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Royer N, Mira J, Lepetit N, Fayolle E, Camdessanché JP, Millet GY. Benefits of Individualized Training in Fatigued Patients with Multiple Sclerosis. Med Sci Sports Exerc 2024; 56:1623-1633. [PMID: 38768010 DOI: 10.1249/mss.0000000000003474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Chronic fatigue is the most common and debilitating symptom in people with multiple sclerosis (PwMS). Recently, exercise has been proven to alleviate chronic fatigue and improve physical functions. Tailoring the training intervention to the potential fatigue causes could optimize the beneficial effects of training on fatigue. The objective of this study was to compare the effectiveness of an individualized (IND) versus a traditional (TRAD) exercise intervention in reducing chronic fatigue. METHODS Twenty-nine PwMS with high chronic fatigue were randomly assigned to 12 wk of either a TRAD or IND exercise intervention. TRAD comprised aerobic and resistance exercises according to the guidelines for PwMS. IND specifically addressed identified individual weaknesses. Participants visited the laboratory before and after training for the following assessments: patient-reported outcomes (fatigue, quality of life, depression questionnaires), incremental cycling test (peak oxygen uptake (V̇O 2peak )), and cycling fatigue test (maximal voluntary contraction, rating of perceived exertion). RESULTS Similar improvements in fatigue, depression, and quality of life were observed between groups ( P > 0.05). Compared with TRAD, IND induced a significant greater increase in V̇O 2peak (+21.0% ± 13.9% vs 6.8% ± 11.5%, P < 0.05) and a greater reduction in rating of perceived exertion at a given submaximal intensity (-30.3% ± 18.9% vs -12.1% ± 20.4%, P < 0.001), whereas maximal voluntary contraction increased similarly in both groups ( P > 0.05). CONCLUSIONS Although tailored exercise improved similarly fatigue and other subjective parameters (depression, quality of life, sleep quality) compared with than traditional exercise intervention, prescribing an individualized intervention led to greater improvement in V̇O 2peak (but not maximal strength) and perception of effort. This may have positive functional consequences for patients.
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Affiliation(s)
| | - José Mira
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, FRANCE
| | - Noa Lepetit
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, FRANCE
| | - Evolène Fayolle
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, FRANCE
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García-Vigara A, Fernandez-Garrido J, Carbonell-Asíns JA, Sánchez-Sánchez ML, Monllor-Tormos A, García-Pérez MÁ, Tarín JJ, Cano A. Physical activity to reduce the burden of frailty after menopause: effectiveness and adherence rate of a resource saving exercise plan. Menopause 2024; 31:634-640. [PMID: 38743912 DOI: 10.1097/gme.0000000000002372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Frailty may be increased by menopause. Physical activity has been proposed to reduce frailty, but poor adherence and cost limit effectiveness. We aimed to investigate both the effectiveness against the frailty burden and the adherence rate of a multicomponent physical activity scheme partially managed by the participating women themselves. METHODS Prospective controlled study consisting of a twice-weekly group physical activity scheme divided into two consecutive periods, one supervised by a health professional (12 wk) and the other supervised by the women themselves (36 wk). Group cohesion and mutual support during the patient-only period were aided by social networking via smartphones. Community-dwelling postmenopausal women were divided into a physical activity group (PAG = 126) and a usual activity control group (UAG = 126), both assessed at baseline and at the end of the study. Participants self-assigned to one of the two study arms. RESULTS Overall, women in the PAG were more likely to improve their frailty status (60.2% vs 42.6%, P < 0.05). The frailty reversal rate from prefrail to robust was significantly higher in the PAG than in the UAG (34.04 vs 8.00%, P < 0.05). Logistic regression confirmed that women in the PAG were more likely to improve their frailty phenotype (odds ratio [OR], 9.12; 95% confidence interval [CI], 3.45-31.52; P < 0.001). Adherence, defined by participants attending 75% of sessions, was attained by 56.35% of women at 48 wk. CONCLUSION A physical activity scheme implemented to improve frailty proved effective and attained acceptable adherence. Conditions in the peer-supervised 36-wk phase may increase sustainability.
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Affiliation(s)
| | | | | | - M Luz Sánchez-Sánchez
- Multi-specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Aitana Monllor-Tormos
- Service of Obstetrics and Gynecology, Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | - Miguel-Ángel García-Pérez
- Department of Genetics, Faculty of Biological Sciences, University of Valencia, Burjassot, and INCLIVA, Valencia, Spain
| | - Juan J Tarín
- Department of Cellular Biology, Functional Biology, and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Valencia, Spain
| | - Antonio Cano
- Department of Pediatrics, Obstetrics, and Gynecology, University of Valencia-INCLIVA, Valencia, Spain
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Jane B, Downey J. Exercise referral schemes in the UK: mapping provision and aims. J Public Health (Oxf) 2024:fdae057. [PMID: 38702841 DOI: 10.1093/pubmed/fdae057] [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: 06/18/2023] [Revised: 02/09/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Exercise Referral Schemes (ERS) are designed so health professionals can refer certain patients to a supervised programme of physical activity. However, evaluations have questioned the effectiveness of these schemes/programmes. The aim of this study was to systematically review the provision of ERS in England and analyse related promotional material. METHODS Content analysis methods were used to analyse scheme websites and promotional material. A coding scheme was used to analyse the data, which included information on the programme's aims, inclusion criteria, type of activities, accessibility and cost. RESULTS The study identified 625 sites offering ERS across 168 geographic areas. Findings highlighted a lack of clarity in what constitutes a scheme. Over a third of schemes did not explicitly state their aims, but of those that did, the focus was mainly on notions of physical and mental health benefits. CONCLUSIONS This study is the first to review the scope and offer of ERS in the UK by examining promotional material and highlights issues around the stated aims of ERS. More clarity on aims is needed in the material that promotes the schemes and most likely within the schemes themselves. Such improvements could make a difference when considering engagement with delivery stakeholders and potential participants.
