720 PMCID: PMC6090750 DOI: 10.1186/s12889-018-5773-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/28/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors). METHODS The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance). RESULTS PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a "healthy route" (Reach). The proportion of patients with at least one cardiovascular risk factor who were "sufficiently active" increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance). CONCLUSIONS In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.
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Affiliation(s)
| | | | - Conxa Castell Abat
- Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain
| | | | - Laura Oliveras
- Department of Preventive Medicine and Epidemiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Juanjo Garcia-Gil
- Blanquerna Health Sciences School, Ramon Llull University, Barcelona, Spain
| | - Antoni Plasencia
- Institute of Global Health Barcelona - IS Global, Barcelona, Spain
| | - Carmen Cabezas Peña
- Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain
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Using formative research with older adults to inform a community physical activity programme: Get Healthy, Get Active. Prim Health Care Res Dev 2018; 20:e60. [PMID: 29976266 PMCID: PMC8512642 DOI: 10.1017/s1463423618000373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim The purpose of this formative study was to explore current knowledge and attitudes towards physical activity, as well as perceived barriers, facilitators and opportunities for physical activity participation among older adults living in the community. The findings have subsequently informed the design, delivery and recruitment strategies of a local community physical activity intervention programme which forms part of Sport England’s national Get Healthy, Get Active initiative. Background There is a growing public health concern regarding the amount of time spent in sedentary and physical activity behaviours within the older adult population. Methods Between March and June 2016, 34 participants took part in one of six focus groups as part of a descriptive formative study. A homogenous purposive sample of 28 community dwelling white, British older adults (six male), aged 65–90 years (M=78, SD=7 years) participated in one of five focus group sessions. An additional convenience pragmatic sub-sample of six participants (three male), aged 65–90 years (M=75, SD=4 years), recruited from an assisted living retirement home participated in a sixth focus group. Questions for focus groups were structured around the PRECEDE stage of the PRECEDE–PROCEDE model of health programme design, implementation and evaluation. Questions addressed knowledge, attitudes and beliefs towards physical activity, as well as views on barriers and opportunities for physical activity participation. All data were transcribed verbatim. Thematic analysis was then conducted with outcomes represented as pen profiles. Findings Consistent views regarding both the potential physical and psychosocial benefits of physical activity were noted regardless of living status. The themes of, opportunities and awareness for physical activity participation, cost, transport, location and season/weather varied between participants living in an assisted living retirement home and community dwelling older adults. Further comparative research on the physical activity requirements of older adults living in assisted living versus community settings are warranted.
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Wattanapisit A, Tuangratananon T, Thanamee S. Physical activity counseling in primary care and family medicine residency training: a systematic review. BMC MEDICAL EDUCATION 2018; 18:159. [PMID: 29970092 PMCID: PMC6029015 DOI: 10.1186/s12909-018-1268-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Physical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs. METHODS The authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review. RESULTS Based on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling. CONCLUSIONS This systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80161 Thailand
| | - Titiporn Tuangratananon
- International Health Policy Program, Thailand, Ministry of Public Health, Muang, Nonthaburi, 11000 Thailand
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"Practice What You Teach" Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): Program Evaluation. J Ambul Care Manage 2018; 41:171-180. [PMID: 29847404 DOI: 10.1097/jac.0000000000000243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.
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A randomized controlled trial of orthodontist-based brief advice to prevent child obesity. Contemp Clin Trials 2018; 70:53-61. [PMID: 29747047 DOI: 10.1016/j.cct.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We conducted a randomized controlled trial to test whether brief exercise and diet advice provided during child patient visits to their orthodontic office could improve diet, physical activity, and age-and-gender-adjusted BMI. METHODS We enrolled orthodontic offices in Southern California and Tijuana, Mexico, and recruited their patients aged 8-16 to participate in a two-year study. At each office visit, staff provided the children with "prescriptions" for improving diet and exercise behaviors. Multilevel models, which adjusted for clustering, determined differential group effects on health outcomes, and moderation of effects. RESULTS We found differential change in BMI favoring the intervention group, but only among male participants (p < 0.001; Cohen's d = 0.085). Of four dietary variables, only junk food consumption changed differentially, in favor of the intervention group (p = 0.020; d = 0.122); the effect was significant among overweight/obese (p = 0.001; d = 0.335) but not normal weight participants. Physical activity declined non-differentially in both groups and both genders. CONCLUSION The intervention, based on the Geoffrey Rose strategy, had limited success in achieving its aims. IMPLICATIONS Orthodontists can deliver non-dental prevention advice to complement other health-practitioner-delivered advice. Higher fidelity to trial design is needed to adequately test the efficacy of clinician-based brief advice on preventing child obesity and/or reversing obesity.
