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Bornhöft L, Bernhardsson S, Nordeman L, Grimby-Ekman A, Dottori M, Larsson MEH. Monitoring handgrip strength to motivate lifestyle choices for patients with diabetes type 2 - a pragmatic randomised controlled trial. Scand J Prim Health Care 2024:1-10. [PMID: 38963325 DOI: 10.1080/02813432.2024.2373298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/22/2024] [Indexed: 07/05/2024] Open
Abstract
METHODS Measurement of HGS with Jamar dynamometers was added to annual check-ups for patients with T2DM by diabetes nurses in primary care with feedback about normal values for age and sex in the intervention group. The control group had standard check-ups. Change in self-reported PA level was measured with questionnaires. RESULTS Seven clinics and 334 patients participated. The intervention led to similar effects on PA in both groups. Patients with T2DM had comparable HGS to the general public. Regression analyses showed statistically significantly higher HGS in the intervention group than in the control group at follow-up and no improvement in PA, HbA1c, or waist circumference. Increased HGS was found for older people, men, and people with normal-to-high inclusion HGS, while patients with low inclusion HGS reduced their strength levels. CONCLUSIONS Measuring HGS and giving feedback to patients with T2DM can lead to increased HGS but does not seem to affect general PA level, HbA1c, or waist circumference. People over 65 years, men, and people with normal-to-high HGS were influenced positively by the intervention. Patients with low HGS may need personalised support to increase physical activity and improve function.ClinicalTrials registration: NCT03693521.
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Affiliation(s)
- Lena Bornhöft
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Primary Health Care Research, Education, Development and Innovation, Region Västra Götaland, Sweden
- Primary Care Rehabilitation, Närhälsan Torslanda Rehabilitation Clinic, Region Västra Götaland, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Primary Health Care Research, Education, Development and Innovation, Region Västra Götaland, Sweden
- General practice - Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Nordeman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Primary Health Care Research, Education, Development and Innovation, Region Västra Götaland, Sweden
| | - Anna Grimby-Ekman
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Maria Dottori
- Primary Health Care Research, Education, Development and Innovation, Region Västra Götaland, Sweden
| | - Maria E H Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Primary Health Care Research, Education, Development and Innovation, Region Västra Götaland, Sweden
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Mino E, Hanson CL, Naber I, Weissenfels A, McHale S, Saftig J, Klamroth S, Gelius P, Abu-Omar K, Whiting S, Wickramasinghe K, Galea G, Pfeifer K, Geidl W. A systematic review and narrative synthesis of physical activity referral schemes' components. Int J Behav Nutr Phys Act 2023; 20:140. [PMID: 38012688 PMCID: PMC10683187 DOI: 10.1186/s12966-023-01518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.
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Affiliation(s)
- Eriselda Mino
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany.
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Inga Naber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Anja Weissenfels
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Sheona McHale
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Jane Saftig
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Sarah Klamroth
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Stephen Whiting
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Kremlin Wickramasinghe
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Gauden Galea
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Wolfgang Geidl
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
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Gustavsson C, Nordqvist M, Bruhn ÅB, Bröms K, Jerdén L, Kallings LV, Wallin L. Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare. BMC Health Serv Res 2023; 23:996. [PMID: 37715160 PMCID: PMC10504760 DOI: 10.1186/s12913-023-09974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/27/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions). METHODS This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions. RESULTS During the implementation intervention, the workplaces' readiness-to-change and the healthcare staff's confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method. CONCLUSION The implementation intervention was not sufficient to produce sustained change of the healthcare staff's behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs' sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws. TRIAL REGISTRATION Registered in the ISRCTN registry with study registration number: ISRCTN15551042 (Registration date: 12/01/2016).
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Maria Nordqvist
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
| | - Åsa Bergman Bruhn
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Lars Jerdén
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Lena V. Kallings
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences (GIH), Box 5626, 114 86 Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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Ryen L, Lundqvist S, Cider Å, Börjesson M, Larsson MEH, Hagberg L. Cost-Effectiveness of Prolonged Physical Activity on Prescription in Previously Non-Complying Patients: Impact of Physical Activity Mediators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3801. [PMID: 36900811 PMCID: PMC10001088 DOI: 10.3390/ijerph20053801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
In Sweden, physical activity on prescription (PAP) is used to support patients in increasing their levels of physical activity (PA). The role of healthcare professionals in supporting PA behavior change requires optimization in terms of knowledge, quality and organization. This study aims to evaluate the cost-effectiveness of support from a physiotherapist (PT) compared to continued PAP at a healthcare center (HCC) for patients who remained insufficiently active after 6-month PAP treatment at the HCC. The PT strategy was constituted by a higher follow-up frequency as well as by aerobic physical fitness tests. The analysis was based on an RCT with a three-year time horizon, including 190 patients aged 27-77 with metabolic risk factors. The cost per QALY for the PT strategy compared to the HCC strategy was USD 16,771 with a societal perspective (including individual PA expenses, production loss and time cost for exercise, as well as healthcare resource use) and USD 33,450 with a healthcare perspective (including only costs related to healthcare resource use). Assuming a willingness-to-pay of USD 57,000 for a QALY, the probability of cost-effectiveness for the PT strategy was 0.5 for the societal perspective and 0.6 for the healthcare perspective. Subgroup analyses on cost-effectiveness based on individual characteristics regarding enjoyment, expectations and confidence indicated potential in identifying cost-effective strategies based on mediating factors. However, this needs to be further explored. In conclusion, both PT and HCC interventions are similar from a cost-effectiveness perspective, indicating that both strategies are equally valuable in healthcare's range of treatments.
