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Wells MD, Dickin DC, Popp J, Wang H. Effect of downhill running grade on lower extremity loading in female distance runners. Sports Biomech 2018; 19:333-341. [PMID: 30274545 DOI: 10.1080/14763141.2018.1510538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hill running is often used as a foundational training mechanism to build strength and speed. Distance runners in particular are at an increased likelihood of encountering steep hills during training runs. There is limited research regarding downhill running, and there is no research available on the biomechanics of females specifically during downhill running. The purpose of this study was to quantify the differences in loading when running downhill at different grades compared to a level surface in female distance runners to determine the potential risk for injury. Fifteen female distance runners (age: 23.5 ± 4.9 y), who ran 56.3 ± 20.9 km a week participated in this study. Participants ran on a force-instrumented treadmill at 4.0 m/s for 2 min at 0%, -5%, -10%, -15%, and -20% grades, with 5 min of rest between conditions. Study findings showed increased impact forces (p < 0.001), and increased loading rates (p < 0.001) with increasing downhill grades compared to level. These results indicate a significantly greater risk of overuse injury to the lower extremity with steeper downhill grades. Individuals need to be aware of these risks to plan and implement training programmes that will increase performance while minimising injury risk.
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Affiliation(s)
- Meredith D Wells
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.,School of Kinesiology, Ball State University, Muncie, IN, USA
| | - D Clark Dickin
- School of Kinesiology, Ball State University, Muncie, IN, USA
| | - Jennifer Popp
- School of Kinesiology, Ball State University, Muncie, IN, USA
| | - Henry Wang
- School of Kinesiology, Ball State University, Muncie, IN, USA
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Évaluation de la pratique sportive chez les personnels navigants professionnels civils et militaires : étude épidémiologique prospective. Sci Sports 2016. [DOI: 10.1016/j.scispo.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wang G, Macera CA, Scudder-Soucie B, Schmid T, Pratt M, Buchner D. A Cost-Benefit Analysis of Physical Activity Using Bike/Pedestrian Trails. Health Promot Pract 2016; 6:174-9. [PMID: 15855287 DOI: 10.1177/1524839903260687] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
From a public health perspective, a cost-benefit analysis of using bike/pedestrian trails in Lincoln, Nebraska, to reduce health care costs associated with inactivity was conducted. Data was obtained from the city's 1998 Recreational Trails Census Report and the literature. Per capita annual cost of using the trails was U.S.$209.28 ($59.28 construction and maintenance, $150 of equipment and travel). Per capita annual direct medical benefit of using the trails was $564.41. The cost-benefit ratio was 2.94, which means that every $1 investment in trails for physical activity led to $2.94 in direct medical benefit. The sensitivity analyses indicated the ratios ranged from 1.65 to 13.40. Therefore, building trails is cost beneficial from a public health perspective. The most sensitive parameter affecting the cost-benefit ratios were equipment and travel costs; however, even for the highest cost, every $1 investment in trails resulted in a greater return in direct medical benefit.