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Curbach J, Apfelbacher C, Knoll A, Herrmann S, Szagun B, Loss J. Physicians' perspectives on implementing the prevention scheme "Physical Activity on Prescription": Results of a survey in Bavaria. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 131-132:66-72. [PMID: 29486976 DOI: 10.1016/j.zefq.2018.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
Abstract
The prevention scheme called "Rezept für Bewegung" (Physical Activity on Prescription, PAP) enables physicians to formally prescribe participation in health-oriented sports programs to their patients. The PAP scheme aims to strengthen the binding character of physicians' patient counselling for physical activity. The research objective was to investigate the physicians' awareness and their use of PAP as a prevention tool in patient counselling, as well as perceived barriers to implementation. A cross-sectional total population mail questionnaire survey was performed in two districts of Bavaria. 2,821 physicians in private practice were contacted; the response rate was 32.7 %. Descriptive data analysis of 923 questionnaires was carried out using SPSS. Only 26.4 % of the respondents (244/923) were familiar with the PAP scheme, and only 7.7 % (71/923) used PAP at least once a month when counselling their patients. Key barriers to implementation include lack of information on the prevention scheme, a limited choice of local matching sports programs and an unclear commitment of health insurances to reimburse patients for participation fees. Every third physician distrusts PAP to be an efficient way of improving physical activity in patients. To foster the implementation of PAP in the future, awareness-raising campaigns and an expansion of sports programs might be helpful. In order to strengthen the physicians' confidence in the effectiveness of preventive patient counselling on physical activity, existing research evidence needs to be spread among physicians.
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Affiliation(s)
- Janina Curbach
- University of Regensburg, Department of Epidemiology and Preventive Medicine/Medical Sociology, Regensburg, Germany.
| | - Christian Apfelbacher
- University of Regensburg, Department of Epidemiology and Preventive Medicine/Medical Sociology, Regensburg, Germany
| | - Angelina Knoll
- University of Applied Science Ravensburg-Weingarten, Department for Social Work, Health and Care, Weingarten, Germany
| | - Sandra Herrmann
- Chemnitz University of Technology, Sociology with special focus on health research, Institute of Sociology, Chemnitz, Germany
| | - Bertram Szagun
- University of Applied Science Ravensburg-Weingarten, Department for Social Work, Health and Care, Weingarten, Germany
| | - Julika Loss
- University of Regensburg, Department of Epidemiology and Preventive Medicine/Medical Sociology, Regensburg, Germany
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The feasibility and RE-AIM evaluation of the TAME health pilot study. Int J Behav Nutr Phys Act 2017; 14:106. [PMID: 28807041 PMCID: PMC5556663 DOI: 10.1186/s12966-017-0560-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/04/2017] [Indexed: 01/23/2023] Open
Abstract
Background Conducting 5 A’s counseling in clinic and utilizing technology-based resources are recommended to promote physical activity but little is known about how to implement such an intervention. This investigation aimed to determine the feasibility and acceptability, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, of a pragmatic, primary care-based intervention that incorporated 5 A’s counseling and self-control through an activity monitor. Methods Primary care patients (n = 40) 55–74 years of age were recruited and randomized to receive a pedometer or an electronic activity monitor (EAM), Jawbone UP24, to monitor activity for 12 weeks. Participants were also invited to a focus group after completing the intervention. Stakeholders (n = 36) were recruited to provide feedback. Results The intervention recruitment rate was 24.7%. The attrition rate was 20% with a significantly higher rate for the pedometer group (p = 0.02). The EAM group increased their minutes of physical activity by 11.1 min/day while the pedometer maintained their activity (0.2 min/day), with no significant group difference. EAM participants liked using their monitor and would continue wearing it while the pedometer group was neutral to these statements (p < 0.05). Over the 12 weeks there were 490 comments and 1094 “likes” given to study peers in the corresponding application for the UP24 monitor. Some EAM participants enjoyed the social interaction feature while others were uncomfortable talking to strangers. Participants stated they would want counseling from a counselor and not their physician or a nurse. Other notable comments included incorporating multiple health behaviors, more in-person counseling with a counselor, and having a funding source for sustainability. Conclusions Overall, the study was well-received but the results raise a number of considerations. Practitioners, counselors, and researchers should consider the following before implementing a similar intervention: 1) utilize PA counselors, 2) target multiple health behaviors, 3) form a social support group, 4) identify a funding source for sustainability, and 5) be mindful of concerns with technology. Trial registration clinicaltrials.gov- NCT02554435. Registered 24 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0560-5) contains supplementary material, which is available to authorized users.