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Affiliation(s)
- Linda Ryen
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Stefan Lundqvist
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Center for Physical Activity Gothenburg, Region Västra Götaland, 413 45 Gothenburg, Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital/Östra, 416 85 Gothenburg, Sweden
| | - Mats Börjesson
- Center for Health and Performance (CHP), University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of MGA, Sahlgrenska University Hospital, Region Västra Götaland, 416 50 Gothenburg, Sweden
| | - Maria E. H. Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, 411 18 Gothenburg, Sweden
- Centre of Clinical Research and Education, Region Värmland, 651 82 Karlstad, Sweden
| | - Lars Hagberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
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Missiou A, Lionis C, Evangelou E, Tatsioni A. Health outcomes in primary care: a 20-year evidence map of randomized controlled trials. Fam Pract 2023; 40:128-137. [PMID: 35809039 PMCID: PMC9909671 DOI: 10.1093/fampra/cmac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To quantify the different types of health outcomes assessed as primary outcomes in randomized controlled trials (RCTs) in the primary care (PC) setting during the last 20 years and identify whether potential gaps exist in specific types of health care and types of intervention. METHODS We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, from January 2000 to September 2020 for published RCTs in PC. We recorded characteristics of eligible studies and mapped evidence by health outcome category (patient health outcomes, health services outcomes); and for each outcome category, by types of health care (preventive, acute, chronic, palliative), and by types of intervention (drug, behavioural, on structure, and on process). For RCTs assessing patient health outcomes as primary outcomes, we further mapped using the quality-of-care dimensions, that is, effectiveness, safety, and patient-centredness. RESULTS Of the 518 eligible RCTs in PC, 357 (68.9%) evaluated a patient health outcome as the primary outcome, and 161 (31.1%) evaluated only health services outcomes as primary outcomes. Many focused on population with chronic illness (224 trials; 43.2%) and evaluated interventions on processes of health care (239 trials; 46.1%). Research gaps identified include preventive and palliative care, behavioural interventions, and safety and patient-centredness outcomes as primary outcomes. CONCLUSION Our evidence map showed research gaps in certain types of health care and interventions. It also showed research gaps in assessing safety and measures to place patient at the centre of health care delivery as primary outcomes.
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Affiliation(s)
- Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece.,Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors. PLoS One 2022; 17:e0276868. [PMID: 36315564 PMCID: PMC9621409 DOI: 10.1371/journal.pone.0276868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients' PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare. METHODS This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27-85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes. RESULTS The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary. CONCLUSION This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.
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Physical activity and health-related quality of life among high-risk women for type 2 diabetes in the early years after pregnancy. BMC Womens Health 2022; 22:84. [PMID: 35313870 PMCID: PMC8939162 DOI: 10.1186/s12905-022-01664-7] [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: 01/04/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous studies have shown that physical activity (PA) correlates positively with health-related quality of life (HRQoL) in the general population. Few studies have investigated associations between device-measured PA and HRQoL among premenopausal women at risk for type 2 diabetes (T2D). In addition to physical well-being, general well-being improved by PA has been suggested to strengthen PA’s benefits in reducing metabolic diseases. The aim of this study was to examine the associations between PA and HRQoL (general and dimensions) among high-risk women in the early post-pregnancy years when T2D risk is highest and to estimate whether current obesity or prior gestational diabetes (GDM) modified these associations. Methods This cross-sectional study of high-risk women [body mass index (BMI) ≥ 30 kg/m2 and/or prior GDM)]4–6 years after delivery measured sleep, sedentary time, daily steps, and light (LPA), moderate-to-vigorous (MVPA), and vigorous PA (VPA) with the SenseWear ArmbandTM accelerometer for seven days and HRQoL with the 15D instrument. Results The analyses included 204 women with a median (IQR) age of 39 (6.0) years and a median BMI of 31.1 kg/m2 (10.9). 54% were currently obese (BMI ≥ 30 kg/m2), and 70% had prior gestational diabetes (GDM+). Women with obesity had lower PA levels than women with normal weight or overweight (p < 0.001) but there was no difference between the GDM+ or GDM− women. Women with both current obesity and GDM+ had highest sedentary time and lowest PA levels. The whole sample’s median 15D score was 0.934 (IQR 0.092), lower among women with obesity compared to the others (p < 0.001), but not different between GDM+ or GDM−. There was a positive correlation between VPA (adjusted rs = 0.262 p = 0.001) and the 15D score. After grouping according to BMI (< and ≥ 30 kg/m2), the associations remained significant only in women without obesity. Among them, sleep, total steps, MVPA, and VPA were positively associated with 15D. Conclusions Higher PA levels are associated with better HRQoL among high-risk women with normal weight and overweight but no differences were found among women affected by obesity in the early years after pregnancy. Trial registration Ethics committees of Helsinki University Hospital (Dnro 300/e9/06) and South Karelian Central Hospital (Dnro 06/08).