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Affiliation(s)
- Ben Jane
- School of Health & Wellbeing, Plymouth Marjon University, Plymouth PL6 8BH, UK
| | - John Downey
- School of Nursing and Midwifery, University of Plymouth, Plymouth PL4 8AA, UK
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Stead A, Vishnubala D, Marino KR, Iqbal A, Pringle A, Nykjaer C. UK physiotherapists delivering physical activity advice: what are the challenges and possible solutions? A qualitative study. BMJ Open 2023; 13:e069372. [PMID: 37116991 PMCID: PMC10151243 DOI: 10.1136/bmjopen-2022-069372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Despite the known health benefits of physical activity (PA), PA levels are in decline. Healthcare professionals, including physiotherapists, have been identified as ideal conduits to promote PA, yet their knowledge and awareness of PA guidelines are poor. The aims of this study were to explore current knowledge of PA guidelines among UK physiotherapists and identify barriers and possible solutions to delivering PA advice. DESIGN A qualitative approach using semistructured interviews that took place between March and May 2021. Data were analysed with a thematic approach using Braun and Clarke's six steps. SETTING Various inpatient and outpatient clinical settings across six UK regions. PARTICIPANTS Eighteen UK-based physiotherapists managing National Health Service patients were recruited through volunteer sampling in March 2021. RESULTS Five themes and 16 subthemes (shown in parenthesis) were identified as barriers and solutions to delivering PA advice: physiotherapist intrinsic barriers (knowledge, fear/confidence); a lack of emphasis and priority given to PA (time constraints, minimal educational and staff training); patient barriers (compliance, expectations and fear of doing PA); increasing awareness of the PA guidelines (staff training, signposting awareness, use of social media and television campaigns); and optimising delivery (use of visual resources, good communication and approaches involving being individualised and gradual for patients with chronic conditions). CONCLUSIONS In this study, physiotherapist participants seemed to have limited awareness of the PA guidelines despite recent updates and were faced with similar barriers to those previously reported in the literature. The solutions suggested could guide strategies to support physiotherapists being able to deliver PA advice. Further research is needed to evaluate the efficiency of any implemented solutions supporting the delivery of PA advice.
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Affiliation(s)
- Alexandra Stead
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Dane Vishnubala
- School of Biomedical Sciences, University of Leeds, Leeds, UK
- Hull York Medical School, Hull, UK
| | | | - Adil Iqbal
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Andy Pringle
- Clinical Exercise and Rehabilitation Research Centre, School of Human Sciences, University of Derby, Derby, UK
| | - Camilla Nykjaer
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Albert FA, Malau-Aduli AEO, Crowe MJ, Malau-Aduli BS. Optimising care coordination strategies for physical activity referral scheme patients by Australian health professionals. PLoS One 2022; 17:e0270408. [PMID: 35834548 PMCID: PMC9282539 DOI: 10.1371/journal.pone.0270408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Physical activity (PA) has been identified as an essential tool for the prevention and management of multi-morbidity in patients. Coordination of patients’ care through interventions like physical activity referral schemes (PARS) could foster the utilization of PA. This study explored the views of General Practitioners (GPs) and Exercise Physiologists (EPs) as key stakeholders, for optimizing patient care and efficiency of PARS. Sequential explanatory mixed methods design was used to explore the perceptions of these health professionals on PA and coordination strategies for PARS patient care. Data analyses included descriptive and inferential statistics for questionnaires and theoretical framework analysis for the semi-structured interviews. Participants demonstrated a good knowledge of PA and valued PARS. However, the findings unravelled external factors, inter-organisational mechanisms, and relational coordination obstacles that hinder efficient coordination of PARS patient care and delay/limit beneficial health outcomes for patients. Incentivising the PARS initiative and empowering patients to seek referral into the programme, are strategies that could boost PARS efficiency. Improving inter-professional relationships between GPs and EPs could lead to enhanced PARS functionality and efficient coordination of care for patients with chronic diseases.
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Affiliation(s)
- Francis A. Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- * E-mail:
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Andersen P, Holmberg S, Årestedt K, Lendahls L, Nilsen P. Factors associated with increased physical activity among patients prescribed physical activity in Swedish routine health care including an offer of counselor support: a 1-year follow-up. BMC Public Health 2022; 22:509. [PMID: 35292017 PMCID: PMC8925134 DOI: 10.1186/s12889-022-12940-4] [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: 06/11/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study addresses knowledge gaps in research regarding influences of routine health care delivery of physical activity on prescription (PAP). The aim was to investigate if patient and health care characteristics are associated with increased physical activity 1 year after prescription among patients offered counselor support in addition to health care professionals' prescription. The study was conducted in primary and secondary care in a Swedish health care region. METHODS All PAP recipients during 1 year were invited (N = 1503) to participate in this observational prospective study. Data were collected from medical records and questionnaires (baseline and follow-up). Descriptive statistics and multiple logistic regression analysis were used. The outcome variable was increased physical activity after 1 year. Study variables were patient and health care characteristics. RESULTS Three hundred and fifty-five patients with complete follow-up data were included. The mean age was 62 years (SD = 14; range, 18-90) and 68% were females. Almost half (47%) had increased physical activity 1 year after PAP. Multiple logistic regression analysis showed that increased physical activity at follow-up was positively associated with lower baseline activity, counselor use, and positive perception of support. Counselor users with low baseline activity had higher odds ratio for increased physical activity at follow-up than non-users (OR = 7.2, 95% CI = 2.2-23.5 vs. OR = 3.2, 95% CI = 1.4-7.5). Positive perception of support was associated with increased physical activity among counselor users but not among non-users. CONCLUSIONS An increase in physical activity after PAP was related to low baseline activity, positive perception of support, and use of counselor support after PAP. Qualified counseling support linked to PAP seems to be important for achieving increased physical activity among patients with lower baseline activity.
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Affiliation(s)
- Pia Andersen
- Department of Research and Development, Region Kronoberg, SE-351 88, Växjö, Sweden. .,Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83, Linköping, Sweden.
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, SE-351 88, Växjö, Sweden.,Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, SE-221 00, Lund, Sweden.,Faculty of Health and Life Sciences, Department of Medicine and Optometry, Linnaeus University, SE-391 82, Kalmar, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, SE-391 82, Kalmar, Sweden.,The Research Section, Region Kalmar County, SE-391 26, Kalmar, Sweden
| | - Lena Lendahls
- Department of Research and Development, Region Kronoberg, SE-351 88, Växjö, Sweden.,Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, SE-391 82, Kalmar, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83, Linköping, Sweden
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Shore CB, Galloway SDR, Gorely T, Hunter AM, Hubbard G. Exercise Referral Instructors' Perspectives on Supporting and Motivating Participants to Uptake, Attend and Adhere to Exercise Prescription: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:203. [PMID: 35010462 PMCID: PMC8750611 DOI: 10.3390/ijerph19010203] [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: 11/01/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Exercise referral schemes are designed to support people with non-communicable diseases to increase their levels of exercise to improve health. However, uptake and attendance are low. This exploratory qualitative study aims to understand uptake and attendance from the perspectives of exercise referral instructors using semi-structured interviews. Six exercise referral instructors from one exercise referral scheme across four exercise referral sites were interviewed. Four themes emerged: (i) the role that instructors perceive they have and approaches instructors take to motivate participants to take-up, attend exercise referral and adhere to their exercise prescription; (ii) instructors' use of different techniques, which could help elicit behaviour change; (iii) instructors' perceptions of participants' views of exercise referral schemes; and (iv) barriers towards providing an exercise referral scheme. Exercise referral instructors play an important, multifaceted role in the uptake, attendance and adherence to exercise referral. On-going education and peer support for instructors may be useful. Instructors' perspectives help us to further understand how health and leisure services can design successful exercise referral schemes.
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Affiliation(s)
- Colin B. Shore
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford GU2 7YH, UK
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK; (S.D.R.G.); (A.M.H.)
| | - Stuart D. R. Galloway
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK; (S.D.R.G.); (A.M.H.)