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Barbosa JMV, Souza WVD, Ferreira RWM, Carvalho EMFD, Cesse EAP, Fontbonne A. Correlates of physical activity counseling by health providers to patients with diabetes and hypertension attended by the Family Health Strategy in the state of Pernambuco, Brazil. Prim Care Diabetes 2017; 11:327-336. [PMID: 28479026 DOI: 10.1016/j.pcd.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
AIMS The aim of this study was to determine correlates of physical activity (PA) counseling by health providers of the Brazilian primary care delivery system, for hypertensive and diabetic subjects, as well as correlates of actual leisure-time PA of these subjects. METHODS This was a cross-sectional study conducted in random samples of 785 hypertensive and 822 diabetic subjects, in the State of Pernambuco, Brazil. Relationships between PA counseling and leisure-time PA and explanatory variables were sought through multiple logistic regressions. RESULTS PA counseling had been received by 59.4% of the diabetic and 53.0% of the hypertensive subjects; around 30% of the diabetic and the hypertensive subjects declared having leisure-time PA. After adjustment, factors associated with PA counseling for diabetic subjects were: female gender, formal schooling, hypertension, obesity; for hypertensive subjects: being on a weight-loss diet, age between 60 and 74 and over 75. For both subject groups, leisure-time PA was more frequent when they lived in a medium-sized municipality, were female, aged between 60 and 75, and on a weight-loss diet. CONCLUSION PA counseling appeared restricted to subjects with excess weight and/or cardiovascular risk factors when it should be directed to all subjects with hypertension or diabetes.
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Affiliation(s)
- Jessyka Mary Vasconcelos Barbosa
- Department of Community Health, Aggeu Magalhaes Research Center, Fiocruz Pernambuco, Av. Prof. Moraes Rego, S/N, Cidade Universitária, 50670-420 Recife, PE, Brazil.
| | - Wayner Vieira de Souza
- Department of Community Health, Aggeu Magalhaes Research Center, Fiocruz Pernambuco, Av. Prof. Moraes Rego, S/N, Cidade Universitária, 50670-420 Recife, PE, Brazil.
| | - Renan Williams Marques Ferreira
- Department of Community Health, Aggeu Magalhaes Research Center, Fiocruz Pernambuco, Av. Prof. Moraes Rego, S/N, Cidade Universitária, 50670-420 Recife, PE, Brazil.
| | - Eduardo Maia Freese de Carvalho
- Department of Community Health, Aggeu Magalhaes Research Center, Fiocruz Pernambuco, Av. Prof. Moraes Rego, S/N, Cidade Universitária, 50670-420 Recife, PE, Brazil.
| | - Eduarda Angela Pessoa Cesse
- Department of Community Health, Aggeu Magalhaes Research Center, Fiocruz Pernambuco, Av. Prof. Moraes Rego, S/N, Cidade Universitária, 50670-420 Recife, PE, Brazil.
| | - Annick Fontbonne
- IRD-Institute of Research for Development, UMR 204 Nutripass, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.
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Keogh JWL, Olsen A, Climstein M, Sargeant S, Jones L. Benefits and Barriers of Cancer Practitioners Discussing Physical Activity with their Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:11-15. [PMID: 26264391 DOI: 10.1007/s13187-015-0893-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Our aim was to synthesise the existing empirical literature and theoretical perspectives on the physical activity (PA) promotion practices and determinants of cancer clinicians and health professionals. We conducted a narrative review of theory and evidence to develop practice recommendations for improving the promotion of PA to cancer patients. Surveyed health professionals were aware of many benefits of PA for their cancer patients, although only ~40 % promoted PA to selected cancer patients. Walking was the most commonly promoted form of PA, with this promoted to assist patients control their weight and cardiovascular health risk. Barriers to promotion of PA included lack of time and knowledge of PA and behaviour change skills. Health professionals appear interested in promoting PA to their cancer patients, yet encounter several barriers. Further research is warranted to assist health professionals improve their PA promotion. An adapted reflective-impulsive model of social behaviour shows promise for assisting health professionals overcome barriers and provides an evidence-based theoretical framework for improving communication with patients. Universities, hospitals and/or health-care accreditation organisations also have important roles to play in assisting health professionals improve their promotion of PA to patients.
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Affiliation(s)
- Justin W L Keogh
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia.
