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Bellanger W, Peurois M, Connan L, Navasiolava N, Missud D, Py T, Bègue C. Comparing physical activity prescription with verbal advice for general practice patients with cardiovascular risk factors: results from the PEPPER randomised controlled trial. BMC Public Health 2023; 23:1402. [PMID: 37475036 PMCID: PMC10360325 DOI: 10.1186/s12889-023-16302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Regular physical activity improves health and quality of life for people with cardiovascular risk factors. However, few studies have demonstrated the applicability of strategies in health care to promote physical activity. OBJECTIVE To evaluate if a written physical activity prescription combined with pedometer increases physical activity over one year compared with verbal advice in patients with cardiovascular disease risk in primary care. METHODS The randomised-controlled, interventional, 12-month PEPPER study recruited patients aged 35 to 74 years, having quarterly followed-ups for hypertension, dyslipidaemia, or diabetes, and judged insufficiently active. Seventeen practices randomised patients into either the experimental group, who received a written, personalised prescription for daily step numbers, pedometer and logbook, or control group, who received verbal advice to do at least 15 min of rapid walking or equivalent daily. The primary outcome was the change in total weekly energy expenditure measured using an accelerometer at 3 months. The secondary outcomes were changes in step count, physical activity levels, quality of life, perceived obstacles to physical activity, and biomedical indicators at 3 and 12 months. RESULTS One hundred and twenty-one participants were randomised. Although, weekly energy expenditure did not differ between the prescription and verbal instruction group, the estimated time spent doing moderate-intensity activity was significantly higher in the prescription group than the verbal group by an average of four minutes/week (p = 0.018)(95% CI [0.7 - 7.4]) reaching 48 min after 12 months (95% CI: 8 - 89). Similarly, this was associated with a clinically, higher average step number of 5256 steps/week increase over a year (95% CI: 660 - 9852). Among the most sedentary subgroup, walking less than 5000 steps/day at baseline, an 8868 steps/week (95% CI [2988 - 14700]) increase was observed in the prescription group. CONCLUSION Prescribing physical activity did not significantly modify total weekly energy expenditure, but slightly increased moderate-intensity activity duration and step counts, particularly among the most sedentary participants. Prescribing personalised physical activity goals encourages sedentary patients to engage in physical activity. TRIAL REGISTRATION The PEPPER trial is registered in the US National Institutes of Health Clinical Trials Registry under number NCT02317003 (15/12/2014).
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Affiliation(s)
- William Bellanger
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Matthieu Peurois
- Department of General Practice, University of Angers, 49000, Angers, France.
- University of Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER,, SFR ICAT, 49000, Angers, France.
| | - Laurent Connan
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Nastassia Navasiolava
- University of Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, 49000, Angers, France
| | - David Missud
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Thibaut Py
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Cyril Bègue
- Department of General Practice, University of Angers, 49000, Angers, France
- University of Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER,, SFR ICAT, 49000, Angers, France
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Amin M, Kerr D, Atiase Y, Aldwikat RK, Driscoll A. Effect of Physical Activity on Metabolic Syndrome Markers in Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Sports (Basel) 2023; 11:sports11050101. [PMID: 37234057 DOI: 10.3390/sports11050101] [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: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
People with Type 2 diabetes mellitus (T2DM) are reported to have a high prevalence of metabolic syndrome (MetS), which increases their risk of cardiovascular events. Our aim was to determine the effect of physical activity (PA) on metabolic syndrome markers in people with T2DM. The study design was a systematic review and meta-analysis of randomised controlled trials evaluating the effect of PA on MetS in adults with T2DM. Relevant databases including SPORTdiscus, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO, EMBASE, SocINDEX were searched up to August 2022. Primary endpoints were changes in MetS markers (blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar, and waist circumference) after an exercise intervention. Using a random effect model with 95% confidence interval (CI), the mean difference between intervention groups and control groups were calculated. Twenty-six articles were included in the review. Overall, aerobic exercise had a significant effect on waist circumference (Mean Difference: -0.34 cm, 95% CI: -0.84, -0.05; effect size: 2.29, I2 = 10.78%). The effect sizes on blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar were not statistically significant. No significant differences were found between exercise and control group following resistance training. Our findings suggest that aerobic exercise can improve waist circumference in people with T2DM and MetS. However, both aerobic and resistance exercise produced no significant difference in the remaining MetS markers. Larger and higher-quality studies are required to determine the full effects of PA on MetS markers in this population.
