The role of physician counseling in improving adherence to physical activity among the general population

Identifying the Characteristics of Responders and Nonresponders in a Behavioral Intervention to Increase Physical Activity Among Patients With Moderate to Severe Asthma: Protocol for a Prospective Pragmatic Study

BACKGROUND

Previous research has suggested that most adults improve their asthma control after a short-term behavioral intervention program to increase physical activity in daily life (PADL). However, the characteristics of individuals who respond and do not respond to this intervention and the medium-term response remain unknown.

OBJECTIVE

This study aims to (1) identify the characteristics of adult responders and nonresponders with asthma to a behavioral intervention to increase physical activity and (2) evaluate the functional and clinical benefits in the medium term.

METHODS

This prospective pragmatic study will include adults with moderate to severe asthma who enroll in a behavioral intervention. All individuals will receive an educational program and an 8-week intervention to increase PADL (1 time/wk; up to 90 min/session). The educational program will be conducted in a class setting through group discussions and video presentations. Behavioral interventions will be based on the transtheoretical model using counseling, incentives, and individual feedback aiming to increase participation in physical activity. Motivational interviewing and guidelines for overcoming barriers will be used to stimulate individuals to reach their goals. Pre- and postintervention assessments will include the following: PADL (triaxial accelerometry), body composition (octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and exacerbations. "Responders" to the intervention will be defined as those who demonstrate an increase in the number of daily steps (≥2500).

RESULTS

In December 2021, the clinical trial registration was approved. Recruitment and data collection for the trial is ongoing, and the results of this study are likely to be published in late 2024.

CONCLUSIONS

The intervention will likely promote different effects according to the clinical characteristics of the individuals, including asthma control, age, anxiety and depression levels, obesity, and several comorbidities. Identifying individuals who respond or do not respond to behavioral interventions to increase PADL will help clinicians prescribe specific interventions to adults with asthma.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05159076; https://clinicaltrials.gov/ct2/show/NCT05159076.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49032.

Relationships between overall physical activity and step counts in able-bodied adults and stroke survivors in developing countries: a cross-sectional study

PURPOSE

To investigate how step counts relate to overall physical activity (PA) in able-bodied adults and stroke survivors in developing countries.

MATERIALS AND METHODS

Sixty able-bodied adults (mean age: 48.8 ± 11.7 years old) and 60 stroke survivors (mean age: 56.7 ± 10.4 years old) were recruited in Benin (West-Africa). Step counts were collected for 7 consecutive days using the Garmin Forerunner 15 activity tracker. Then, participants completed the adapted French version of the International Physical Activity Questionnaire (IPAQ-AF) to report their PA over the same period. Spearman's rank correlation coefficients (ρ) were calculated between IPAQ-AF scores and the mean steps per day.

RESULTS

Very high correlations were observed between IPAQ-AF total scores and step counts, in able-bodied adults (ρ = 0.94; p < 0.001), and in stroke survivors (ρ = 0.91; p < 0.001). IPAQ-AF leisure-time presented negligible correlation with step counts in able-bodied adults. No activity was reported in occupation and intense domains in stroke survivors.

CONCLUSION

There is a strong relationship between overall PA and step counts in able-bodied adults and stroke survivors in Benin. Step counts appear to be an indicator of PA levels in developing countries, suggesting walking as a potential exercise to improve PA levels in stroke survivors.Implications for RehabilitationStep counts could serve as an indicator of physical activity levels in stroke survivors in developing countries.Walking may be suggested as exercise to improve physical activity levels in stroke survivors in developing countries.In Africa French speaking countries, the IPAQ-AF could be used to assess physical activity in stroke survivors and findings might guide programs to promote an active lifestyle as needed.

Increased physical activity reduces sleep disturbances in asthma: A randomized controlled trial

BACKGROUND AND OBJECTIVE

Individuals with asthma are more likely to develop sleep-disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms.

METHODS

This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre- and post-intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health-related quality of life and anxiety and depression levels were conducted.

RESULTS

Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma-symptom-free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma-related quality of life questionnaire and a reduction in anxiety symptoms.

CONCLUSION

Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms.