- Human Potential Centre, AUT University, Auckland, New Zealand.
- Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia.
| | - Alicia Olsen
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Michael Climstein
- Exercise, Health and Performance Faculty Research Group, University of Sydney, Sydney, Australia
| | - Sally Sargeant
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4229, Australia
| | - Lynnette Jones
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
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Physical Activity Prescription: A Critical Opportunity to Address a Modifiable Risk Factor for the Prevention and Management of Chronic Disease: A Position Statement by the Canadian Academy of Sport and Exercise Medicine. Clin J Sport Med 2016; 26:259-65. [PMID: 27359294 DOI: 10.1097/jsm.0000000000000363] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Thornton JS, Frémont P, Khan K, Poirier P, Fowles J, Wells GD, Frankovich RJ. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. Br J Sports Med 2016; 50:1109-14. [PMID: 27335208 DOI: 10.1136/bjsports-2016-096291] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 12/31/2022]
Abstract
Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin/Swiss Society of Sports Medicine (SGSM/SSSM), Sport Doctors Australia (SDrA), Swedish Society of Exercise and Sports Medicine (SFAIM), and CASEM.
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Affiliation(s)
| | - Pierre Frémont
- Dip Sport Med (CASEM), Laval University, Ville de Québec, Quebec, Canada
| | - Karim Khan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and Faculty of Pharmacy, Laval University, Québec, Canada
| | | | - Greg D Wells
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Richard E, Jongstra S, Soininen H, Brayne C, Moll van Charante EP, Meiller Y, van der Groep B, Beishuizen CRL, Mangialasche F, Barbera M, Ngandu T, Coley N, Guillemont J, Savy S, Dijkgraaf MGW, Peters RJG, van Gool WA, Kivipelto M, Andrieu S. Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment. BMJ Open 2016; 6:e010806. [PMID: 27288376 PMCID: PMC4908903 DOI: 10.1136/bmjopen-2015-010806] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cardiovascular disease and dementia share a number of risk factors including hypertension, hypercholesterolaemia, smoking, obesity, diabetes and physical inactivity. The rise of eHealth has led to increasing opportunities for large-scale delivery of prevention programmes encouraging self-management. The aim of this study is to investigate whether a multidomain intervention to optimise self-management of cardiovascular risk factors in older individuals, delivered through an coach-supported interactive internet platform, can improve the cardiovascular risk profile and reduce the risk of cardiovascular disease and cognitive decline. METHODS AND ANALYSIS HATICE is a multinational, multicentre, prospective, randomised, open-label blinded end point (PROBE) trial with 18 months intervention. Recruitment of 2600 older people (≥65 years) at increased risk of cardiovascular disease will take place in the Netherlands, Finland and France. Participants randomised to the intervention condition will have access to an interactive internet platform, stimulating self-management of vascular risk factors, with remote support by a coach. Participants in the control group will have access to a static internet platform with basic health information.The primary outcome is a composite score based on the average z-score of the difference between baseline and 18 months follow-up values of systolic blood pressure, low-density-lipoprotein and body mass index. Main secondary outcomes include the effect on the individual components of the primary outcome, the effect on lifestyle-related risk factors, incident cardiovascular disease, mortality, cognitive functioning, mood and cost-effectiveness. ETHICS AND DISSEMINATION The study was approved by the medical ethics committee of the Academic Medical Center in Amsterdam, the Comité de Protection des Personnes Sud Ouest et Outre Mer in France and the Northern Savo Hospital District Research Ethics Committee in Finland.We expect that data from this study will result in a manuscript published in a peer-reviewed clinical open access journal. TRIAL REGISTRATION NUMBER ISRCTN48151589.
