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

Are physical activity referral scheme components associated with increased physical activity, scheme uptake, and adherence rate? A meta-analysis and meta-regression

BACKGROUND

Physical activity referral schemes (PARS) are composed of various components, such as a written prescription or a person-centered approach. The role of these components in their effectiveness is yet to be understood. Therefore, we aimed to explore the relationships between PARS components and physical activity, scheme uptake, and adherence rate; and to estimate the effect of PARS.

METHODS

We searched Scopus, PubMed, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE. Eligible studies were published between 1990 and November 2023 in English or German, investigated PARS with participants aged ≥ 16 years, and reported physical activity, scheme uptake, or scheme adherence. Separate random-effects meta-analysis by comparison group were conducted for physical activity. Scheme uptake and adherence rates were pooled using proportional meta-analysis. The components were analyzed via univariate meta-regression. We rated the risk of bias using RoB2 and ROBINS-I, and the certainty of evidence using GRADE.

RESULTS

Fifty-two studies were included. PARS were more effective in increasing physical activity than usual care (k = 11, n = 5046, Hedges' g = 0.18, 95%CI 0.12 to 0.25; high certainty of evidence). When PARS were compared with physical activity advice or enhanced scheme versions, the pooled Hedges' g values for physical activity were -0.06 (k = 5, n = 1082, 95%CI -0.21 to 0.10; low certainty of evidence), and 0.07 (k = 9, n = 2647, 95%CI -0.03 to 0.18; low certainty of evidence) respectively. Scheme uptake was 87% (95%CI 77% to 94%, k = 14, n = 5000) across experimental studies and 68% (95%CI 51% to 83%, k = 14, n = 25,048) across non-experimental studies. Pooled scheme adherence was 68% (95%CI 55% to 80%, k = 16, n = 3939) and 53% (95%CI 42% to 63%, k = 18, n = 14,605). The meta-regression did not detect any significant relationships between components and physical activity or scheme uptake. A person-centered approach, screening, and brief advice were positively associated with scheme adherence, while physical activity sessions were negatively associated.

CONCLUSION

PARS are more effective in increasing physical activity than usual care only. We did not identify any components as significant predictors of physical activity and scheme uptake. Four components predicted scheme adherence, indicating that the component-effectiveness relationship warrants further research.

Exercise for peri- and postmenopausal women: Recommendations from synergistic alliances of women's medicine and health psychology for the promotion of an active lifestyle

Adopting healthy behaviors is a multifaceted and complex process that poses significant challenges for individuals. Despite awareness of the detrimental effects of certain behaviors on health, many individuals continue to engage in risky practices. Traditional medical advice and prescriptions, while well intentioned, often fall short in fostering lasting lifestyle changes. Although individuals may also have good intentions, solely relying on doctor's counsel does not ensure successful lifestyle adjustments. One primary reason for this limitation is the lack of specialized expertise in behavioral modification among gynecologists and healthcare providers. Health psychologists are specialized professionals capable of effectively guiding and assisting individuals in modifying health-related behaviors. Their expertise in behavior change strategies and psychological interventions proves invaluable in empowering individuals to embrace healthier lifestyles and contributes to people's well-being. This paper emphasizes the importance of collaborative efforts between medical professionals, such as gynecologists, and health psychologists to promote healthy behaviors among peri- and postmenopausal women and enhance women's health. By forging integrative alliances, they can develop comprehensive and tailored interventions. By bridging the gap between medical advice and behavior modification, this collaborative effort has the potential to ensure a more effective intervention process. This holistic approach not only addresses women's specific health needs but also fosters sustainable behavior change when promoting healthy behaviors among middle-aged women. The ultimate goal of such a synergy is to improve women's health outcomes and contribute to a healthier society overall.

Analysis of Madrid Primary Health-Care staff for the implementation of exercise prescription

OBJECTIVE

To assess the self-perception of nurses and general practitioners (GPs) toward Physical Activity on Prescription (PAP) in Madrid Primary Health-Care (PHC).

DESIGN

A survey-cohort study. SITE: Nurses and GPs of Madrid PHC System.

PARTICIPANTS

A total of 319 GPs and 285 nurses' responders.

MEASUREMENTS

Data were analyzed under a classification tree analysis by four predictor variables: (i) Health professional (Nurses/GPs); (ii) Exercise prescription collaboration with all health professionals: physicians, nurses, psychologists, physical therapists, sports medicine physicians, sports scientists, nutritionists, and teachers (Yes/No); (iii) PA promotion collaboration with Sports Scientists (Yes/No); and (iv) The stage of change of PHC staff to PA promotion (0-4 Likert scale).

RESULTS

Regarding the predictor variable (i), responders without PA guidelines knowledge and positive attitude to collaborate with nurses in PA promotion are more GPs of female sex (nurses n=33 and GPs n=175) than male sex (nurses n=3 and GPs n=59) (p<.001). For the predictor variable (ii) only 9.30% of PHC staff with a positive attitude to collaborate with all health professionals in PA promotion and exercise prescription. For the predictor variable (iii) was shown low collaboration with sports physicians and sports scientists under a multidisciplinary PAP approach (26.50% responders). Finally, in the predictor variable (iv) Staff maintaining PAP for at least 6 months, self-considered active, and with PAP knowledge want to collaborate with Sports scientists (Yes=233; No=133).