Presence of exercise physiology or similar coursework in the curricula of Brazilian health science undergraduate programs

Bolstered by evidence of the health benefits of exercise, health professionals advise their patients about it. Thus these professionals should have a basic knowledge of exercise physiology. In Brazil, a graduate degree is not mandatory, so for many health providers, the only opportunity to receive information on exercise physiology content is during their undergraduate study. Therefore, it is imperative that health science undergraduate programs include content on exercise physiology. The aim of the study was to verify the presence of exercise physiology (or similar coursework) in the curricula of seven health science undergraduate programs (biomedicine, physical education, nursing, physiotherapy, medicine, nutrition, and psychology). The study was divided into three phases: 1) a survey of the total number of undergraduate programs (n = 4,940) through an electronic system of the Brazilian Ministry of Education (e-MEC); 2) a random selection of 10% of the total undergraduate programs (n = 494) for further analysis of the curriculum; and 3) analysis of the curricula of the selected undergraduate programs. Of 494 undergraduate programs, we did not find curricula for 77 of them. Therefore, the final sample consisted of 417 undergraduate programs. In total, 65.9% of the undergraduate programs did not offer coursework in exercise physiology. The chi-square test revealed a significant association between undergraduate curricula in health science and the presence or absence of exercise physiology coursework [X²(6, n = 417) = 293.0, P < 0.0001]. We did not find exercise physiology coursework in most of the analyzed undergraduate programs. Alternatives to solve the lack of exercise physiology coursework would be the inclusion of content related to exercise physiology in professional/graduate education or in continuing education programs.

A Behavior Change Intervention Aimed at Increasing Physical Activity Improves Clinical Control in Adults With Asthma: A Randomized Controlled Trial

BACKGROUND

Higher levels of physical activity have been associated with better asthma clinical control.

RESEARCH QUESTION

Does a behavior change intervention aimed at increasing physical activity change asthma clinical control, physical activity, sedentary time, health-related quality of life (HRQoL), and anxiety and depression symptoms?

STUDY DESIGN AND METHODS

This single-blind, randomized controlled trial included participants who were allocated to an intervention group (IG) or to a control group (CG). Both groups received usual care and disease-specific education. Participants in the IG also underwent an 8-week behavior change intervention aimed at increasing physical activity. Prior to and following the intervention period, measures were made of asthma clinical control (Asthma Control Questionnaire [ACQ]), physical activity, sedentary time and sleep quality (ActiGraph), HRQoL (Asthma Quality of Life Questionnaire), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data on asthma exacerbations were recorded 12 months prior to and throughout the intervention period.

RESULTS

Fifty-one participants were included (CG, n = 26; IG, n = 25). On completion of the intervention period, compared with the CG, those in the IG exhibited improvements in asthma control (mean difference [95% CI] in ACQ score, -0.8 [-1.1 to -0.4]); in daily step count, 3,605 [1,937 to 8,867] steps/d; in sleep efficiency, 9.2% [-7.1% to 21.9%]; and a reduction in sedentary time, -1.1 [-2.9 to -0.6] h/d). No between-group difference in HRQoL was observed. The percentage of participants who experienced exacerbations during the intervention period was 27% in the IG vs 60% in the CG (P = .04). The change in time spent in moderate-intensity physical activity was inversely associated with change in ACQ (r = -0.60). Compared with the CG, a higher percentage of participants in the IG reported a reduction in anxiety symptoms (43% vs 0%; P < .02).

INTERPRETATION

In adults with moderate to severe asthma, a comprehensive behavior change intervention that increased physical activity also produced improvements in asthma clinical control, sedentary time, sleep quality, and anxiety symptoms.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT03705702; URL: www.clinicaltrials.gov.

Overview of Physical Activity Counseling in Primary Care

Physical inactivity is a global health burden. Promoting physical activity in primary care through physical activity counseling is an effective intervention. This article provides an overview of and perspectives on physical activity counseling in primary care. The identification of physical inactivity as a health problem may increase the awareness of physical inactivity among patients and primary care providers, which will lead to an action plan. The contents of physical activity counseling should be based on evidence-based recommendations. Safety issues should be evaluated appropriately to optimize the utilization of primary care services. Physical activity counseling methods should be "tailored" for an individual using appropriate counseling methods and setting-specific resources. Multilevel barriers to physical activity counseling in primary care (i.e., healthcare providers, patients, and systems) must be addressed. Setting-specific strategies to overcome these barriers should be implemented to maximize the effectiveness of physical activity counseling in primary care.