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands (UHI), Inverness IV2 3JH, UK; (T.G.); (G.H.)
| | - Angus M. Hunter
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK; (S.D.R.G.); (A.M.H.)
- Department of Sports Science, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands (UHI), Inverness IV2 3JH, UK; (T.G.); (G.H.)
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The match between what is prescribed and reasons for prescribing in exercise referral schemes: a mixed method study. BMC Public Health 2021; 21:1003. [PMID: 34044789 PMCID: PMC8161921 DOI: 10.1186/s12889-021-11094-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Exercise referral schemes (ERS) aim to tackle non-communicable disease (NCD) by increasing physical activity levels through prescribed exercise. However, there is a sparsity of knowledge upon what exercises are prescribed and if they are targeted towards tackling NCD. Method Mixed methods were employed. Quantitative data was extracted from exercise prescription cards of 50 participants and were assessed for frequency, intensity, type and time of prescribed exercise. Descriptive measures of aggregate data are expressed as median (range: minimum-maximum). Thematic analysis of semi-structured interviews generated qualitative data on exercise referral instructors’ experiences of prescribing exercise. Results Thirty-eight different types of exercise were prescribed. Median prescription was 4 (1–11) exercises per session, at a moderate intensity. Participants were prescribed a median of 35 (5–70) minutes of aerobic exercise per referral session. Exercise referral instructors prescribed exercise to improve activities of daily living, promote independence and autonomy of participants, rather than explicitly targeting the referral condition. Conclusions Knowledge that prescribed exercises are not explicitly targeted to the referral condition provides critical information in understanding the purpose of exercise prescription. Future evaluations of ERS should be mindful of this, that is, perceived outcomes might not match up to what is being prescribed within ERS. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11094-z.
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Golubinski V, Wild EM, Winter V, Schreyögg J. Once is rarely enough: can social prescribing facilitate adherence to non-clinical community and voluntary sector health services? Empirical evidence from Germany. BMC Public Health 2020; 20:1827. [PMID: 33256677 PMCID: PMC7706247 DOI: 10.1186/s12889-020-09927-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background Non-clinical health interventions provided by the voluntary and community sector can improve patients’ health and well-being and reduce pressure on primary and secondary care, but only if patients adhere to them. This study provides novel insights into the impact of doctor referrals to such services, known as social prescribing, on patients’ adherence to them. Methods Using a negative binomial model, we analysed electronic visitor records from a community health advice and navigation service in Germany between January 2018 and December 2019 to determine whether social prescribing was associated with greater adherence to the service (measured in terms of return visits) compared to patients who self-referred. We also explored whether this effect differed according to patient characteristics. Results Based on 1734 observations, we found that social prescribing was significantly associated with a greater number of return visits compared to patient self-referrals (p < 0.05). For patients who visited the service because of psychological concerns, the effect of social prescribing was lower. For all other patient characteristics, the effect remained unchanged, suggesting relevance to all other patient groups. Conclusions The results of our study indicate that social prescribing may be an effective way to facilitate adherence to non-clinical community and voluntary sector health services. This knowledge is important for policy makers who are deciding whether to implement or expand upon social prescribing schemes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09927-4.
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Affiliation(s)
- Veronika Golubinski
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354, Hamburg, Germany
| | - Eva-Maria Wild
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354, Hamburg, Germany.
| | - Vera Winter
- Department of Health Care Management, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Jonas Schreyögg
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354, Hamburg, Germany
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Okwose NC, O'Brien N, Charman S, Cassidy S, Brodie D, Bailey K, MacGowan GA, Jakovljevic DG, Avery L. Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study. BMJ Open 2020; 10:e036382. [PMID: 32958484 PMCID: PMC7507843 DOI: 10.1136/bmjopen-2019-036382] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Clinical guidelines recommend regular physical activity for patients with heart failure to improve functional capacity and symptoms and to reduce hospitalisation. Cardiac rehabilitation programmes have demonstrated success in this regard; however, uptake and adherence are suboptimal. Home-based physical activity programmes have gained popularity to address these issues, although it is acknowledged that their ability to provide personalised support will impact on their effectiveness. This study aimed to identify barriers and facilitators to engagement and adherence to a home-based physical activity programme, and to identify ways in which it could be integrated into the care pathway for patients with heart failure. DESIGN A qualitative focus group study was conducted. Data were analysed using thematic analysis. PARTICIPANTS A purposive sample of 16 patients, 82% male, aged 68±7 years, with heart failure duration of 10±9 years were recruited. INTERVENTION A 12-week behavioural intervention targeting physical activity was delivered once per week by telephone. RESULTS Ten main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence. CONCLUSIONS Endorsement of interventions by clinicians to reduce patients' fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support for long-term maintenance. TRIAL REGISTRATION NUMBER NCT03677271.
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Affiliation(s)
- Nduka C Okwose
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - Nicola O'Brien
- Department of Psychology, Northumbria University - City Campus, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Sarah Charman
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - Sophie Cassidy
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - David Brodie
- School of Health and Social Sciences, Buckinghamshire New University, High Wycombe, Buckinghamshire, United Kingdom
| | - Kristian Bailey
- Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
- Faculty of Health and Life Scienes, Coventry University, Coventry, United Kingdom
| | - Leah Avery
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
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Calonge-Pascual S, Fuentes-Jiménez F, Casajús Mallén JA, González-Gross M. Design and Validity of a Choice-Modeling Questionnaire to Analyze the Feasibility of Implementing Physical Activity on Prescription at Primary Health-Care Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6627. [PMID: 32932923 PMCID: PMC7559833 DOI: 10.3390/ijerph17186627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Worldwide health policies are trying to implement physical activity on prescription (PAP) at healthcare settings. However, there is not a proper methodology to analyze PHC organizational staff factors. This study aims to validate two questionnaires to assess the self-perception of nurses and general practitioners to implement PAP at primary healthcare (PHC) settings. The designed choice-modeling Google-form questionnaire was sent to 11 expert nurses and 11 expert sports medicine physicians. Experts evaluated each question on a 1-5 points Likert-type scale according to their expertise. Aiken's V coefficient values ≥0.75 were used to validate separately each question using the Visual Basic-6.0 software. A total of 10 sports medicine physicians and 10 nurses with 28.4 ± 5.1 y and 16.3 ± 11.8 y of PAP experience, respectively, validated the questionnaire. One expert in each group was not considered for offering 3 ± SD answers in ≥2 questions respect to the mean of the rest of experts. Final Aiken's V coefficient values were 0.89 (0.77-1.00) for the nurses' questionnaire and 0.84 (0.77-0.95) for the physicians' one. The questionnaires designed to assess the PAP self-perception of PHC nurses and physicians were validated. This methodology could be used to analyze PHC organizational staff factors in order to achieve an efficient PAP implementation in other PHC contexts.