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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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O'Regan A, Pollock M, D'Sa S, Niranjan V. ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients. BMJ Open Sport Exerc Med 2021; 7:e001050. [PMID: 34150320 PMCID: PMC8174512 DOI: 10.1136/bmjsem-2021-001050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Exercise prescribing can help patients to overcome physical inactivity, but its use in general practice is limited. The purpose of this narrative review was to investigate contemporaneous experiences of general practitioners and patients with exercise prescribing. METHOD PubMed, Scopus, Science Direct and Cochrane reviews were reviewed using the terms 'exercise prescription', 'exercise prescribing', 'family practice', 'general practice', 'adults' and 'physical activity prescribing'. RESULTS After screening by title, abstract and full paper, 23 studies were selected for inclusion. Qualitative, quantitative and mixed-methods studies revealed key experiences of general practitioners and patients. Barriers identified included: physician characteristics, patients' physical and psychosocial factors, systems and cultural failures, as well as ambiguity around exercise prescribing. We present a synthesis of the key strategies to overcome these using an ABC approach: A: assessment of physical activity: involves asking about physical activity, barriers and risks to undertaking an exercise prescription; B: brief intervention: advice, written prescription detailing frequency, intensity, timing and type of exercise; and C: continued support: providing ongoing monitoring, accountability and progression of the prescription. Multiple supports were identified: user-friendly resources, workshops for doctors, guidelines for specific illnesses and multimorbidity, electronic devices, health system support and collaboration with other healthcare and exercise professionals. DISCUSSION This review has identified levers for facilitating exercise prescribing and adherence to it. The findings have been presented in an ABC format as a guide and support for general practitioners to prescribe exercise.
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Affiliation(s)
- Andrew O'Regan
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Saskia D'Sa
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University College Dublin, Dublin, Ireland
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Martinsson Ngouali T, Börjesson M, Cider Å, Lundqvist S. Nonresponders of Physical Activity on Prescription (PAP) Can Increase Their Exercise Capacity with Enhanced Physiotherapist Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4795. [PMID: 33946255 PMCID: PMC8124559 DOI: 10.3390/ijerph18094795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Abstract
Swedish physical activity on prescription (PAP) is an evidence-based method to promote physical activity. However, few studies have investigated the effect of Swedish PAP on physical fitness, in which better cardiorespiratory fitness is associated with lower risks of all-cause mortality and diagnose-specific mortality. Direct measures of cardiorespiratory fitness, usually expressed as maximal oxygen uptake, are difficult to obtain. Hence, exercise capacity can be assessed from a submaximal cycle ergometer test, taking the linear relationship between heart rate, work rate, and oxygen uptake into account. The aim of this study was to evaluate exercise capacity in the long term, following PAP treatment with enhanced physiotherapist support in a nonresponding patient cohort. In total, 98 patients (48 women) with insufficient physical activity levels, with at least one component of the metabolic syndrome and nonresponding to a previous six-month PAP treatment, were randomized to PAP treatment with enhanced support from a physiotherapist and additional exercise capacity tests during a two-year period. A significant increase in exercise capacity was observed for the whole cohort at two-year follow-up (7.6 W, p ≤ 0.001), with a medium effect size (r = 0.34). Females (7.3 W, p = 0.025), males (8.0 W, p = 0.018) and patients ≥58 years old (7.7 W, p = 0.002) improved significantly, whereas a nonsignificant increase was observed for patients <58 years old (7.6 W, p = 0.085). Patients with insufficient physical activity levels who did not respond to a previous six-month PAP treatment can improve their exercise capacity following PAP treatment with enhanced support from a physiotherapist during a two-year period. Future studies should include larger cohorts with a control group to ensure valid estimations of exercise capacity and PAP.