Effects of a behaviour change intervention aimed at increasing physical activity on clinical control of adults with asthma: study protocol for a randomised controlled trial

Background

In adults with asthma, physical activity has been associated with several asthma outcomes. However, it is unclear whether changes in physical activity, measured via an accelerometer, have an effect on asthma control. The objective of the present study is, in adults with moderate-to-severe asthma, to investigate the effects of a behaviour change intervention, which aims to increase participation in physical activity, on asthma clinical control.

Methods

This is a single-blind (outcome assessor), two-arm, randomised controlled trial (RCT). Fifty-five participants with moderate-to-severe asthma, receiving optimized pharmacological treatment, will be randomly assigned (computer-generated) into either a Control Group (CG) or an Intervention Group (IG). Both groups will receive usual care (pharmacological treatment) and similar educational programmes. In addition to these, participants in the IG will undergo the behaviour change intervention based on feedback, which aims to increase participation in physical activity. This intervention will be delivered over eight sessions as weekly one-on-one, face-to-face 40-min consultations. Both before and following the completion of the intervention period, data will be collected on asthma clinical control, levels of physical activity, health-related quality of life, asthma exacerbation and levels of anxiety and depression symptoms. Anthropometric measurements will also be collected. Information on comorbidities, lung function and the use of asthma medications will be extracted from the participant’s medical records.

Discussion

If successful, this study will demonstrate that, in adults with asthma, a behavioural change intervention which aims to increase participation in physical activity also affects asthma control.

Trial registration

Clinical Trials.gov PRS (Protocol registration and Results System): NCT-03705702 (04/10/2018).

Effectiveness of a theory-based multicomponent intervention (Movement Coaching) on the promotion of total and domain-specific physical activity: a randomised controlled trial in low back pain patients

Background

The promotion of physical activity is a major field in rehabilitation and health promotion but evidence is lacking on what method or strategy works best. Ensuing from this research gap, the present study compared the effectiveness of a comprehensive theory based multicomponent intervention (Movement Coaching) to a low intensity intervention in low back pain patients.

Methods

A monocenter randomized controlled trial with three measuring points (T0 = baseline, T1 = six month follow-up, T2 = twelve month follow-up) was conducted. N = 412 chronic low back pain patients participated. The Movement Coaching group (n = 201) received a comprehensive multicomponent intervention with small-group intervention, phone- and web 2.0-intervention. The low intensity control (n = 211) received two oral presentations that were available for download afterwards. Main outcome was total physical activity measured by Global Physical Activity Questionnaire at 12 month follow-up. Additionally, workplace, leisure time and transportation activities were compared. A split-plot anova was conducted for evaluating repeated measure effects and between group effects.

Results

At six and twelve month follow-up there were no statistically significant between group differences in total (T1: p = 0.79; T2: p = 0.30) as well as domain-specific physical activity (workplace (T1: p = 0.16; T2: p = 0.65), leisure time (T1: p = 0.54; T2: p = 0.89), transportation (T1: p = 0.29; T2: p = 0.77) between Movement Coaching and the control group. In both groups, workplace physical activity showed the highest proportion of total physical activity. From baseline to twelve month follow-up the results showed a decline in total physical activity (Movement Coaching: p = 0.04; control group: p = 0.50).

Conclusions

The comprehensive Movement Coaching intervention was not found to be more effective than a low intensity intervention in promoting total and domain-specific physical activity in chronic low back pain patients.

Trial registration

This study is registered at German Clinical Trials Register (DRKS)-ID: DRKS00004878.

A survey of physicians and physiotherapists on physical activity promotion in Nigeria

Background

Effective control of non-communicable diseases and promotion of population-wide physical activity participation require the active engagement of health professionals. Physiotherapists and physicians, as part of their practice, routinely screen and assess physical activity status, and recommend health enhancing physical activity participation for their patients. This study aims to compare Nigerian physiotherapists and physicians’ knowledge of physical activity message, role perception and confidence, perceived feasibility and barriers, and overall disposition to promoting physical activity in their practice.