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Affiliation(s)
- Guijing Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Iliffe S, Kendrick D, Morris R, Masud T, Gage H, Skelton D, Dinan S, Bowling A, Griffin M, Haworth D, Swanwick G, Carpenter H, Kumar A, Stevens Z, Gawler S, Barlow C, Cook J, Belcher C. Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. Health Technol Assess 2015; 18:vii-xxvii, 1-105. [PMID: 25098959 DOI: 10.3310/hta18490] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Regular physical activity (PA) reduces the risk of falls and hip fractures, and mortality from all causes. However, PA levels are low in the older population and previous intervention studies have demonstrated only modest, short-term improvements. OBJECTIVE To evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years. DESIGN The ProAct65+ study was a pragmatic, three-arm parallel design, cluster randomised controlled trial of class-based exercise [Falls Management Exercise (FaME) programme], home-based exercise [Otago Exercise Programme (OEP)] and usual care among older people (aged ≥ 65 years) in primary care. SETTING Forty-three UK-based general practices in London and Nottingham/Derby. PARTICIPANTS A total of 1256 people ≥ 65 years were recruited through their general practices to take part in the trial. INTERVENTIONS The FaME programme and OEP. FaME included weekly classes plus home exercises for 24 weeks and encouraged walking. OEP included home exercises supported by peer mentors (PMs) for 24 weeks, and encouraged walking. MAIN OUTCOME MEASURES The primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity (MVPA) per week, 12 months after cessation of the intervention. Secondary outcomes included functional assessments of balance and falls risk, the incidence of falls, fear of falling, quality of life, social networks and self-efficacy. An economic evaluation including participant and NHS costs was embedded in the clinical trial. RESULTS In total, 20,507 patients from 43 general practices were invited to participate. Expressions of interest were received from 2752 (13%) and 1256 (6%) consented to join the trial; 387 were allocated to the FaME arm, 411 to the OEP arm and 458 to usual care. Primary outcome data were available at 12 months after the end of the intervention period for 830 (66%) of the study participants. The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40% to 49% in the FaME arm, from 41% to 43% in the OEP arm and from 37.5% to 38.0% in the usual-care arm. A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [adjusted odds ratio (AOR) 1.78, 95% confidence interval (CI) 1.11 to 2.87; p = 0.02]. There was no significant difference in MVPA between OEP and usual care (AOR 1.17, 95% CI 0.72 to 1.92; p = 0.52). Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level. In the 12 months after the close of the intervention phase, there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm (incidence rate ratio 0.74, 95% CI 0.55 to 0.99; p = 0.042). Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care, as did perceptions of benefits from exercise. Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm. There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes, including quality-adjusted life-years. FaME is more expensive than OEP delivered with PMs (£269 vs. £88 per participant in London; £218 vs. £117 in Nottingham). The cost per extra person exercising at, or above, target was £1919.64 in London and £1560.21 in Nottingham (mean £1739.93). CONCLUSION The FaME intervention increased self-reported PA levels among community-dwelling older adults 12 months after the intervention, and significantly reduced falls. Both the FaME and OEP interventions appeared to be safe, with no significant differences in adverse reactions between study arms. TRIAL REGISTRATION This trial is registered as ISRCTN43453770. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Tahir Masud
- Clinical Gerontology Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Heather Gage
- Department of Economics, University of Surrey, Guildford, UK
| | - Dawn Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Susie Dinan
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Bowling
- Health Sciences, University of Southampton, Southampton, UK
| | - Mark Griffin
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Deborah Haworth
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Glen Swanwick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Zoe Stevens
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena Gawler
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Cate Barlow
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Juliette Cook
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Carolyn Belcher
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Pratt M, Norris J, Lobelo F, Roux L, Wang G. The cost of physical inactivity: moving into the 21st century: Table 1. Br J Sports Med 2012; 48:171-3. [DOI: 10.1136/bjsports-2012-091810] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wright RL, Robinson P, Peters D. Lifetime adherence to physical activity recommendations and fall occurrence in community-dwelling older adults: A retrospective cohort study. JOURNAL OF HUMAN SPORT AND EXERCISE 2012. [DOI: 10.4100/jhse.2012.71.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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El Ansari W, Andersson E. Beyond value? Measuring the costs and benefits of public participation. JOURNAL OF INTEGRATED CARE 2011. [DOI: 10.1108/14769011111191467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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GIBBISON GODFREYA, JOHNSON CDOUGLAS. Stages of Change in Physical Exercise and Social Support: An Integrated Socio-Psycho-Economic Approach. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2011. [DOI: 10.1111/j.1559-1816.2011.00801.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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Physical activity among 60–69-year-olds in England: knowledge, perception, behaviour and risk factors. AGEING & SOCIETY 2010. [DOI: 10.1017/s0144686x10000486] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTThis paper examines the risk factors that influence physical activity levels among a representative sample of older people in England and their awareness of the Chief Medical Officer's recommended level of physical activity. The paper analyses data from the cross-sectional, nationally-representative Health Surveys for England (HSfE) in 2006 and 2007. In HSfE2006, 1,550 adults aged 60–69 years responded to a physical activity participation questionnaire, and in HSfE2007, 561 adults aged 60–64 years were asked about their knowledge of the physical activity requirement and their attitudes to participation. Very few respondents knew the recommended physical activity target, but more than one-half thought they had enough physical activity in their daily life, and over three-quarters thought they were ‘very’ or ‘fairly’ physically active compared with age peers. The perceived barriers to physical activity included work commitments, lack of leisure time and poor health. It was found that obesity, not being in work and having a limiting long-term illness associated with a lower likelihood of physical activity. Participation in sports and exercise, walking, heavy housework and gardening were all lower in non-working than working adults. Older adults had unrealistic views of their activity levels, and of work and lack of time as barriers to physical activity. It is concluded that more attention needs to be paid to health promotion and education among the over-sixties, especially those not in paid work.