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Affiliation(s)
- Tom Martinsson Ngouali
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Centrum för Fysisk Aktivitet Göteborg, Region Västra Götaland, 416 68 Gothenburg, Sweden;
| | - Mats Börjesson
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, University of Gothenburg, 416 85 Gothenburg, Sweden
| | - Åsa Cider
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | - Stefan Lundqvist
- Centrum för Fysisk Aktivitet Göteborg, Region Västra Götaland, 416 68 Gothenburg, Sweden;
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
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11
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Fagevik Olsén M, Wiklund M, Sandberg E, Lundqvist S, Dean E. Long-term effects of physical activity prescription after bariatric surgery: A randomized controlled trial. Physiother Theory Pract 2021; 38:1591-1601. [PMID: 33576284 DOI: 10.1080/09593985.2021.1885087] [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
PURPOSE This study examined the effects of physical activity prescription (PAP) in patients after gastric bypass surgery. Patients' physical activity (PA) levels and outcomes were followed over their first postoperative year. METHODS Patients slated for bariatric surgery were randomized to a control group (n = 64) (basic information about postoperative PA) or an intervention group (n = 57) (also received physical therapist-prescribed PAP). Outcome measures were self-reported PA/exercise and sedentary time; and weight, waist circumference, blood pressure, and blood lipids; recorded pre-operatively and at 2, 6, and 12 months postoperatively. Follow-ups were conducted by nurses/dieticians. Trial registration: "Research and Development in Sweden" number 107371. RESULTS There were no differences between the groups except for higher level of PA (579 vs. 182 minutes/week) six months after surgery (p = .046) and a larger decrease in cholesterol (-24 vs. -8%) after a year (p = .017) in the intervention group. Patients in both groups lost considerable weight, had reduced waist circumference, and increased PA (p < .001). CONCLUSION Although marked differences between groups were not observed over one year, the intervention group increased its PA 6-months postoperatively, but not at other time points. Whether long-term outcomes of PAP use are more robust with physical therapist participation across follow-ups warrants study.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Wiklund
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erica Sandberg
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Lundqvist
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centrum För Fysisk Aktivitet Göteborg, Gothenburg, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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12
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Joelsson M, Lundqvist S, Larsson MEH. Tailored physical activity on prescription with follow-ups improved motivation and physical activity levels. A qualitative study of a 5-year Swedish primary care intervention. Scand J Prim Health Care 2020; 38:399-410. [PMID: 33174772 PMCID: PMC7782336 DOI: 10.1080/02813432.2020.1842965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To explore how physically inactive patients, with metabolic risk factors, experienced long term treatment with physical activity on prescription. DESIGN Qualitative content analysis of individual interviews after strategical sampling of respondents. SETTING Fifteen primary health care centres in Gothenburg, Sweden. SUBJECTS Twenty physically inactive patients, with one or more metabolic syndrome components, 9 women, 11 men, mean age 58 years (25-73); 10 patients were responders and 10 non-responders to the intervention. MAIN OUTCOME MEASURES Categories describing treatment effect and successful intervention. RESULTS The interviews revealed three categories of effect. First, individual adjustments contributed to increased physical activity. Second, follow-up and support were valuable aids for prioritising and maintaining lifestyle changes. Third, motivation could be higher if patients make their own choices and experienced positive health effects. The overarching emerging theme was 'tailored physical activity on prescription with regular follow-ups can contribute to increased and maintained motivation and physical activity levels.' UNLABELLED Conclusion Physical activity on prescription in a Swedish primary care setting was successful when the recommended physical activity and follow up was individually adapted. KEY POINTS Individually adapted physical activity on prescription gave insight to increase physical activity levels in a 5-year Swedish primary care intervention directed towards inactive patients with the metabolic syndrome Motivation increased for patients designing their own routines for physical activity. Experiences of positive health effects helped maintain or increase physical activity levels, and follow-up and support from healthcare professionals helped to prioritise life style changes.
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Affiliation(s)
- Monica Joelsson
- Närhälsan Gibraltar Rehabilitation, Region Västra Götaland, Gothenburg, Sweden
- CONTACT Monica Joelsson Närhälsan Gibraltar Rehabilitation, Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Lundqvist
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centrum för fysisk aktivitet Göteborg, Region Västra Götaland, Gothenburg, Sweden
| | - Maria E. H. Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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13
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Lundqvist S, Börjesson M, Cider Å, Hagberg L, Ottehall CB, Sjöström J, Larsson MEH. Long-term physical activity on prescription intervention for patients with insufficient physical activity level-a randomized controlled trial. Trials 2020; 21:793. [PMID: 32933577 PMCID: PMC7493144 DOI: 10.1186/s13063-020-04727-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Physical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting. METHODS We included 190 patients, 27-77 years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups. RESULTS At the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups. CONCLUSION During long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT03012516 . Registered on 30 December 2016-retrospectively registered.