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Affiliation(s)
- Sergio Calonge-Pascual
- ImFINE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040 Madrid, Spain; (S.C.-P.); (F.F.-J.)
| | - Francisco Fuentes-Jiménez
- ImFINE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040 Madrid, Spain; (S.C.-P.); (F.F.-J.)
| | - José A. Casajús Mallén
- GENUD Research Group, Faculty of Health Sciences, University of Zaragoza, Pedro Miral s/n, 50008 Zaragoza, Spain;
- Biomedical Research Center of Physiopathology of Obesity and Nutrition, CIBERobn, (CB12/03/30038), Carlos III Health Institute, Avenida de Monforte de Lemos 5, 28029 Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040 Madrid, Spain; (S.C.-P.); (F.F.-J.)
- Biomedical Research Center of Physiopathology of Obesity and Nutrition, CIBERobn, (CB12/03/30038), Carlos III Health Institute, Avenida de Monforte de Lemos 5, 28029 Madrid, Spain
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Garner-Purkis A, Alageel S, Burgess C, Gulliford M. A community-based, sport-led programme to increase physical activity in an area of deprivation: a qualitative case study. BMC Public Health 2020; 20:1018. [PMID: 32600289 PMCID: PMC7322853 DOI: 10.1186/s12889-020-08661-1] [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: 05/19/2019] [Accepted: 04/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Engaging in physical activity is essential for maintaining mental and physical health but a high proportion of adults are inactive, especially in areas of socioeconomic deprivation. We evaluated a novel exercise referral scheme funded by Sport England and run by a social enterprise in an area of socioeconomic deprivation in inner London. This study aimed to examine the experiences of participants and staff and to identify barriers and facilitators of implementation and participation in this and potentially similar projects. Methods Thirty-five semi-structured interviews with project participants (N = 25) and staff members involved with the project (N = 10) were conducted based at one centre in London in 2017/2018. The interview schedule was informed by the Theoretical Domains Framework. Data was analysed using the Framework method and NVivo software. Results Three themes emerged from the data: ‘Not like your regular gym’, Individual journeys and Practical aspects of the scheme. Study participants regarded the environment of the project centre as friendly and sociable. The project differed from a commercial gym by offering free or subsidised membership and the participation of people of all sizes and abilities. Classes were provided free of charge and this, together with mentor support, facilitated participation and continuation in the project. Participants reported changes not only in their physical activity level, but also in their physical and mental health. Additionally, their families’ lifestyle changes were reported. Difficulties of accessing the project included lack of awareness of the project and lack of engagement from key referring groups. Conclusions Providing free or subsidised classes incorporating individualised assessment, follow-up and support appeared to facilitate engagement in physical activity among socioeconomically deprived populations. The supportive social context of the centre was a major facilitator. Differing levels of abilities and health status among participants call for special attention. Increasing community and referrer awareness of available exercise referral schemes and enhancing communication between sources of referrals and project staff may help to address access issues.
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Affiliation(s)
- Aphra Garner-Purkis
- King's College London, School of Population Health and Environmental Sciences, London, UK
| | - Samah Alageel
- King's College London, School of Population Health and Environmental Sciences, London, UK. .,King Saud University, College of Applied Medical Sciences, Community Health Sciences Department, Riyadh, Saudi Arabia.
| | - Caroline Burgess
- King's College London, School of Population Health and Environmental Sciences, London, UK
| | - Martin Gulliford
- King's College London, School of Population Health and Environmental Sciences, London, UK
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Chia KSW, Wong PKK, Gonzalez S, Kotlyar E, Faux SG, Shiner CT. Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension. Pulm Circ 2020; 10:2045894020922806. [PMID: 32489642 PMCID: PMC7238796 DOI: 10.1177/2045894020922806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
Exercise training was not traditionally recommended for patients with pulmonary hypertension. However, recent work has demonstrated that exercise improves endurance and quality-of-life in patients with pulmonary hypertension. Unfortunately, patients with pulmonary hypertension are often sedentary. While some studies have examined patient attitudes to exercise, none have investigated physician perspectives on exercise in patients with pulmonary hypertension. This multinational survey of physicians involved in treating patients with pulmonary hypertension sought to ascertain physician attitudes to exercise and physician-identified barriers and enablers of exercise in this patient population. We collected cross-sectional survey data from a cohort of 280 physicians, including rehabilitation physicians, cardiologists, respiratory physicians and rheumatologists. We found that overall, 86% physicians recommended exercise, in line with current guidelines, although there were differences in the rationale for prescribing exercise and in the type of exercise prescription. Barriers to exercise included patient-related factors, such as patient ill health preventing exercise; poor patient motivation and lack of understanding regarding the benefits of exercise. Systemic barriers included cost/funding issues and limited availability of appropriate services. Perceived enablers of exercise included access to appropriate programmes, provision of education and supportive treating clinicians. Further research is required to identify and implement interventions to promote physical activity in patients with pulmonary hypertension.
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Affiliation(s)
- Karen S W Chia
- Department of Rehabilitation Medicine, St Vincent's Hospital Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Peter K K Wong
- Department of Rheumatology, Westmead Hospital, Sydney, Australia.,Rural Clinical School, Coffs Harbour, University of New South Wales, Sydney, Australia
| | - Senen Gonzalez
- Royal Talbot Rehabilitation Centre, Melbourne, Australia
| | - Eugene Kotlyar
- Department of Rehabilitation Medicine, St Vincent's Hospital Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia.,Department of Cardiology, St Vincent's Hospital, Sydney, Australia
| | - Steven G Faux
- Department of Rehabilitation Medicine, St Vincent's Hospital Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Christine T Shiner
- Department of Rehabilitation Medicine, St Vincent's Hospital Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
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14
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de Lira C, Taveira H, Rufo-Tavares W, Santos D, Celini P, Oliveira L, Andrade M, Nikolaidis P, Rosemann T, Knechtle B, Vancini R. Does Health Professional Counseling Impact the Quality-of-Life Levels of Older Adults Enrolled in Physical Activity Programs? MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E146. [PMID: 32218371 PMCID: PMC7231264 DOI: 10.3390/medicina56040146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: There are studies showing that exercise counseled by health professionals can improve physical fitness. However, less is known about the effects of exercise counseling on quality of life. The aim of this study was to investigate health-related quality of life of older adults who received or did not receive physical exercise counseling by sport and exercise professionals or physicians. Materials and Methods: This was a cross-sectional study that investigated quality of life of older adults who did or did not receive exercise counseling from health professionals. Older adults who were physically active took part in this study: 45 participants performed exercise advised by sport and exercise professionals (SEPCG), 19 participants performed exercise advised by physicians (PCG), and 26 participants performed exercise without counseling (NCG). Participants answered the SF-36 to estimate quality of life. Results: Analysis revealed that responses on all SF-36 subscales were higher in those participants who received counseling by sport and exercise professionals (Functioning capacity, β = -26.283, p < 0.001 and β = -26.482, p < 0.001, Role limitations due to physical problems, β = -43.372, p < 0.001 and β = -45.177, p < 0.001, Pain, β = -17.634, p < 0.001 and β = -16.015, p < 0.001, General health perceptions, β = -38.008, p < 0.001 and β = -32.529, p < 0.001, Vitality, β = -18.573, p < 0.001 and β = -16.406, p = 0.001, Social functioning, β = -37.963, p < 0.001 and β = -29.224, p < 0.001, Role limitations due to emotional problems, β = -52.246, p < 0.001 and β = -40.173, p < 0.001, Mental health, β = -17.381, p < 0.001 and β = -12.121, p < 0.001, PCG and NCG respectively). Conclusions: The results showed that those older adults who were counseled by sport and exercise professionals presented better quality of life, possibly because these professionals counseled exercise based on current guidelines for exercise prescription.