CONCLUSIONS

Nurses and GPs are conscious of health-related PA benefits despite the lack of PAP knowledge and lack of willingness to collaborate with other health personnel, exercise professionals, and community resources available.

Primary school children's health and its association with physical fitness development and health-related factors

The health status (HS) of children is influenced by a variety of factors, including physical fitness (PF) or social and environmental characteristics. We present a 4-year longitudinal study carried out with 263 primary school children. PF was assessed yearly using the German Motor Performance Test 6-18. Demographic data, leisure time behavior and socioeconomic factors were collected using questionnaires for children and parents. Based on parents' ratings in year 4, children were categorized as either "very good health status" (VGHS) or "good health status or below" (GHSB). Children with VGHS (73%) showed a larger improvement of global PF (p < 0.001), a significantly higher proportion of being/playing outside (p < 0.001), significantly lower proportions of overweight (p < 0.001), of media availability in the bedroom (p = 0.011) and of daily media consumption > 2 h (p = 0.033) compared to children with GHSB. Regarding socio-economic factors, children with VGHS revealed significantly fewer parents with lower education (p = 0.002), lower physical activity levels (p = 0.030) and lower migration background (p < 0.001). Physical fitness (p = 0.019) and outdoors exercising (p = 0.050) were the only variables to provide significantly higher chances of perceiving one's own health as very good when tested within a complex model including all the variables studied in this work. Considering the little focus on PF in the current Austrian physical education curriculum and the favorable environmental features of the Tyrolean region, more emphasis should be given to promoting didactical and pedagogical approaches that allow schoolers to be active in the nature.

A systematic review and narrative synthesis of physical activity referral schemes' components

BACKGROUND

Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness.

METHODS

Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness.

RESULTS

We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%).

CONCLUSIONS

Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.

Occupational Health: Physical Activity, Musculoskeletal Symptoms and Quality of Life in Computer Workers: A Narrative Review

Computer work has assumed a very important role for many companies, but specific occupational and health symptoms associated with the use of computers can appear. According to the literature, physical activity is considered a key player in the prevention and control of work-related musculoskeletal symptoms, contributing to a better quality of life in computer workers. The principal aims of this review are to contribute to a better understanding of the relationship among sedentary behavior, physical activity and quality of life of computer workers; to outline the importance of promoting the development of an educational program for Occupational Health directed at computer workers at the level of quality of life, musculoskeletal symptoms, and physical activity; and to call for attention to the factors needed to initiate and maintain a health program that involves the active participation of workers who must be concerned about their health. This review demonstrates the important role of workplaces in health promotion and the opportunities that workplaces provide to establish and continue successful health-promotion programs for computer workers, generating important benefits for the health and quality of life of individuals and groups.

Relationship between Health Counselor Characteristics and Counseling Impact on Individuals at High-Risk for Lifestyle-Related Disease: Sub-Analysis of the J-HARP Cluster-Randomized Controlled Trial

Early diagnosis and treatment are necessary to prevent lifestyle-related diseases among high-risk individuals. This study aimed to examine the impact of counselor characteristics on clinic visits among individuals at high risk for lifestyle-related diseases. A total of 8975 patients aged 40 to 74 years with lifestyle-related comorbidities, who underwent an annual health checkup and received health counseling, were included in this study. Data intervention timing, mode of counseling, number of counseling sessions, and explanation methods were collected. We assessed the impact of counselor characteristics, including profession (public health nurse, clinical nurse, and nutritionist), age, and years of counseling experience, on counseling outcomes. The probability ratios (95% confidence intervals) of clinic visits were 1.22 (1.11-1.35) for public health nurses and 1.04 (0.90-1.20) for nurses compared with nutritionists. After adjustment for participant and counselor characteristics and initial timing, mode, and number of counseling sessions, the corresponding probability ratios (95% confidence intervals) were 1.16 (1.05-1.29) and 1.12 (0.95-1.31), respectively. Counselor age and years of experience did not influence clinic visits of the target population. Public health nurses were more effective in increasing clinic visits among the target population owing to their profession-specific knowledge, skills, and experience.

Relationships between Socioeconomic Indicators and Motor Performance of Schoolchildren in Slovakia

Physical inactivity is currently a significant problem in Western societies. Among the many factors that affect the amount of physical activity in children, socioeconomic status, the type of school, and the area where they live can play a major role in physical development. A total of 31,620 children (6.3 ± 0.53 years; 15,726 boys; 15,893 girls), representing 55.6 % of the entire Slovak population of first graders, participated in eight motor performance (MP) tests, the results of which were correlated with somatic parameters (body height, body weight, and body mass index (BMI)) and socioeconomic indicators (SEIs) within the children’s respective territorial regions. The largest correlations were observed between MP and unemployment rate (r = −0.802) and between MP and economically active population with primary education (r = −0.807). Other correlations between MP and SEIs were also found at the level of self-governing regions (r = 0.995) and districts (r = 0.551). SEIs and MP were strongly correlated, indicating that children who grow up in better socioeconomic environments display greater MP. Therefore, national and local governments should provide tangible and intangible resources to enable the proper development of children’s MP.