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Affiliation(s)
- Stefan Lundqvist
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centrum för fysisk aktivitet Göteborg, Gothenburg, Region Västra Götaland, Sweden.
| | - Mats Börjesson
- Center for Health and Performance (CHP), University of Gothenburg, Gothenburg, Sweden.,Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Hagberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Johan Sjöström
- Centrum för fysisk aktivitet Göteborg, Gothenburg, Region Västra Götaland, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Gothenburg, Region Västra Götaland, Sweden
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14
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Andersen P, Holmberg S, Årestedt K, Lendahls L, Nilsen P. Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165679. [PMID: 32781558 PMCID: PMC7460230 DOI: 10.3390/ijerph17165679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 12/21/2022]
Abstract
The effectiveness of counsellor support in addition to physical activity on prescription (PAP) from health care professionals has rarely been evaluated. This observational follow-up study investigated differences in physical activity levels and health-related quality of life (HRQoL) one year after PAP regarding patients’ use of counsellor support in addition to PAP in routine care. The study was conducted in a Swedish health care region in which all patients receiving PAP from health care professionals were offered counsellor support. Data were collected from medical records and questionnaires (baseline and follow-up). Of the 400 study participants, 37% used counsellor support. The group of counsellor users attained a higher level of physical activity one year after receiving PAP compared to the group of non-users (p < 0.001). The level of physical activity was measured by a validated index (score 3–19) calculated from weekly everyday activity and exercise training. Comparison of the change in scores between baseline and follow-up showed a significant difference between the two groups, (p < 0.001). The median difference in the PAP + C group was 2.0 (interquartile range, 7.0) and 0.0. among non-users (interquartile range, 4.0). Significant differences in HRQoL were due to positive improvements among counsellor users, with the main improvement in general health. The conclusion is that patients using counsellor support after receiving PAP from health care professionals had higher physical activity and better HRQoL one year after compared with patients who did not use this support.
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Affiliation(s)
- Pia Andersen
- Department of Research and Development, Region Kronoberg, SE-351 88 Växjö, Sweden; (S.H.); (L.L.)
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83 Linköping, Sweden;
- Correspondence:
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, SE-351 88 Växjö, Sweden; (S.H.); (L.L.)
- 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; (S.H.); (L.L.)
- 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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15
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Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Functionality of Physical Activity Referral Schemes (PARS): A Systematic Review. Front Public Health 2020; 8:257. [PMID: 32671011 PMCID: PMC7329989 DOI: 10.3389/fpubh.2020.00257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Physical activity (PA) is vital to maintaining good health. However, WHO estimates that 60% of the world's population are inadequately active. To enhance PA, Physical Activity Referral Schemes (PARS) have been established by some countries. Objective: This study examined the functionality of the PARS process across different countries. Methods: This systematic review was performed and reported in accordance with the PRISMA guidelines. Sixteen electronic databases were searched from January 1990 to May 2020. PARS studies, published in English language and in peer-reviewed journals, that reported adherence, outcomes, disease conditions, interventions, facilitators and barriers, were included in this review. Results: Twenty-seven studies conducted across eight countries met the inclusion criteria. Most patients were referred for sedentary/inactivity reasons and supervised group-based activities was the most used intervention. Participants' average adherence rate was 77.5%. Adherence was either facilitated or hindered by type of support provided during and after intervention period. Inclusion of PA allied health specialist in the intervention enhanced positive health outcomes. Conclusion: PARS is a key driver and motivator for individuals to undertake and adhere to PA interventions. Utilization of guidelines on evidence-based interventional PA for different types of diseases, effective use of common group supervised activities and the involvement of PA specialists may aid PA adherence and foster positive health outcomes.
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Affiliation(s)
- Francis Ali Albert
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Melissa J Crowe
- Division of Tropical Health and Medicine, James Cook University, Douglas, QLD, Australia
| | - Aduli E O Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, QLD, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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16
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Knobé S. [Exercise on prescription: a systematic review and socio-ecological perspectives]. SANTE PUBLIQUE 2020; 31:827-836. [PMID: 32550665 DOI: 10.3917/spub.196.0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This article presents a systematic review (2009-2018) of the literature in social sciences and public health concerning exercise on prescription. The review is oriented towards studies about the beneficiaries of these prescriptions and seeks to question the use of socio-ecological indicators. METHOD The interrogation of bibliographic databases made it possible to retain 28 papers taking into account the following inclusion criteria: (1) publication in a peer-reviewed journal; (2) prescription of physical activity by a health professional; (3) adult beneficiaries; (4) prescription for a supervised physical activity program; (5) physical activity program of at least one month; (6) socio-demographic or psychosocial indicators complementary to age and sex only. RESULTS The prescription of physical activity refers to various interventions in terms of target audiences, modalities of supervision, duration of care or type of monitoring at the end of the program. The studies are mainly related to the measurement of the physical activity level during and/or after the intervention. They mobilize essentially individual indicators and analyze few other determinants from a socio-ecological perspective. CONCLUSION Taking into account the different types and levels of determinants, in a multidimensional approach, would make it possible to identify the social, relational and territorial factors, as well as their respective weight and their links, to refine the health promotion actions and to favor levers of access to less sedentary lifestyles and lasting changes in everyday practices.