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Affiliation(s)
- Mohammed Amin
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Yacoba Atiase
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
| | - Rami Kamel Aldwikat
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, VIC 3800, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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Willett M, Rushton A, Stephens G, Fenton S, Rich S, Greig C, Duda J. Feasibility of a theoretically grounded, multicomponent, physiotherapy intervention aiming to promote autonomous motivation to adopt and maintain physical activity in patients with lower-limb osteoarthritis: protocol for a single-arm trial. Pilot Feasibility Stud 2023; 9:54. [PMID: 37004124 PMCID: PMC10064730 DOI: 10.1186/s40814-023-01274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lower-limb osteoarthritis (OA) causes high levels of pain and disability in adults over 45 years of age. Adopting and maintaining appropriate levels of physical activity (PA) can help patients with lower-limb OA self-manage their symptoms and reduce the likelihood of developing secondary noncommunicable diseases. However, patients with lower-limb OA are less active than people without musculoskeletal pain. This single-arm feasibility trial seeks to determine the feasibility and acceptability of a complex multicomponent physiotherapy behaviour change intervention that aims to aid patients with lower-limb OA to adopt and maintain optimal levels of PA. METHODS This trial will be conducted at one site in a National Health Service physiotherapy outpatient setting in the West Midlands of England. Up to thirty-five participants with lower-limb OA will be recruited to receive a physiotherapy intervention of six sessions that aims to optimise their PA levels during phases of behavioural change: adoption, routine formation and maintenance. The intervention is underpinned by self-determination theory (and other motivational frameworks) and seeks to foster a motivationally optimal (empowering) treatment environment and implement behaviour change techniques (BCTs) that target PA behaviours across the three phases of the intervention. Physiotherapists (n = 5-6) will receive training in the why and how of developing a more empowering motivational environment and the delivery of the intervention BCTs. Participants will complete patient-reported and performance-based outcome measures at baseline and 3-month (to reflect behavioural adoption) and 6-month (maintenance) post-baseline. Feasibility and acceptability will be primarily assessed through semi-structured interviews (purposively recruiting participants) and focus groups (inviting all physiotherapists and research staff). Further evaluation will include descriptive analysis of recruitment rates, loss of follow-up and intervention fidelity. DISCUSSION A novel complex, multicomponent theoretical physiotherapy behaviour change intervention that aims to create a more empowering motivational treatment environment to assist patients with lower-limb OA to adopt and maintain optimal PA levels has been developed. Testing the feasibility and acceptability of the intervention and its associated physiotherapist training and related trial procedures is required to determine whether a full-scale parallel group (1:1) randomised controlled trial to evaluate the interventions effectiveness in clinical practice is indicated. TRIAL REGISTRATION Trial register: International Standard Randomised Controlled Trial identification number: ISRCTN12002764 . Date of registration: 15 February 2022.
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Affiliation(s)
- Matthew Willett
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Physical Therapy, Elborn College, Western University, London, Canada
| | - Gareth Stephens
- Research and Development, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Sally Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sarah Rich
- Research and Development, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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Asiamah N, Opoku E, Kouveliotis K. The association between nurses’ physical activity counselling and patients’ perceptions of care quality in a primary care facility in Ghana. PLoS One 2022; 17:e0270208. [PMID: 35862464 PMCID: PMC9302826 DOI: 10.1371/journal.pone.0270208] [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: 03/06/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Many countries including Ghana and Australia have adopted physical activity (PA) counselling in healthcare as a public health improvement strategy. Even so, more evidence is needed to improve clinical PA counselling among clinicians, including nurses. This study examined the association between nurses’ physical activity counselling (NPAC) and patients’ perceptions of care quality. The study adopted a cross-sectional design with a sensitivity analysis against potential confounding. The setting of the study was a public primary care facility in Darkuman, Accra. Participants were 605 patients in wards and the Outpatient Department of the facility. Data were collected using a self-reported questionnaire and analyzed using structural equation modeling. A sensitivity analysis was conducted to select potential confounding variables for the study. The study found that higher care quality was associated with larger scores of NPAC (β = 0.34; CR = 8.65; p = 0.000). NPAC has no significant direct association with patient satisfaction (β = 0.01; CR = 0.22; p > 0.05) and loyalty (β = 0.05; CR = 1.21; p > 0.05), but care quality and patient satisfaction fully mediate the association between NPAC and patient loyalty. It is concluded that NPAC in healthcare can improve care quality and indirectly increase patient satisfaction and loyalty through care quality. The incorporation of PA counselling into clinical nursing may, therefore, be consistent with the core mission of hospitals.
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Affiliation(s)
- Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Colchester, United Kingdom
- Department of Health Services Research, Africa Centre for Epidemiology, Accra, Ghana
- * E-mail: ,
| | - Emmanuel Opoku
- Department of Marketing, Accra Technical University, Accra Metro, Accra, Ghana
| | - Kyriakos Kouveliotis
- Department of Health Care Management, International Telematic University Uninettuno, Italy, Rome
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Asiamah N, Adu-Gyamfi K, Frimpong FKS, Avor WMK. Development of a Scale Measuring Nurses' Physical Activity Counseling in a Primary Care Facility: Implications for Healthcare Quality. Hosp Top 2021; 99:119-129. [PMID: 33459201 DOI: 10.1080/00185868.2020.1871575] [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: 10/22/2022]
Abstract
This study constructed a scale for measuring nurses' physical activity (PA) counseling in healthcare from the points of view of regular patients. Confirmatory factor analysis produced a two-factor solution with 7 items. The first factor extracted was "follow-up", which accounted for a variance of 44.5% out of a total variance of 64.8% and comprises 4 items. The second factor, "PA recommendation", accounted for a variance of 20.3% and comprises 3 items. The final scale had a good internal consistency (Cronbach's α = 0.75; factor loading ≥0.50) as well as satisfactory validity indicators.
