Understanding adherence of hypertensive patients in Mexico to an exercise-referral scheme for increasing physical activity

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.

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

BACKGROUND

Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines.

METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme.

RESULTS

Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT).

CONCLUSIONS

Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.

Regular Physical Activities and Related Factors among Middle-Aged and Older Adults in Jinan, China: A Cross-Sectional Study

The objective of this study was to investigate the prevalence of regular physical activity (RPA) among middle-aged and older adults in urban communities in Jinan, China, and to identify the factors related to RPA. A cross-sectional survey was conducted among middle-aged and elderly urban residents. A total of 1406 participants were included in the final data analysis. The results of the four models consistently showed that the relevant factors of RPA were educational level, previously diagnosed hypertension (PDH) and depression. In terms of educational level, compared with illiteracy, from the first model to the fourth model, the odds ratios (ORs) and 95% confidence intervals (CIs) of senior middle school were 2.072 (1.418, 3.026), 2.072 (1.418, 3.026), 1.905 (1.289, 2.816) and 1.926 (1.302, 2.848), respectively, and the ORs and 95% CIs of college or above were 2.364 (1.462, 3.823), 2.364 (1.462, 3.823), 2.001 (1.208, 3.312) and 2.054 (1.239, 3.405). In terms of PDH, compared with those with PDH, from the first model to the fourth model, ORs and 95% CIs of non-PDH were 1.259 (1.003, 1.580), 1.259 (1.003, 1.580), 1.263 (1.006, 1.585) and 1.261 (1.004, 1.584), respectively. For depression, compared with those without depression, also from the first model to the fourth model, ORs and 95% CIs of depression were 0.702 (0.517, 0.951), 0.702 (0.517, 0.951), 0.722 (0.532, 0.981) and 0.719 (0.529, 0.977), respectively. In conclusion, the results of this study showed that participation in RPA among middle-aged and older adults in Jinan urban communities was significantly associated with education level, PDH and depression.