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10
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White DG. Evaluating evidence and making judgements of study quality: Loss of evidence and risks to policy and practice decisions. CRITICAL PUBLIC HEALTH 2010. [DOI: 10.1080/09581590010028228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Iliffe S, Kendrick D, Morris R, Skelton D, Gage H, Dinan S, Stevens Z, Pearl M, Masud T. Multi-centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial. Trials 2010; 11:6. [PMID: 20082696 PMCID: PMC2821309 DOI: 10.1186/1745-6215-11-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 01/18/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Regular physical activity reduces the risk of mortality from all causes, with a powerful beneficial effect on risk of falls and hip fractures. However, physical activity levels are low in the older population and previous studies have demonstrated only modest, short-term improvements in activity levels with intervention. DESIGN/METHODS Pragmatic 3 arm parallel design cluster controlled trial of class-based exercise (FAME), home-based exercise (OEP) and usual care amongst older people (aged 65 years and over) in primary care. The primary outcome is the achievement of recommended physical activity targets 12 months after cessation of intervention. Secondary outcomes include functional assessments, predictors of exercise adherence, the incidence of falls, fear of falling, quality of life and continuation of physical activity after intervention, over a two-year follow up. An economic evaluation including participant and NHS costs will be embedded in the clinical trial. DISCUSSION The ProAct65 trial will explore and evaluate the potential for increasing physical activity among older people recruited through general practice. The trial will be conducted in a relatively unselected population, and will address problems of selective recruitment, potentially low retention rates, variable quality of interventions and falls risk. TRIAL REGISTRATION Trial Registration: ISRCTN43453770.
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Affiliation(s)
- Steve Iliffe
- Department of Primary Care & Population Health, University College London, Rowland Hill St, London NW3 2PF, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Richard Morris
- Department of Primary Care & Population Health, University College London, Rowland Hill St, London NW3 2PF, UK
| | - Dawn Skelton
- School of Health, HealthQWest, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Heather Gage
- Department of Economics, University of Surrey, Guildford, GU2 7XH, UK
| | - Susie Dinan
- Department of Primary Care & Population Health, University College London, Rowland Hill St, London NW3 2PF, UK
| | - Zoe Stevens
- Department of Primary Care & Population Health, University College London, Rowland Hill St, London NW3 2PF, UK
| | - Mirilee Pearl
- Department of Primary Care & Population Health, University College London, Rowland Hill St, London NW3 2PF, UK
| | - Tahir Masud
- Department of Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Kruse M, Davidsen M, Madsen M, Gyrd-Hansen D, Sørensen J. Costs of heart disease and risk behaviour: implications for expenditure on prevention. Scand J Public Health 2009; 36:850-6. [PMID: 19004902 DOI: 10.1177/1403494808095955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The objective of this paper is firstly to estimate the healthcare costs attributable to heart disease in Denmark using recently available data for 2002-05. Secondly, to estimate the attributable healthcare costs of lifestyle risk factors among heart patients, in order to inform decision making about prevention programmes specifically targeting patients with heart disease. METHODS For a cohort consisting of participants in a national representative health interview survey, register-based information about hospital diagnosis was used to identify patients with heart disease. Healthcare consumption during 2002- 05 among individuals developing heart disease during 2002-05 was compared with individuals free of heart disease. Healthcare costs attributable to heart disease were estimated by linear regression with adjustment for confounding factors. The attributable costs of excess drinking, physical inactivity and smoking among future heart patients were estimated with the same method. RESULTS Individuals with heart disease cost the healthcare system on average 3,195 (p<0.0001) per person-year more than individuals without heart disease. The attributable cost of unhealthy lifestyle factors among individuals at risk of heart disease was about 11%-16% of the attributable cost of heart disease. CONCLUSIONS Heart disease incurs significant additional costs to the healthcare sector, and more so if heart patients have a history of leading an unhealthy life. Consequently, strategies to prevent or cease unhealthy lifestyle may not only result in cost savings due to avoided heart disease. Additional cost savings may be obtained because heart patients who prior to the disease led a more healthy life consume fewer healthcare resources.