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Affiliation(s)
- Claudio de Lira
- Faculdade de Educação Física e Dança, Universidade Federal de Goiás, Goiânia 74690-900, Brazil
| | - Henrique Taveira
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (H.T.); (W.R.-T.); (P.C.); (L.O.); (R.V.)
| | - Weverton Rufo-Tavares
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (H.T.); (W.R.-T.); (P.C.); (L.O.); (R.V.)
| | - Douglas Santos
- Colegiado de Educação Física, Universidade do Estado da Bahia, Teixeira de Freitas 45992-255, Brazil;
| | - Paulo Celini
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (H.T.); (W.R.-T.); (P.C.); (L.O.); (R.V.)
| | - Lucas Oliveira
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (H.T.); (W.R.-T.); (P.C.); (L.O.); (R.V.)
| | - Marilia Andrade
- Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo 04023-900, Brazil;
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
| | - Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland;
| | - Rodrigo Vancini
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (H.T.); (W.R.-T.); (P.C.); (L.O.); (R.V.)
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15
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Husk K, Blockley K, Lovell R, Bethel A, Lang I, Byng R, Garside R. What approaches to social prescribing work, for whom, and in what circumstances? A realist review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:309-324. [PMID: 31502314 PMCID: PMC7027770 DOI: 10.1111/hsc.12839] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 05/06/2023]
Abstract
The use of non-medical referral, community referral or social prescribing interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of 'if-then' statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web-based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.
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Affiliation(s)
- Kerryn Husk
- NIHR CLAHRC South West Peninsula (PenCLAHRC)Faculty of Medicine and DentistryUniversity of PlymouthPlymouthUK
| | - Kelly Blockley
- NIHR CLAHRC South West Peninsula (PenCLAHRC)College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rebecca Lovell
- European Centre for Environment and Human HealthCollege of Medicine and HealthUniversity of ExeterExeterUK
| | - Alison Bethel
- NIHR CLAHRC South West Peninsula (PenCLAHRC)College of Medicine and HealthUniversity of ExeterExeterUK
| | - Iain Lang
- NIHR CLAHRC South West Peninsula (PenCLAHRC)College of Medicine and HealthUniversity of ExeterExeterUK
| | - Richard Byng
- NIHR CLAHRC South West Peninsula (PenCLAHRC)Faculty of Medicine and DentistryUniversity of PlymouthPlymouthUK
| | - Ruth Garside
- European Centre for Environment and Human HealthCollege of Medicine and HealthUniversity of ExeterExeterUK
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Trigueros R, Álvarez JF, Cangas AJ, Aguilar-Parra JM, Méndez-Aguado C, Rocamora P, López-Liria R. Validation of the Scale of Basic Psychological Needs towards Physical Exercise, with the Inclusion of Novelty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E619. [PMID: 31963663 PMCID: PMC7014240 DOI: 10.3390/ijerph17020619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to validate and adapt to the Spanish context of Physical Education, the Spanish version of the Scale of Basic Psychological Needs in the context of physical exercise, with the incorporation of novelty to the scale. The sample that took part in the study was 2372 people from 16 to 48 years old from the province of Almeria. In order to analyze the psychometric properties of the scale, several analyses have been carried out. The results have offered support both for the eight-factor structure and for the higher-order double model where the eight subscales are joined into two constructs called frustration and satisfaction. The structure of both models was invariant with respect to gender and age. Cronbach's alpha values were above 0.70 in the subscales and scales; and adequate levels of temporal stability. In addition, the subfactors pertaining to the satisfaction of basic psychological needs positively predicted the intrinsic motivation for physical activity, while each of the subfactors of the frustration of psychological needs predicted it negatively. The results of this study provide evidence of the reliability and validity of the BPNS in the Spanish context of physical activity.
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Affiliation(s)
- Ruben Trigueros
- Department of Psychology, Hum-878 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain; (J.F.Á.); (C.M.-A.)
| | - Joaquín F. Álvarez
- Department of Psychology, Hum-878 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain; (J.F.Á.); (C.M.-A.)
| | - Adolfo J. Cangas
- Department of Psychology, Hum-760 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain;
| | - José M. Aguilar-Parra
- Department of Psychology, Hum-878 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain; (J.F.Á.); (C.M.-A.)
| | - Cristina Méndez-Aguado
- Department of Psychology, Hum-878 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain; (J.F.Á.); (C.M.-A.)
| | - Patricia Rocamora
- Department of Nursing Science, Physiotherapy and Medicine, Hum-498 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain; (P.R.); (R.L.-L.)
| | - Remedios López-Liria
- Department of Nursing Science, Physiotherapy and Medicine, Hum-498 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain; (P.R.); (R.L.-L.)
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17
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Randomized Controlled Trial of Primary Health Care Strategies for the Promotion of Leisure-Time Physical Activity Among Older Brazilians. J Phys Act Health 2019; 16:706-714. [PMID: 31310991 DOI: 10.1123/jpah.2017-0502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/22/2019] [Accepted: 04/20/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Physical activity promotion within primary health care is in the spotlight. However, few studies have evaluated the long-term effectiveness of possible interventions. This study aimed to compare the effectiveness of 3 primary health care interventions in increasing leisure-time physical activity among older Brazilians. METHODS Experimental study with 142 older residents of an ongoing urban cohort in São Paulo (Brazil). Participants were randomized into 3 groups: minimal intervention group, physician-based counseling group, and individual counseling and referral for physical activity programs group (CRG). We used the long version of the International Physical Activity Questionnaire to assess leisure-time physical activity at baseline, 4 years after baseline without any intervention, 3 months after intervention, and 6 months after intervention. Statistical analysis included repeated analysis of variance. RESULTS At baseline, 31% of the individuals were active, and this figure remained stable for a period of 4 years. Three months after the interventions, there was a significant increase in leisure-time physical activity for CRG compared with the minimal intervention (P < .001) and physician-based counseling (P < .02) groups, and these differences persisted after 6 months (P < .001 and P < .05, respectively). CONCLUSION Results indicate that interventions with CRG are effective in producing sustained changes in physical activity among older Brazilians.
