Physical activity advice to manage chronic conditions for adults with arthritis or hypertension, 2007

Factors associated with physical activity promotion efforts in individuals with chronic diseases: A systematic review from the perspective of patients

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.

Rural-Urban Differences in Physical Activity Tracking and Engagement in a Web-Based Platform

OBJECTIVES

Despite the well-established health benefits of regular participation in physical activity, most adults do not meet recommended exercise guidelines. In rural communities, limited local resources and geographic dispersion make engaging in regular activity particularly difficult. Web-based solutions offer a potential solution for addressing physical activity disparities between rural and urban areas.

METHODS

This study examined the physical activity logs of users (n = 6695) of a web-based platform called Walk Georgia, comparing residents of metropolitan and nonmetropolitan areas. We tabulated descriptive statistics for variables of interest, cross-tabulated for metropolitan and nonmetropolitan groups. We then used independent-samples t tests to compare logged activity between metropolitan and nonmetropolitan residing user groups.

RESULTS

In the analysis of group type (n = 6654), users were more likely to enroll in the program as part of a group than as individuals (n = 4391; 65.9%), particularly for users in metropolitan areas (3558 of 5192; 68.5%). Although the groups shared certain activities, nonmetropolitan residents were more likely than metropolitan residents to engage in maintenance-based activities. Nonmetropolitan residents earned fewer program points for their activity than metropolitan users (P = .007), largely because of lower average exercise difficulty (P < .001).

CONCLUSIONS

The web-based platform was effective in helping individuals track physical activity. Despite engaging in similar amounts of physical activity by time, on average, users in nonmetropolitan areas engaged in less rigorous and more maintenance-based tasks than users in metropolitan areas. One strategy for increasing physical activity among rural populations may be to leverage social support provided by group enrollment in such programming.

Provision of physical activity advice for patients with chronic diseases in Shenzhen, China

BACKGROUND

Physical activity (PA) may best be promoted to patients during clinical consultations. Few studies investigated the practice of PA advice given by physicians, especially in China. This study aimed to investigate the prevalence and contents of PA advice given by physicians in China and its association with patients' characteristics.

METHODS

Face-to-face questionnaire asking the prevalence and contents of PA advice given by physicians was administered to adult patients in three major hospitals in Shenzhen, China. Attitude of compliance, stature, PA level, and socio-demographic information were also collected. Data was analyzed via descriptive statistics and binary logistic regression.

RESULTS

Of the 454 eligible patients (Age: 47.0 ± 14.4 years), only 19.2% (n = 87) reported receiving PA advice, whereas 21.8%, 23.0%, 32.2%, and 55.2% of patients received advices on PA frequency, duration, intensity, and type, respectively. Male patients were more likely to receive PA advice from physicians [odds ratio (OR): 1.81; 95% confidence interval (CI): 1.08-3.05], whereas patients who were unemployed (OR: 0.16; 95% CI: 0.04-0.67), and who already achieved adequate amount of PA (OR: 0.29; 95% CI: 0.12-0.71) were less likely to receive PA advice.

CONCLUSIONS

Prevalence of physicians providing physical activity advice to patients is low, there is a pressing need to take intervention measures to educate healthcare providers.

Racial/Ethnic and Socioeconomic Disparities in Osteoarthritis Management

This article reviews the literature on racial and socioeconomic disparities in the management of osteoarthritis. Treatments investigated include arthritis education, dietary weight management, exercise/physical therapy, pharmacologic therapy with nonsteroidal antiinflammatory drugs and opioids, intra-articular steroid injections, and total joint replacement. The amount of evidence for each treatment modality varied, with the most evidence available for racial and socioeconomic disparities in total joint arthroplasty. Black patients, Hispanic patients, and patients with low socioeconomic status (SES) are less likely to undergo total joint replacement than white patients or patients with high SES, and generally have worse functional outcomes and more complications.

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of PA interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes.

The evaluation of physical activity for community-dwelling patients with hypertension

AIMS AND OBJECTIVES

The study aimed to evaluate the proportion of Chinese patients with hypertension who meet the Chinese Hypertension Management Guideline recommendations for weekly physical activity and to determine possible associated factors that impact meeting the weekly physical activity recommendation.

BACKGROUND

Accurate evaluation of physical activity levels for hypertensive patients is important to determine patients' health outcomes and intervention measures. However, most of the evidence on the prevalence of physical activity comes from developed countries; therefore, studies from developing countries are needed.

DESIGN

Across-sectional design was adopted for the study.