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17
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Borland M, Bergfeldt L, Nordeman L, Bollano E, Andersson L, Rosenkvist A, Jakobsson M, Olsson K, Corin M, Landh L, Grüner Sveälv B, Scharin Täng M, Philip Wigh J, Lundwall A, Cider Å. Exercise‐based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation – A randomized controlled study. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Maria Borland
- Närhälsan Sörhaga Rehabilitation Center Alingsås Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg Boraas Sweden
- Department of Health and Rehabilitation/Physiotherapy Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Lena Nordeman
- Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg Boraas Sweden
- Department of Health and Rehabilitation/Physiotherapy Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Entela Bollano
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | | | | | - Marika Jakobsson
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
| | - Kristin Olsson
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
| | | | | | - Bente Grüner Sveälv
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | | | - Julia Philip Wigh
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
| | - Adam Lundwall
- Habo Health Center Bra Liv Health Center Habo Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation/Physiotherapy Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
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18
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Hagberg L, Lundqvist S, Lindholm L. What is the time cost of exercise? Cost of time spent on exercise in a primary health care intervention to increase physical activity. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:14. [PMID: 32206041 PMCID: PMC7079439 DOI: 10.1186/s12962-020-00209-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background In health care interventions aimed at increased physical activity, the individual’s time spent on exercise is a substantial input. Time costs should therefore be considered in cost-effectiveness analyses. The aim of this study was to estimate the cost of time spent on exercise among 333 primary health care patients with metabolic risk factors receiving physical activity on prescription. Methods Based on a theoretical framework, a yardstick was constructed with experience of work (representing claim of salary as compensation) as the lower anchor-point, and experience of leisure activity forgone due to extended exercise time (no claim) as the higher anchor-point. Using this yardstick experience of exercise can be valued. Another yardstick was constructed with experience of cleaning at home in combination with willingness to pay for cleaning as the lowest anchor-point. Results The estimated costs of exercise time were between 14 and 37% of net wages, with physical activity level being the most important factor in determining the cost. Among sedentary individuals, the time cost was 21–51% of net wages while among individuals performing regular exercise it was 2–10%. When estimating the cost of time spent on exercise in a cost-effectiveness analysis, experience of exercise, work, leisure activity forgone, and cleaning at home (or other household work that may be relevant to purchase) should be measured. The individual’s willingness to pay for cleaning at home and their net salary should also be measured. Conclusions When using a single valuation of cost of time spent on exercise in health care interventions, for employed participants 15–30% of net salary should be used. Among unemployed individuals, lower cost estimation should be applied. Better precision in cost estimations can be achieved if participants are stratified by physical activity levels. Trial registration The study was conducted as a survey of existing clinical physical activity on prescription work, and was approved by the Regional Ethical Review Board in Gothenburg, Sweden (ref: 678-14)
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Affiliation(s)
- Lars Hagberg
- 1Centre for Health Care Science, Faculty of Medicine and Health, Örebro University, P.O.Box 1324, 701 13 Örebro, Sweden
| | - Stefan Lundqvist
- 2Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centrum för Fysisk Aktivitet Göteborg, Svangatan 2B, Region Västra Götaland, 416 68 Göteborg, Sweden
| | - Lars Lindholm
- 4Unit of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
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19
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Wattanapisit A, Thanamee S, Wongsiri S. Physical activity counselling among GPs: a qualitative study from Thailand. BMC FAMILY PRACTICE 2019; 20:72. [PMID: 31142277 PMCID: PMC6540406 DOI: 10.1186/s12875-019-0968-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Physical activity (PA) counselling is an intervention to promote PA among patients in primary care, yet it remains limited in this clinical setting. This study aimed to explore PA counselling practices among general practitioners (GPs), as well as barriers to and recommendations for improving PA counselling. METHODS This qualitative study employed a descriptive approach. Data were collected by in-depth interviews and analysed by thematic analysis. The study was conducted in district hospitals in Nakhon Si Thammarat, Thailand, from February 2017 to February 2018. The study participants were GPs who worked at district hospitals. RESULTS Seventeen GPs (6 males and 11 females, mean age 29.8 ± 3.4 years) from 6 district hospitals were interviewed. Their clinical experience ranged from 2 to 12 years (mean 4.7 ± 2.9). The GPs saw 30-80 outpatients/day (mean 56.2 ± 14.1) and spent 1-8 min (mean 3.8 ± 1.8) with each patient. They emphasised PA in patients with poorly controlled non-communicable diseases (NCDs) using the word 'exercise' in the Thai language as well as discussing time and frequency of exercise. PA was considered a non-pharmacological treatment in the management of NCDs, which improved patient health and quality of life. Barriers to PA counselling among GPs included time constraints, insufficient knowledge, and lack of opportunities to follow-up previously counselled patients. GPs suggested that training in PA counselling was required. CONCLUSIONS GPs concurred that PA counselling is essential in the treatment of NCDs. Physicians' recommendations to improve the quality of PA counselling in primary care include 3 Ts: training in PA counselling, tools for prescribing PA, and teams of healthcare professionals. Implementing use of written PA prescriptions may encourage patients to increase PA. Multidisciplinary teams should be developed to support PA counselling in the clinical setting. Further studies should focus on appropriate techniques to implement PA counselling and overcome existing barriers.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80161, Thailand.