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Affiliation(s)
- Marie Kruse
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Timpka T, Finch CF, Goulet C, Noakes T, Yammine K. Meeting the Global Demand of Sports Safety. Sports Med 2008; 38:795-805. [DOI: 10.2165/00007256-200838100-00001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Gibbison GA, Johnson CD. Family history of chronic disease and participation in healthy behaviours. HEALTH ECONOMICS, POLICY, AND LAW 2007; 2:297-315. [PMID: 18634652 DOI: 10.1017/s1744133107004185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article presents an investigation into whether individuals incorporate information on their family genetic (health) endowment into decision making regarding participation in behaviours related to the production of health capital. Competing theoretical perspectives exist as to how genetic endowment should affect participation in health-related behaviours. There is also a growing consensus that the availability of genetic information holds important consequences for the individual in terms of investment in human capital, the pricing and availability of health insurance, and labour market opportunity. Therefore, the question of how individuals use the greater availability of genetic data is important. Our empirical results indicate that poor genetic endowment tends to be associated with a lower probability of participation in cigarette smoking, but also a lower probability of participation in regular exercise.
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Affiliation(s)
- Godfrey A Gibbison
- School of Economic Development, Georgia Southern University, Statesboro, GA 30460, USA.
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15
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Hill K, Smith R, Fearn M, Rydberg M, Oliphant R. Physical and Psychological Outcomes of a Supported Physical Activity Program for Older Carers. J Aging Phys Act 2007; 15:257-71. [PMID: 17724393 DOI: 10.1123/japa.15.3.257] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study evaluated health benefits of a supported physical activity program for 116 older carers (mean age 64.4 [SD = 7.9], 85% women). Participants undertook a 6-month center-based physical activity program (strength training, yoga, or Tai Chi). Eighty-eight participants (76%) completed the program. Multivariate repeated-measures ANOVA identified overall significant improvement postint-ervention (p = .004). Univariate analyses revealed significant improvements for balance, strength, gait endurance, depression, and SF-36 (physical component; p < .05). There was no change in the Zarit Carer Burden Scale (p > .05). Change in performance scores did not differ significantly between those with higher and lower attendance at classes, although there was significantly greater improvement in gait endurance and balance (p < .05) in those attending classes run twice weekly than in those attending once-weekly classes. In conclusion, a carer physical activity program, providing additional carer support to facilitate participation, can achieve high levels of involvement by carers and significant health benefits.
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Affiliation(s)
- Keith Hill
- National Ageing Research Institute, Parkville, Victgoria, Australia
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16
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Dalziel K, Segal L, Elley CR. Cost utility analysis of physical activity counselling in general practice. Aust N Z J Public Health 2006; 30:57-63. [PMID: 16502953 DOI: 10.1111/j.1467-842x.2006.tb00087.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the economic performance of the 'Green Prescription' physical activity counselling program in general practice. METHODS Cost utility analysis using a Markov model was used to estimate the cost utility of the Green Prescription program over full life expectancy. Program effectiveness was based on published trial data (878 inactive patients presenting to NZ general practice). Costs were based on detailed costing information and were discounted at 5% per anum. The main outcome measure is cost per quality adjusted life year (QALY) gained. Extensive one-way sensitivity analyses were performed along with probabilistic (stochastic) analysis. RESULTS Incremental, modelled cost utility of the Green Prescription program compared with 'usual care' was dollar NZ2,053 per QALY gained over full life expectancy (range dollar NZ827 to dollar NZ37,516 per QALY). Based on the probabilistic sensitivity analysis, 90% of ICERs fell below dollar NZ7,500 per QALY. CONCLUSIONS Based on a plausible and conservative set of assumptions, if decision makers are willing to pay at least dollar NZ2,000 per QALY gained the Green Prescription program is likely to represent better value for money than 'usual care'. IMPLICATIONS The Green Prescription program performs well, representing a good buy relative to other published cost effectiveness estimates. Policy makers should consider encouraging general practitioners to prescribe physical activity advice in the primary care setting, in association with support from exercise specialists.