METHODS

The participants were recruited using a convenience sampling method from three healthcare community centres in Guangzhou, southern China. The data were collected using self-report questionnaires. Ordinal logistic regression was used to test factors associated with meeting the weekly physical activity recommendation.

RESULTS

Two hundred and seventy-six (58.6%) hypertensive patients in our study did insufficient physical activity (<150 min/week). One hundred thirty-four (31.3%) patients achieved the weekly physical activity recommendation (≥150 min/week), and 52 (10.1%) met the recommendation for physical activity for additional health benefits (≥300 min/week). In the adjusted ordinal logistic regression analyses, patients over 60 years of age (OR = 1.35, p < .001), who were unemployed (OR = 1.24, p = .036), had lower blood pressure levels (OR = 0.88, p = .019) and no hypertension-related complications (OR = 1.18, p = .021), and regarded self-rated health as good or excellent (OR = 2.37, p = .018), had a higher likelihood of meeting the weekly physical activity recommendation.

CONCLUSIONS

Our results showed that the number of Chinese hypertensive patients meeting the weekly physical activity recommendation is suboptimal. Age, employment status, blood pressure, self-rated health and complications related to hypertension were associated with meeting the weekly physical activity recommendation.

RELEVANCE TO CLINICAL PRACTICE

The findings implied that hypertensive patients who did insufficient physical activity were subgroups that needed specific instructions in physical activity and motivation to take part in physical activity. Nurses should consider providing counselling and supervision to these patients.

Sedentary behavior and physical function: objective evidence from the Osteoarthritis Initiative

OBJECTIVE

Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity (MVPA) levels.

METHODS

Sedentary behavior was objectively measured by accelerometer on 1,168 participants ages 49-83 years in the Osteoarthritis Initiative with radiographic knee OA at the 48-month clinic visit. Physical function was assessed using 20-meter walk and chair stand testing. Sedentary behavior was identified by accelerometer activity counts/minute <100. The cross-sectional association between sedentary quartiles and physical function was examined by multiple linear regression, adjusting for demographic factors (age, sex, race/ethnicity, education level), health factors (comorbidity, body mass index, knee pain, knee OA severity, presence of knee symptoms), and average daily MVPA minutes.

RESULTS

Adults with knee OA spent two-thirds of their daily time in sedentary behavior. The average gait speed among the most sedentary quartile was 3.88 feet/second, which was significantly slower than the speed of the less sedentary groups (4.23, 4.33, and 4.33 feet/second, respectively). The average chair stand rate among the most sedentary group was significantly lower (25.9 stands/minute) than the rates of the less sedentary behavior groups (28.9, 29.1, and 31.1 stands/minute, respectively). These trends remained significant in multivariable analyses adjusted for demographic factors, health factors, and average daily MVPA minutes.

CONCLUSION

Being less sedentary was related to better physical function in adults with knee OA independent of MVPA time. These findings support guidelines to encourage adults with knee OA to decrease time spent in sedentary behavior in order to improve physical function.

Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes

OBJECTIVES

Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation."

RESEARCH DESIGN

Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.

RESULTS

Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% CI, 0.19-0.61).

CONCLUSIONS

Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate.

A web-based patient activation intervention to improve hypertension care: study design and baseline characteristics in the web hypertension study

BACKGROUND

Despite the known health risks of hypertension, many hypertensive patients still have uncontrolled blood pressure. Clinical inertia, the tendency of physicians not to intensify treatment, is a common barrier in controlling chronic diseases. This trial is aimed at determining the impact of activating patients to ask providers to make changes to their care through tailored feedback.

METHODS

Diagnosed hypertensive patients were enrolled in this RCT and randomized to one of two study groups: (1) the intervention condition--Web-based hypertension feedback, based on the individual patient's self-report of health variables and previous BP measurements, to prompt them to ask questions during their next physician's visit about hypertension care (2) the control condition--Web-based preventive health feedback, based on the individual's self-report of receiving preventive care (e.g., pap testing), to prompt them to ask questions during their next physician's visit about preventive care. The primary outcome of the study is change in blood pressure and change in the percentage of patients in each group with controlled blood pressure.

CONCLUSION

Five hundred participants were enrolled and baseline characteristics include a mean age of 60.0 years; 57.6% female; and 77.6% white. Overall 37.7% participants had uncontrolled blood pressure; the mean body mass index (BMI) was in the obese range (32.4) and 21.8% had diabetes. By activating patients to become involved in their own care, we believe the addition of the web-based intervention will improve blood pressure control compared to a control group who receive web-based preventive messages unrelated to hypertension.