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18
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Insufficient Reporting of Factors Associated With Exercise Referral Scheme Uptake, Attendance, and Adherence: A Systematic Review of Reviews. J Phys Act Health 2019; 16:667-676. [PMID: 31203705 DOI: 10.1123/jpah.2018-0341] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 02/08/2019] [Accepted: 04/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise referral schemes (ERS) are prescribed programs to tackle physical inactivity and associated noncommunicable disease. Inconsistencies in reporting, recording, and delivering ERS make it challenging to identify what works, why, and for whom. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this narrative review of reviews. Electronic databases were searched for systematic reviews of ERS. Inclusion criteria and quality assessed through A Measurement Tool to Assess Systematic Reviews (AMSTAR). Data on uptake, attendance, and adherence were extracted. RESULTS Eleven reviews met inclusion criteria. AMSTAR quality was medium. Uptake ranged between 35% and 81%. Groups more likely to take up ERS included (1) females and (2) older adults. Attendance ranged from 12% to 49%. Men were more likely to attend ERS. Effect of medical diagnosis upon uptake and attendance was inconsistent. Exercises prescribed were unreported; therefore, adherence to exercise prescriptions was unreported. The influence of theoretically informed approaches on uptake, attendance, and adherence was generally lacking; however, self-determination, peer support, and supervision were reported as influencing attendance. CONCLUSIONS There was insufficient reporting across studies about uptake, attendance, and adherence. Complex interventions such as ERS require consistent definitions, recording, and reporting of these key facets, but this is not evident from the existing literature.
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Bird ML, Mortenson BW, Chu F, Acerra N, Bagnall E, Wright A, Hayley K, Yao J, Eng JJ. Building a Bridge to the Community: An Integrated Knowledge Translation Approach to Improving Participation in Community-Based Exercise for People After Stroke. Phys Ther 2019; 99:286-296. [PMID: 30698783 PMCID: PMC6383711 DOI: 10.1093/ptj/pzy146] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/05/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND People who have had a stroke and are living in the community have low levels of physical activity, which reduces their functional capacity and increases risks of developing secondary comorbid conditions. Exercise delivered in community centers can address these low levels of physical activity; however, implementing evidence-based programs to meet the needs of all community stakeholders is challenging. OBJECTIVES The objective of this study was to determine implementation factors to facilitate participation in relevant exercise and physical activity for people with chronic health conditions, like stroke. DESIGN The design consisted of a qualitative observational study using an integrated knowledge translation approach. METHODS Supported by an integrated knowledge translation approach, a series of focus groups-with stakeholder group representation that included people who had had a stroke and care partners, community organizations (ie, support groups, community center staff), health care providers, and exercise deliverers-was conducted. During the focus groups, participants provided perspectives on factors that could influence implementation effectiveness. Focus groups were recorded, transcribed, and thematically analyzed. RESULTS Forty-eight stakeholders participated. Based on the themes, a new implementation model that describes the importance of relationships between community centers, clinicians, and people who have had a stroke is proposed. The development of partnerships facilitates the implementation and delivery of exercise programs for people with ongoing health needs. These partnerships address unmet needs articulated in the focus groups and could fill a gap in the continuity of care. CONCLUSIONS Data from this study support the need for the community sector to offer a continuing service in partnership with the health system and people with chronic health needs. It indicates the potential of clinicians to partner with people with chronic health conditions and empower them to improve participation in relevant health behaviors, like community-based exercise.
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Affiliation(s)
- Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - B William Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia
| | - Francis Chu
- Vancouver Coastal Health Authority, Community, Vancouver, British Columbia, Canada
| | - Nicole Acerra
- Vancouver Coastal Health Authority, Division of Physical Therapy
| | - Eric Bagnall
- West Vancouver Community Centre, Health and Wellness, Vancouver, British Columbia, Canada
| | | | | | - Jennifer Yao
- Vancouver Coastal Health Authority, Division of Physical Medicine and Rehabilitation
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, 212-2177 Westbrook Mall, Vancouver, BC, V6T 1Z3 Canada,Address all correspondence to Dr Eng at:
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20
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The Demise of an Australian Physical Activity Alliance. J Phys Act Health 2018; 15:795-798. [PMID: 30122101 DOI: 10.1123/jpah.2018-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical activity health promotion coalitions are uncommon but important for beneficial collective impact on public health. The authors sought to obtain the viewpoints of member organizations of an Australian physical activity alliance, the National Physical Activity Alliance. METHODS The authors conducted an online survey regarding member agenda, commitment, and vision for the alliance. Questions were mostly open ended (eg, "What are the 3 areas of priority related to physical activity that you would like The Alliance to focus on?"). A total of 11 Australian organizations involved in physical activity public health (eg, the nongovernment organization Alzheimer's Australia and the professional fitness association Fitness Australia). RESULTS 82% of members responded to the survey. Member programs and goals were diverse and overlapping. There was agreement among members that the main priority area for alliance focus was a national exercise referral scheme. Barriers for members achieving their own goals as well as alliance goals focused on governmental issues, including inadequate government funding for physical activity public health. CONCLUSIONS This novel survey highlights the promise and difficulties of a physical activity coalition, with the difficulties, namely lack of governmental funding, resulting in a stagnation of the alliance's activities since the study was carried out.
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Grant A, Dreischulte T, Guthrie B. Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing. BMJ Open 2017; 7:e015281. [PMID: 28283493 PMCID: PMC5353272 DOI: 10.1136/bmjopen-2016-015281] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time. DESIGN Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices. SETTING Ten (30%) primary care practices participating in the trial from Scotland, UK. RESULTS Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability. CONCLUSIONS Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation. TRIAL REGISTRATION NUMBER NCT01425502.
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Affiliation(s)
- Aileen Grant
- School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Tobias Dreischulte
- Medicines Governance Unit, NHS Tayside, Dundee, UK
- Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
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22
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Arsenijevic J, Groot W. Physical activity on prescription schemes (PARS): do programme characteristics influence effectiveness? Results of a systematic review and meta-analyses. BMJ Open 2017; 7:e012156. [PMID: 28153931 PMCID: PMC5293992 DOI: 10.1136/bmjopen-2016-012156] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Physical activity on prescription schemes (PARS) are health promotion programmes that have been implemented in various countries. The aim of this study was to outline the differences in the design of PARS in different countries. This study also explored the differences in the adherence rate to PARS and the self-reported level of physical activity between PARS users in different countries. METHOD A systematic literature review and meta-analyses were conducted. We searched PubMed and EBASCO in July 2015 and updated our search in September 2015. Studies that reported adherence to the programme and self-reported level of physical activity, published in the English language in a peer-reviewed journal since 2000, were included. The difference in the pooled adherence rate after finishing the PARS programme and the adherence rate before or during the PARS programme was 17% (95% CI 9% to 24%). The difference in the pooled physical activity was 0.93 unit score (95 CI -3.57 to 1.71). For the adherence rate, a meta-regression was conducted. RESULTS In total, 37 studies conducted in 11 different countries met the inclusion criteria. Among them, 31 reported the adherence rate, while the level of physical activity was reported in 17 studies. Results from meta-analyses show that PARS had an effect on the adherence rate of physical activity, while the results from the meta-regressions show that programme characteristics such as type of chronic disease and the follow-up period influenced the adherence rate. CONCLUSIONS The effects of PARS on adherence and self-reported physical activity were influenced by programme characteristics and also by the design of the study. Future studies on the effectiveness of PARS should use a prospective longitudinal design and combine quantitative and qualitative data. Furthermore, future evaluation studies should distinguish between evaluating the adherence rate and the self-reported physical activity among participants with different chronic diseases.