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Affiliation(s)
- Kim Dalziel
- Centre for Health Economics, Faculty of Business and Economics, Building 75, Clayton Campus, Monash University, Wellington Rd, Clayton, Victoria 3800.
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Munro JF, Nicholl JP, Brazier JE, Davey R, Cochrane T. Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial. J Epidemiol Community Health 2005; 58:1004-10. [PMID: 15547060 PMCID: PMC1732655 DOI: 10.1136/jech.2003.014225] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults. DESIGN Pragmatic, cluster randomised community intervention trial. SETTING 12 general practices in Sheffield; four randomly selected as intervention populations, and eight as control populations. PARTICIPANTS All those aged 65 and over in the least active four fifths of the population responding to a baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control practices. INTERVENTION Eligible subjects were invited to free locally held exercise classes, made available for two years. MAIN OUTCOME MEASURES All cause and exercise related cause specific mortality and hospital service use at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility analysis was also undertaken. RESULTS Twenty six per cent of the eligible intervention practice population attended one or more exercise sessions. There were no significant differences in mortality rates, survival times, or admissions. After adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status, although this reached significance only for the energy dimension and two composite scores (p<0.05). The incremental average QALY gain of 0.011 per person in the intervention population resulted in an incremental cost per QALY ratio of 17 174 (95% CI = 8300 to 87 120). CONCLUSIONS Despite a low level of adherence to the exercise programme, there were significant gains in health related quality of life. The programme was more cost effective than many existing medical interventions, and would be practical for primary care commissioning agencies to implement.
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Affiliation(s)
- James F Munro
- Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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18
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Taylor AH, Cable NT, Faulkner G, Hillsdon M, Narici M, Van Der Bij AK. Physical activity and older adults: a review of health benefits and the effectiveness of interventions. J Sports Sci 2005; 22:703-25. [PMID: 15370483 DOI: 10.1080/02640410410001712421] [Citation(s) in RCA: 322] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this multidisciplinary review paper is to critically review evidence from descriptive, efficacy and effectiveness studies concerned with physical activity and older people. Both levels of fitness (aerobic power, strength, flexibility and functional capability) and measures of physical activity involvement decline with age, and the extent to which this is due to a biological ageing processes or disuse (physical inactivity) is critically examined. The review will consider the evidence for a causal relationship between sedentary behaviour/physical activity programmes and cardiovascular, musculoskeletal and psycho-social health, independent living and health-related quality of life into old age. The review also considers the effectiveness of different physical activity interventions for older people and issues relating to cost-effectiveness. The implications for future policy in terms of research, health care services, and education and training are briefly discussed.
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Affiliation(s)
- A H Taylor
- School of Sport and Health Sciences, University of Exeter, Exeter, UK.
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Abstract
BACKGROUND While the beneficial effect of exercise capacity on mortality is well-accepted, its effect on health-care costs remains uncertain. This study investigates the relationship between exercise capacity and health-care costs. METHODS The Veterans Affairs Health Care System recently implemented a Decision Support System that provides data on patterns of care, patient outcomes, workload, and costs. Total inpatient and outpatient costs were derived from existing administrative and clinical data systems, were adjusted for relative value units, and were expressed in relative cost units. We used univariable and multivariable analyses to evaluate the 1-year total costs in the year following a standard exercise test. Costs were compared with exercise capacity estimated in metabolic equivalents (METs), other test results, and clinical variables for 881 consecutive patients who were referred for clinical reasons for treadmill testing at the Palo Alto Veterans Affairs Health Care System facility between October 1, 1998, and September 30, 2000. RESULTS The patients had a mean age of 59 years, 95% were men, and 74% were white. Eight patients (< 1%) died during the year of follow-up. Exercise testing showed an average maximum heart rate of 138 beats/min, 8.2 METs, and a peak Borg scale of 17. In unadjusted analysis, costs were incrementally lower by an average of 5.4% per MET increase (p < 0.001). In a multivariable analysis adjusting for demographic variables, treadmill test performance and results, and clinical history, METs were found to be the most significant predictor of cost (F-statistic, 21.8; p < 0.001). CONCLUSION These findings are consistent with the hypothesis that exercise capacity is inversely associated with health-care costs.