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Affiliation(s)
- Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Susan Jongstra
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yannick Meiller
- Department of Information and Operations Management, ESCP Europe, Paris, France
| | | | - Cathrien R L Beishuizen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mariagnese Barbera
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Nicola Coley
- INSERM, University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | | | - Stéphanie Savy
- INSERM, University of Toulouse UMR1027, Toulouse, France
| | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden
| | - Sandrine Andrieu
- INSERM, University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
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Friederichs SAH, Oenema A, Bolman C, Lechner L. Long term effects of self-determination theory and motivational interviewing in a web-based physical activity intervention: randomized controlled trial. Int J Behav Nutr Phys Act 2015; 12:101. [PMID: 26283094 PMCID: PMC4538737 DOI: 10.1186/s12966-015-0262-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Our main objective in the current study was to evaluate the long-term effectiveness (12 months from baseline) of I Move (a web-based computer tailored physical activity intervention, based on self-determination theory and motivational interviewing). To this end, we compared I Move to a web-based computer tailored physical activity intervention based on traditional health behavior theories (Active Plus), and to a no-intervention control group. As a secondary objective, the present study aimed to identify participant characteristics that moderate the long term effects of I Move and Active Plus. Methods A randomized controlled trial was conducted, comparing three research conditions: 1) the I Move condition, participants in this condition received I Move; 2) the Active Plus condition, participants in this condition received Active Plus; 3) the control condition; participants in this condition received no intervention and were placed on a waiting list. Main outcome measures were weekly minutes of moderate to vigorous physical activity and weekly days with minimal 30 min of physical activity. All measurements were taken by web-based questionnaires via the study website. Intervention effects were analyzed using multilevel linear regression analyses. Results At 12 months from baseline, I Move was found to be effective in increasing weekly minutes of moderate to vigorous physical activity (ES = .13), while Active Plus was not. In contrast, Active Plus was found to be effective in increasing weekly days with ≥ 30 min PA at 12 months (ES = .11), while I Move was not. No moderators of the effects of I Move were found. Conclusions The results suggest that web-based computer tailored physical activity interventions might best include elements based on both self-determination theory/motivational interviewing and traditional health behavioral theories. To be more precise, it is arguable that the focus of the theoretical foundations, used in new web-based PA interventions should depend on the intended program outcome. In order to draw firm conclusions, however, more research on the effects of self-determination theory and motivational interviewing in web-based physical activity promotion is needed. Trial registration Dutch Trial Register NTR4129
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Affiliation(s)
- Stijn A H Friederichs
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. box 2960, 6401, DL, Heerlen, The Netherlands.
| | - Anke Oenema
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Catherine Bolman
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. box 2960, 6401, DL, Heerlen, The Netherlands.
| | - Lilian Lechner
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. box 2960, 6401, DL, Heerlen, The Netherlands.
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Rossen J, Yngve A, Hagströmer M, Brismar K, Ainsworth BE, Iskull C, Möller P, Johansson UB. Physical activity promotion in the primary care setting in pre- and type 2 diabetes - the Sophia step study, an RCT. BMC Public Health 2015; 15:647. [PMID: 26164092 PMCID: PMC4499440 DOI: 10.1186/s12889-015-1941-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022] Open
Abstract
Background Physical activity prevents or delays progression of impaired glucose tolerance in high-risk individuals. Physical activity promotion should serve as a basis in diabetes care. It is necessary to develop and evaluate health-promoting methods that are feasible as well as cost-effective within diabetes care. The aim of Sophia Step Study is to evaluate the impact of a multi-component and a single component physical activity intervention aiming at improving HbA1c (primary outcome) and other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes. Methods/design Sophia Step Study is a randomized controlled trial and participants are randomly assigned to either a multi-component intervention group (A), a pedometer group (B) or a control group (C). In total, 310 patients will be included and followed for 24 months. Group A participants are offered pedometers and a website to register steps, physical activity on prescription with yearly follow-ups, motivational interviewing (10 occasions) and group consultations (including walks, 12 occasions). Group B participants are offered pedometers and a website to register steps. Group C are offered usual care. The theoretical framework underpinning the interventions is the Health Belief Model, the Stages of Change Model, and the Social Cognitive Theory. Both the multi-component intervention (group A) and the pedometer intervention (group B) are using several techniques for behavior change such as self-monitoring, goal setting, feedback and relapse prevention. Measurements are made at week 0, 8, 12, 16, month 6, 9, 12, 18 and 24, including metabolic and cardiovascular biomarkers (HbA1c as primary health outcome), accelerometry and daily steps. Furthermore, questionnaires were used to evaluate dietary intake, physical activity, perceived ability to perform physical activity, perceived support for being active, quality of life, anxiety, depression, well-being, perceived treatment, perceived stress and diabetes self- efficacy. Discussion This study will show if a multi-component intervention using pedometers with group- and individual consultations is more effective than a single- component intervention using pedometers alone, in increasing physical activity and improving HbA1c, other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes. Trial registration ClinicalTrials.gov Identifier: NCT02374788. Registered 28 January 2015.
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Affiliation(s)
- Jenny Rossen
- Sophiahemmet University, Stockholm, Sweden. .,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Agneta Yngve
- Sophiahemmet University, Stockholm, Sweden. .,School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Örebro, Sweden.
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, and Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
| | - Barbara E Ainsworth
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
| | | | | | - Unn-Britt Johansson
- Sophiahemmet University, Stockholm, Sweden. .,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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