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Affiliation(s)
- Jelena Arsenijevic
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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McMahon NE, Visram S, Connell LA. Mechanisms of change of a novel weight loss programme provided by a third sector organisation: a qualitative interview study. BMC Public Health 2016; 16:378. [PMID: 27165634 PMCID: PMC4862220 DOI: 10.1186/s12889-016-3063-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/28/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session). Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme), alumni support (face-to-face and online) and family attendance at exercise sessions. METHODS Data were collected through interviews with programme providers (n = 2) and focus groups with participants (n = 12). Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. RESULTS Clients' interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. CONCLUSIONS There is an urgent need to establish robust interventions that can support people who are overweight and obese to achieve a healthy weight and maintain this change. Third sector organisations may be a feasible alternative to private and public sector weight loss programmes. We have presented findings from one example of a novel community-based weight loss programme and identified how the programme components resulted in change amongst the participants. Further research is needed to robustly test the effectiveness, and cost-effectiveness, of this programme.
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Affiliation(s)
- Naoimh E McMahon
- College of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Shelina Visram
- School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, TS17 6BH, UK
| | - Louise A Connell
- College of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK
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Baxter S, Blank L, Johnson M, Everson-Hock E, Woods HB, Goyder E, Payne N, Mountain G. Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIt has been argued that transition points in life, such as the approach towards and early years of retirement, present key opportunities for interventions to improve the health of the population. Interventions that may change or preserve activity levels around the time of retirement have the potential to provide benefits in terms of increased health and well-being for people in later life. Research has highlighted health inequalities in health statuses in the retired population and in response to interventions.ObjectiveWe aimed to conduct a systematic review and meta-synthesis of the types and effectiveness of interventions to increase physical activity among people around the time of retirement. We also aimed to identify factors that may underpin the effectiveness or acceptability of interventions, and how issues of health inequalities may be addressed.Data sourcesThe following electronic databases were searched: (1) MEDLINE; (2) Applied Social Sciences Index and Abstracts; (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database); (4) Cumulative Index to Nursing and Allied Health Literature; (5) Science Citation Index; (6) Social Science Citation Index; (7) PsycINFO; (8) Evidence for Policy and Practice Information and Co-ordinating Centre; (9) SPORTDiscus; (10) Social Policy and Practice; (11) Health Management Information Consortium; and (12) Sociological Abstracts. We also searched for grey literature, checked reference lists of included papers and screened other reviews.Review methodsA systematic review of quantitative and qualitative literature was carried out between February 2014 and April 2015. The searches aimed to identify, first, evidence of effectiveness of interventions for older adults at the point of transition to retirement and, second, data relating to perceptions of barriers and facilitators to intervention effectiveness. A meta-synthesis of the two types of evidence was also carried out to provide further interpretation of the review findings.ResultsA systematic search of the literature identified a large number of potentially relevant studies. Of these, 103 studies examining the effectiveness of interventions and 55 qualitative papers met the criteria for inclusion. A review of the effectiveness literature indicated a dearth of studies that investigate interventions that specifically examine the transition to retirement. More general studies in older adults indicated that a range of interventions might be effective for people around retirement age. The qualitative literature indicated the importance of considering the appeal and enjoyment, and social aspects, of interventions. Although there were a range of different measures in use, many were self-reported and few studies included an evaluation of sedentary time. A meta-synthesis across the data types indicated that elements reported as significant by participants did not always feature in the interventions.LimitationsOwing to the lack of evidence relating to the retirement transition, we examined the literature relating to older adults. The applicability of these data to people around retirement age may need consideration.ConclusionsAlthough the retirement transition is considered a significant point of life change, only a small volume of literature has reported interventions specifically in this period. The included literature suggests that interventions should take account of views and preferences of the target population and evaluate effectiveness by measuring meaningful outcomes and using a control group design.Study registrationThis study is registered as PROSPERO CRD42014007446.FundingThe National Institute for Health Research Public Health Research programme.
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Facilitators and barriers in the collaboration between the primary care and the sport sector in order to promote physical activity: A systematic literature review. Prev Med 2015; 81:460-78. [PMID: 26522091 DOI: 10.1016/j.ypmed.2015.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this review was to identify collaborative initiatives between the primary care and the sport sector in order to promote physical activity (PA), and barriers and facilitators in these initiatives. METHOD Pubmed, SportDiscus, Web of Science, and SOCindex were systematically searched for publications published between 2000 and June 2014. Publications reporting on collaboration between the primary care and the sport sector to promote PA were included. Publications reporting on non-empirical data were excluded, except for study protocols. RESULTS The search process yielded 1352 publications. After selection, 40 publications were included. Twenty-eight different initiatives were divided into four forms of collaboration, and two approaches to promote PA were distinguished with different kinds of facilitators and barriers. In the referral of patients, sport professionals' lack of medical knowledge, and health professionals' lack of time, were seen as barriers. In networks to organize activities to promote PA among the community, different shared interests and different cultures were seen as barriers. CONCLUSION This review showed that performance of intersectoral collaboration and the collaboration between both sectors are still unexplored. This review provides a first step towards an insight into collaboration and factors that facilitate or hinder collaboration between these sectors.
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Din NU, Moore GF, Murphy S, Wilkinson C, Williams NH. Health professionals' perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales. HEALTH EDUCATION JOURNAL 2015; 74:743-757. [PMID: 26527835 PMCID: PMC4604423 DOI: 10.1177/0017896914559785] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. DESIGN Qualitative semi-structured group interviews. SETTING General practice premises. METHODS Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. RESULTS Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smoking cessation. Professionals linked decisions on whether to advise physical activity to patients to their own physical activity levels and to subjective judgements of patient motivation. While some described ERS as a holistic alternative to medication, with potential social benefits, others expressed concerns regarding their limited reach and potential to exacerbate inequalities. Barriers to referral included geographic isolation and uncertainties about patient selection criteria, medico-legal responsibilities and a lack of feedback about patient progress. CONCLUSION Clinicians' concerns about expertise, priority setting and time constraints should be addressed to enhance physical activity promotion in primary care. Further research is needed to fully understand decision making relating to provision of physical activity advice and use of ERS.