- Walailak University Hospital, Thasala, Nakhon Si Thammarat, 80161, Thailand.
| | | | - Sunton Wongsiri
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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20
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Lundqvist S, Börjesson M, Larsson MEH, Cider Å, Hagberg L. Which patients benefit from physical activity on prescription (PAP)? A prospective observational analysis of factors that predict increased physical activity. BMC Public Health 2019; 19:482. [PMID: 31046720 PMCID: PMC6498468 DOI: 10.1186/s12889-019-6830-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background There is robust evidence that regular physical activity (PA) has positive health effects. However, the best PA methods and the most important correlates for promoting PA remain unclear. Physical activity on prescription (PAP) aims to increase the patient’s motivation for and level of PA. This study investigated possible predictive baseline correlates associated with changes in the PA level over a 6-month period of PAP treatment in order to identify the primary care patients most likely to benefit from a PAP intervention. Methods The study included 444 patients with metabolic risk factors who were aged 27 to 85 years and physically inactive. The patients received PAP treatment that included individual counseling plus an individually-tailored PA recommendation with a written prescription and individualised structured follow-up for 6 months. Eight baseline correlates of PA were analysed against the PA level at the 6-month follow-up in a predictor analysis. Results Five baseline correlates predicted the PA level at the 6-month follow-up: self-efficacy expectations for changing PA; the patient’s preparedness and confidence regarding readiness to change PA; a BMI < 30; and a positive valued physical health. The proportion of patients increasing the PA level and achieving a PA level that was in accordance with public health recommendations was higher with a positive valued baseline correlate. The odds of achieving the recommended PA level increased substantially when 2 to 4 predictive correlates were present. PA levels increased to a greater extent among patients with low PA at baseline than patients with high PA at baseline, especially in combination with 2 to 4 positively-valued correlates (87–95% vs. 62–75%). Conclusions This study identified potential predictive correlates of an increased PA level after a 6-month PAP intervention. This contributes to our understanding of PAP and could help individualise PAP support. The proportion of patients with the lowest PA level at baseline increased their PA level in a higher extent (84%) and thus may benefit the most from PAP. These results have clinical implications for behavioural change in those patients having the greatest health gains by increasing their PA level. Trial registration ClinicalTrials.gov; NCT03586011. Retrospectively registered on July 17, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6830-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Lundqvist
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Närhälsan Göteborg centrum för fysisk aktivitet, Region Västra Götaland, Gothenburg, Sweden.
| | - Mats Börjesson
- Department of Food and Nutrition and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Hagberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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21
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Kakamu T, Hidaka T, Kumagai T, Masuishi Y, Kasuga H, Endo S, Sato S, Takeda A, Koizumi M, Fukushima T. Unhealthy changes in eating habits cause acute onset hypertension in the normotensive community-dwelling elderly-3 years cohort study. Medicine (Baltimore) 2019; 98:e15071. [PMID: 30985658 PMCID: PMC6485880 DOI: 10.1097/md.0000000000015071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to determine what lifestyle changes can predict acute onset hypertension in the normotensive community-dwelling elderly.This study targeted elderly people enrolled in National Health Insurance in Fukushima Prefecture, Japan. The subjects were 24,490 people who took all of the specific health examination conducted by National Health Insurance in fiscal years 2013, 2014, and 2015 continuously and had a recorded systolic blood pressure (BP) <130 mm Hg and diastolic BP <85 mm Hg in the first 2 fiscal years. We examined their lifestyle changes for the first 2 fiscal years using the questionnaires given at the health examination. Multivariate Poisson regression analysis was conducted to examine the relationship between new-onset hypertension observed at the last examination and unhealthy lifestyle changes.The mean age of the subjects was 61.5 ± 8.2 years old at baseline. We observed new-onset hypertension in 1.062 subjects at the last examination. Of the study subjects, 12,027 (49.1%) answered to having at least one of the items of unhealthy lifestyle change in the questionnaire. In the multivariate logistic regression, eating supper before bedtime showed a significant increase in the risk ratio for acute onset hypertension (risk ratio 1.27, 95% confidence interval, 1.01-1.58).This study indicated that eating before bedtime is a risk factor of new-onset hypertension in the normotensive community-dwelling elderly. Adequate health guidance to avoid unhealthy lifestyle changes is required even in normotensive people as this hypertension is preventable.