Methods

A total of 153 physicians and 94 physiotherapists recruited from 10 government hospitals in five states in Northern Nigeria completed a standardized physical activity promotion questionnaire that elicited information on the knowledge of physical activity, role perception and confidence, feasibility, and barriers to physical activity promotion. Descriptive and inferential statistics were used to analyze the data.

Results

The physiotherapists and physicians were fairly knowledgeable on physical activity message (14.2 ± 2.1/20), reported minimal or little barrier to physical activity promotion (23.7 ± 3.1/30), perceived physical activity promotion as their role (13.0 ± 1.8/15), were confident in their ability to discuss and recommend physical activity promotion (7.6 ± 1.6/10) and believed promoting physical activity was feasible for them (15.6 ± 2.6/20). However, over 40% of the physiotherapists and physicians do not know the correct dosage of physical activity that could confer health benefits to patients. The physicians showed better overall disposition to physical activity promotion than the physiotherapists (P = 0.048), but more physiotherapists than the physicians believed ‘it is part of their role to suggest to patients to increase their daily physical activity’ (95.7% vs 88.2%, P = 0.043) and were more ‘confident in suggesting specific physical activity programs for their patients’ (87.2% vs 64.5%, P < 0.001).

Conclusion

Physiotherapists and physicians in Nigeria demonstrated good disposition to promoting physical activity but many of them have knowledge deficits on the correct dosage required for better health for their patients. These health professionals can serve as good advocates for physical activity promotion in Nigeria, but many of them may require knowledge update on health enhancing physical activity for effective health promotion and primary prevention of non-communicable diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s40945-017-0034-8) contains supplementary material, which is available to authorized users.

Nutrition and self-care practices of patients with chronic Metabolic Syndrome: a qualitative study

OBJECTIVE: To analyze subjective aspects of eating habits and self-care of patients living with chronic symptoms linked to metabolic syndrome. METHODS: A clinical and qualitative (exploratory, non-experimental) study, conducted with an intentionally small sample of nine patients in treatment at an outpatient endocrinology clinic of a university hospital in São Paulo, Brazil. The sample was closed when data saturation occurred. The in-depth interviews were conducted with a psychodynamic orientation toward the conduct of dialogues. The categorization of the discourse was developed through content analysis. The psychodynamic approach provided a theoretical reference complemented by social anthropology. RESULTS: Eating habits have been revealed as mediators of autonomy and as a source of vulnerability in the process of coping with chronic illness. Reception and understanding of the psychological and cultural aspects of food are needed in treatment faced with the difficulty of establishing changes in eating behavior. CONCLUSION: This is a contribution of an interdisciplinary approach that values listening subjectivity during treatment.

Revisão de artigos de ortopedia e medicina esportiva publicados em periódicos brasileiros

O objetivo desta revisão é apresentar os artigos com especial interesse nas áreas de Ortopedia e Medicina Esportiva publicados em periódicos nacionais qualificados pelo ISI, fora da área de publicação específica em Ortopedia em dois anos. Neste período foram localizados 38 artigos publicados em diversas revistas nacionais com distintos desenhos de pesquisa. Torna-se evidente uma maior divulgação das publicações em Ortopedia e Medicina Esportiva em periódicos gerais, viabilizando ao especialista maior fonte de referências e pesquisas.

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial

Background

Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies.

Objective

Using a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations.

Method

Sixty-three women and 16 men (49.2 years ± 8.8) were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program) or control (no action) group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n = 79), body mass, BMI, % body fat, waist and hip circumference (n = 76), systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n = 66) were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data.

Results

Significant increases were found in the intervention group for step-counts (p < .001), time spent in leisure walking (p = .02) and positive affect (p = .027). Significant decreases were found in this group for time spent in weekday (p = .003), weekend (p = .001) and total sitting (p = .001) with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p = .008), occupational (p = .045) and total walking (p = .03), and significantly fewer minutes in time spent in weekend (p = .003) and total sitting (p = .022).

Conclusion

A pedometer-based walking program, incorporating a physical activity consultation, is effective in promoting walking and improving positive affect over 12 weeks in community based individuals. The discussion examines possible explanations for the lack of significant changes in health outcomes. Continued follow-up of this study will examine adherence to the intervention and possible resulting effects on health outcomes.