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Affiliation(s)
- Nafees U Din
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, Wales, UK
| | - Graham F Moore
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Wales, UK
| | - Simon Murphy
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Wales, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, Wales, UK
| | - Nefyn H Williams
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, Wales, UK
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Kerkelä ES, Jonsson L, Lindwall M, Strand J. Individual experiences following a 6-month exercise intervention: A qualitative study. Int J Qual Stud Health Well-being 2015; 10:26376. [PMID: 26282865 PMCID: PMC4539384 DOI: 10.3402/qhw.v10.26376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose Dropout is a common problem in various exercise interventions. The individual's experience is believed to greatly impact dropout, yet little is known about the individual experiences of taking part in exercise interventions. The aim of this study was to examine individuals’ experiences following a self-determination theory–based exercise intervention in order to gain understanding of how standardized interventions can be adjusted to fit individuals’ specific needs, capacities, and circumstances. Methods A qualitative approach with semi-structured interviews was conducted with eight informants (three male and five female) aged between 26 and 47 years, whom all had participated in a 6-month exercise intervention with individual coaching based on self-determination theory and motivational interviewing. The interviews were analyzed thematically with an inductive approach. Results Aspects that influenced the informants’ motivation and participation in the exercise intervention were linked to three themes: the frames of the intervention, measurable changes, and the individual's context. The themes present information about the process and to what extent the informants felt that the intervention was adapted to fit their lives and needs. Conclusions This study emphasizes the importance of individualizing exercise interventions to support individuals’ diverse capacities and psychological needs.
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Affiliation(s)
| | - Linus Jonsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden;
| | - Magnus Lindwall
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.,Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer Strand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Littlecott HJ, Moore GF, Moore L, Murphy S. Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11:109. [PMID: 25209188 PMCID: PMC4173052 DOI: 10.1186/s12966-014-0109-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 08/18/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes. METHODS A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning. RESULTS Significant intervention effects were found for autonomous motivation and social support for exercise at 6 months. No intervention effect was observed for self-efficacy. The data are consistent with a hypothesis of partial mediation of the intervention effect by autonomous motivation. Analysis of moderators showed significant improvements in relative autonomy in all subgroups. The greatest improvements in autonomous motivation were observed among patients who were least active at baseline. DISCUSSION The present study offered key insights into psychosocial processes of change in an exercise referral scheme, with effects on physical activity mediated by autonomous motivation. Findings support the use of self-determination theory as a framework for ERS. Further research is required to explain socio-demographic patterning in responses to ERS, with changes in motivation occurring among all sub-groups of participants, though not always leading to higher adherence or behavioural change. This highlights the importance of socio-ecological approaches to developing and evaluating behaviour change interventions, which consider factors beyond the individual, including conditions in which improved motivation does or does not produce behavioural change. TRIAL REGISTER NUMBER ISRCTN47680448.
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Affiliation(s)
- Hannah J Littlecott
- />DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales UK
| | - Graham F Moore
- />DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales UK
| | - Laurence Moore
- />MRC/CSO Social & Public Health Sciences Unit (SPHSU), University of Glasgow, Glasgow, Scotland UK
| | - Simon Murphy
- />DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales UK
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Hawkins JL, Oliver EJ, Wyatt-Williams J, Scale E, van Woerden HC. Assessing the feasibility of using uniaxial accelerometers with an online support platform in the delivery of a community-based exercise referral scheme. J Prim Care Community Health 2014; 5:288-90. [PMID: 24861974 DOI: 10.1177/2150131914536053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Exercise referral schemes are established within community-based health care; however, they have been criticized for failing to evidence long-term behavior change relative to usual care. As such, recent reviews have called for refinement of their delivery with a focus on embedded strategies targeting client motivation. This research letter presents findings from an initial pilot trial conducted within Wales' National Exercise Referral Scheme (NERS), examining the feasibility of using validated physical activity monitoring devices and an accompanying online platform within standard scheme delivery. 30 individuals referred to generic or cardiovascular pathways were offered the system; of these 17 agreed to participate. Common reasons for declining were clustered into lack of technology literacy or access, condition severity, or fear of costs associated with losing the device. Analysis of follow-up interviews after 4 weeks of use indicated that while participants found the monitoring devices practical and informative, only a minority (n = 4) were using the system in full. Crucially, the system element most aligned with contemporary theories of motivation (the online portal) was not used as expected. In addition, feedback from exercise referral professionals indicated that there were demands for support from clients, which might be mitigated by more effective independent system use. Recommendations for larger scale trials using similar systems include consideration of targeted patient groups, equity of access, and providing adequate technological support that is currently beyond the capacity of the NERS system.
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Affiliation(s)
| | | | - Jeannie Wyatt-Williams
- National Exercise Referral Scheme Coordinator for Wales, Welsh Local Government Association, Cardiff, UK
| | - Elaine Scale
- National Exercise Referral Scheme, Coordinator for Pembrokeshire, Milford Haven Leisure Centre, Milford Haven, UK
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Cnossen IC, van Uden-Kraan CF, Rinkel RNPM, Aalders IJ, de Goede CJT, de Bree R, Doornaert P, Rietveld DHF, Langendijk JA, Witte BI, Leemans CR, Verdonck-de Leeuw IM. Multimodal guided self-help exercise program to prevent speech, swallowing, and shoulder problems among head and neck cancer patients: a feasibility study. J Med Internet Res 2014; 16:e74. [PMID: 24610383 PMCID: PMC3961811 DOI: 10.2196/jmir.2990] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/12/2014] [Accepted: 01/18/2014] [Indexed: 12/22/2022] Open
Abstract
Background During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients’ quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment. Objective Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients. Methods Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently. Results Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients’ diaries and weekly coaching sessions, patients’ perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients’ perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators. Conclusions Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.
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Affiliation(s)
- Ingrid C Cnossen
- VU University Medical Center, Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands
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F. Moore G, Raisanen L, Moore L, Ud Din N, Murphy S. Mixed-method process evaluation of the Welsh National Exercise Referral Scheme. HEALTH EDUCATION 2013. [DOI: 10.1108/he-08-2012-0046] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Integration of health and social care – what can Wales learn … and contribute? QUALITY IN AGEING AND OLDER ADULTS 2013. [DOI: 10.1108/14717791311311102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zschucke E, Gaudlitz K, Ströhle A. Exercise and physical activity in mental disorders: clinical and experimental evidence. J Prev Med Public Health 2013; 46 Suppl 1:S12-21. [PMID: 23412549 PMCID: PMC3567313 DOI: 10.3961/jpmph.2013.46.s.s12] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 12/07/2012] [Indexed: 12/13/2022] Open
Abstract
Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.
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Affiliation(s)
- Elisabeth Zschucke
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
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Murphy SM, Edwards RT, Williams N, Raisanen L, Moore G, Linck P, Hounsome N, Din NU, Moore L. An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative. J Epidemiol Community Health 2012; 66:745-53. [PMID: 22577180 PMCID: PMC3402741 DOI: 10.1136/jech-2011-200689] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention. METHOD A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale. RESULTS Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (-1.56, [corrected] 95% CI -2.75 to -0.38) and depression (-1.39, [corrected] 95% CI -2.60 to -0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12,111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session. CONCLUSIONS NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds. Trial registration Current Controlled Trials ISRCTN47680448.
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Affiliation(s)
- Simon Mark Murphy
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales, UK.
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