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Affiliation(s)
- Nestor Asiamah
- Department of Clinical Research, Africa Centre for Epidemiology, Accra North, Ghana
| | - Kwame Adu-Gyamfi
- Department of Hospitality Management, Niagara College, Ontario, Canada
| | | | - Wisdom Mensah Kwasi Avor
- Department of Nursing, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
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Abstract
Evidence supports exercise as a first-line option for many chronic diseases. Although recommendations suggest 150 to 300 minutes a week of moderate-intensity or 75 to 150 minutes a week of vigorous-intensity aerobic activity, replacing sedentary behaviors with light-intensity activities reduces risks of all-cause mortality, and cardiovascular disease (CVD) mortality and incidence of CVD and type 2 diabetes mellitus. Exercise has positive effects on brain function, cognition, and depressive symptoms. Based on such evidence, health care providers should incorporate evaluation of physical activity into patient care. Patients should be evaluated for readiness and ability to exercise and encouraged to increase activity level.
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Affiliation(s)
- Leigh Ann McInnis
- School of Nursing, Middle Tennessee State University, 1500 Greenland Drive, Box 81, Murfreesboro, TN 37132, USA.
| | - Angela Morehead
- School of Nursing, Middle Tennessee State University, 1500 Greenland Drive, Box 81, Murfreesboro, TN 37132, USA
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The Influence of Physicians' Physical Activity Prescription on Indicators of Health Service Quality. J Healthc Qual 2020; 43:e70-e76. [PMID: 32604131 DOI: 10.1097/jhq.0000000000000275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Many researchers are of the opinion that the incorporation of physical activity prescription (PAP) into healthcare is a move that can add value to healthcare, but there are others who think this move would rather disrupt clinical practice. This study, therefore, examined the influence of physicians' PAP (PPAP) on healthcare quality indicators. METHODS The study adopted a correlational approach and was performed at a primary care facility. Participants were 605 patients in wards and the outpatient department of a district healthcare facility. A self-reported questionnaire was used to gather data. Structural equation modeling was used to present findings. RESULTS The study found that PPAP has a positive influence on care quality (β = 0.4, critical ratio = 10.59, and p = .000), patient satisfaction, and patient loyalty. Physical activity prescription also has a positive indirect influence on patient loyalty through patient satisfaction. CONCLUSIONS Physicians' physical activity prescription in healthcare can improve healthcare quality indicators. A key implication of our results is that the incorporation of PPAP into healthcare could be in harmony with the key mission of hospitals. Physical activity prescription in healthcare could be a way to satisfy and retain patients.
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Macek P, Biskup M, Terek-Derszniak M, Stachura M, Krol H, Gozdz S, Zak M. Optimal Body Fat Percentage Cut-Off Values in Predicting the Obesity-Related Cardiovascular Risk Factors: A Cross-Sectional Cohort Study. Diabetes Metab Syndr Obes 2020; 13:1587-1597. [PMID: 32494175 PMCID: PMC7229792 DOI: 10.2147/dmso.s248444] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Reliable obesity assessment is essential in evaluating the risk of cardiovascular risk factors (CRFs). Non-availability of clearly defined cut-offs for body fat percentage (BF%), as well as a widespread application of surrogate measures for obesity assessment, may result in incorrect prediction of cardio-metabolic risk. PURPOSE The study aimed to determine optimal cut-off points for BF%, with a view of predicting the CRFs related to obesity. PATIENTS AND METHODS The study involved 4735 (33.6% of men) individuals, the Polish-Norwegian Study (PONS) participants, aged 45-64. BF% was measured with the aid of bioelectrical impedance analysis (BIA) method. The gender-specific cut-offs of BF% were found with respect to at least one CRF. A P-value approach, and receiver operating characteristic curve analyses were pursued for BF% cut-offs, which optimally differentiated normal from the risk groups. The associations between BF% and CRFs were determined by logistic regression models. RESULTS The cut-offs for BF% were established as 25.8% for men and 37.1% for women. With the exception of dyslipidemia, in men and women whose BF% was above the cut-offs, the odds for developing CRFs ranged 2-4 times higher than those whose BF% was below the cut-offs. CONCLUSION Controlling BF% below the thresholds indicating an increased health hazard may be instrumental in appreciably reducing overall exposure to developing cardio-metabolic risk.
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Affiliation(s)
- Pawel Macek
- Department of Physical Activity, Posturology, and Gerontology, Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Department of Epidemiology and Cancer Control, Holycross Cancer Centre, Kielce, Poland
| | - Malgorzata Biskup
- Department of Physical Activity, Posturology, and Gerontology, Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland
| | | | - Michal Stachura
- Department of Economics and Finance, Faculty of Law and Social Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Halina Krol
- Department of Physical Activity, Posturology, and Gerontology, Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Clinical Oncology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Stanislaw Gozdz
- Department of Physical Activity, Posturology, and Gerontology, Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- Research and Education Department, Holycross Cancer Centre, Kielce, Poland
| | - Marek Zak
- Department of Physical Activity, Posturology, and Gerontology, Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
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