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Affiliation(s)
- Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | - Tomohiro Kumagai
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
- Fukushima National Health Insurance Organization, Fukushima, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | - Sei Sato
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | - Akiko Takeda
- Fukushima National Health Insurance Organization, Fukushima, Japan
| | - Makoto Koizumi
- Fukushima National Health Insurance Organization, Fukushima, Japan
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22
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Eynon M, Foad J, Downey J, Bowmer Y, Mills H. Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review. Scand J Med Sci Sports 2019; 29:638-650. [PMID: 30742334 DOI: 10.1111/sms.13403] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/04/2018] [Accepted: 02/05/2019] [Indexed: 12/30/2022]
Abstract
This paper aimed to systematically review the evidence base to uncover the key psychosocial factors that underpin adherence to an exercise referral scheme (ERS). Databases PsycINFO, MEDLINE, SPORTDiscus, Web of Science, PubMed, PsycARTICLES, Open Grey, and PsycEXTRA were systematically searched. A parallel results-based convergent synthesis was performed by identifying key themes from quantitative and qualitative studies separately. After applying inclusion and exclusion criteria, the review included 24 eligible studies. Key findings showed intrinsic motivation, psychological need satisfaction, social support, and self-efficacy to be the prominent psychosocial factors associated with ERS adherence. In addition, lower expectations for change when entering the scheme was associated with ERS adherence. This review should serve as a catalyst to provide evidence-based ERS and as such ERS providers should seek to place an emphasis on participants' expectations and beliefs when entering the scheme. Moreover, targeting the key factors of intrinsic motivation, psychological need satisfaction, social support, and self-efficacy throughout the duration of an ERS should serve to facilitate adherence.
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Affiliation(s)
- Michael Eynon
- Faculty of Sport, Health & Applied Science, St Mary's University, Twickenham, London, UK
| | - Jessica Foad
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - John Downey
- Faculty of Sport, Health & Applied Science, St Mary's University, Twickenham, London, UK
| | - Yasmin Bowmer
- Faculty of Sport, Health & Applied Science, St Mary's University, Twickenham, London, UK
| | - Hayley Mills
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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23
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Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life? Health Qual Life Outcomes 2019; 17:33. [PMID: 30736815 PMCID: PMC6368755 DOI: 10.1186/s12955-019-1102-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL). Aim To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL. Method Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL. Result Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20–2.54] and 1.81 [1.25–2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96–5.34] compared to those with low PA and high education (OR 1.46 [0.89–2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42–3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89–6.63]. Conclusion Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH. Electronic supplementary material The online version of this article (10.1186/s12955-019-1102-4) contains supplementary material, which is available to authorized users.
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24
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The Relationships Between Physical Activity and Cardiometabolic Risk Factors Among Women Participating in a University-Based Worksite Wellness Program. J Occup Environ Med 2018; 60:1098-1107. [PMID: 30188493 DOI: 10.1097/jom.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Associations between changes in physical activity (PA) and cardiometabolic risk factors among women with overweight/obesity enrolled in a university-based worksite wellness program (WWP) were examined. METHODS Data from 173 women who completed a 26-week WWP were analyzed retrospectively. Participants completed diet and PA assessments and received client-centered diet/lifestyle counseling at baseline, and 12 and 26 weeks thereafter. Anthropometrics, blood pressure, and total cholesterol were measured; PA was self-reported using the International Physical Activity Questionnaire-short form at each visit. RESULTS Significant improvements in anthropometrics (P < 0.001), blood pressure (P < 0.001), total cholesterol (P = 0.014), and PA (P = 0.007) were found at 26 weeks. In adjusted linear regression models, a 10 metabolic-equivalent-minute increase in PA was associated with 0.01% corresponding decreases in weight and waist circumference. CONCLUSION Among women who completed this WWP, increased PA was associated with reductions in anthropometric measures.
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25
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Gustavsson C, Nordqvist M, Bröms K, Jerdén L, Kallings LV, Wallin L. What is required to facilitate implementation of Swedish physical activity on prescription? - interview study with primary healthcare staff and management. BMC Health Serv Res 2018; 18:196. [PMID: 29562922 PMCID: PMC5863486 DOI: 10.1186/s12913-018-3021-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/16/2018] [Indexed: 12/02/2022] Open
Abstract
Background The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Methods Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. Results We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management’s beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. Conclusion The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation. Electronic supplementary material The online version of this article (10.1186/s12913-018-3021-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Nissers vag 3, SE-79182, Falun, Uppsala, Sweden. .,School of Education, Health and Social Studies, Dalarna University, SE-79188, Falun, Sweden. .,School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE- 721 23, Västerås, Sweden. .,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.
| | - Maria Nordqvist
- Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Nissers vag 3, SE-79182, Falun, Uppsala, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE- 721 23, Västerås, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.,Centre for Research & Development, Uppsala University, Region Gävleborg, CFUG, SE-801 88, Gävle, Sweden
| | - Lars Jerdén
- Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Nissers vag 3, SE-79182, Falun, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, SE-79188, Falun, Sweden
| | - Lena V Kallings
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.,Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences (GIH), Box 5626, SE-114 86, Stockholm, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, SE-79188, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-177 70, Stockholm, Sweden.,Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 40530, Gothenburg, Sweden
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