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Affiliation(s)
- J Peter Weiss
- Division of Cardiovascular Medicine, Stanford University Medical Center and Veterans Affairs Health Care System, Palo Alto, CA 94304, USA
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Wang G, Macera CA, Scudder-Soucie B, Schmid T, Pratt M, Buchner D. Cost effectiveness of a bicycle/pedestrian trail development in health promotion. Prev Med 2004; 38:237-42. [PMID: 14715217 DOI: 10.1016/j.ypmed.2003.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A persistently low population level of physical activity is a challenge for public health. Data on cost effectiveness of environmental interventions are needed to inform the development and implementing of such interventions. OBJECTIVE To conduct cost-effectiveness analysis of bicycle/pedestrian trails. DESIGN The costs of trail development and number of users of four trails in Lincoln, NE, were obtained. The costs were adjusted to 2003 dollars. The physical activity-related outcomes/items are number of users who were more physically active since they began using the trails, number of users who were physically active for general health, and number of users who were physically active for weight loss. Cost-effectiveness measures were derived. Sensitivity analysis was performed. RESULTS The annual trail development cost US$289,035, 73% of which was construction cost. Of the 3,986 trail users, 88% were active at least 3 days a week. The average annual cost for persons becoming more physically active was US$98 (range US$65-253); the cost was US$142 (range US$95-366) for persons who are active for general health, and US$884 (range US$590-2,287) for persons who are active for weight loss. CONCLUSION This analysis provides basic cost-effectiveness measures of bicycle/pedestrian trails. Policymakers can use this information in making resource allocation decisions.
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Affiliation(s)
- Guijing Wang
- Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway NE, Mailstop K46, Atlanta, GA 30341-3717, USA.
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21
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The Costs of Injury from Sport, Exercise and Physical Activity: A Review of the Evidence. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1476-2854(04)02017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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22
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Abstract
The benefits of physical activity in reducing morbidity and mortality are well-established, but the effect of physical inactivity on direct medical costs is less clear.
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Affiliation(s)
- M Pratt
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
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23
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24
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Haapanen-Niemi N, Miilunpalo S, Vuori I, Pasanen M, Oja P. The impact of smoking, alcohol consumption, and physical activity on use of hospital services. Am J Public Health 1999; 89:691-8. [PMID: 10224980 PMCID: PMC1508744 DOI: 10.2105/ajph.89.5.691] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study investigated the associations of smoking, excess alcohol consumption, and physical inactivity with the use of hospital care. METHODS A cohort of 19- to 63-year-old Finnish men (n = 2534) and women (n = 2668) were followed prospectively for 16 years. Number of hospital days was extracted from the national hospital discharge registry, while data concerning exposure variables were derived from the baseline questionnaire. RESULTS After adjustment for confounders, male smokers had 70% (95% confidence interval [CI] = 49%, 95%) and female smokers had 49% (95% CI = 29%, 71%) more hospital days due to my cause than did those who had never smoked. Men consuming a moderate amount of alcohol had 21% (95% CI = 10%, 31%) fewer hospital days due to any cause than did nondrinkers. Men who had the lowest energy expenditure during leisure-time physical activity had 36% (95% CI = 15%, 63%) more hospital days than the most active men. The figure for women was 23% (95% CI = 4%, 44%). CONCLUSIONS Smoking was strongly associated with an increased use of hospital services. The associations of alcohol consumption and leisure-time physical activity with use of hospital care depended on the diagnosis under study.
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25
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Murphy P, Waddington I. Sport for all: Some public health policy issues and problems. CRITICAL PUBLIC HEALTH 1998. [DOI: 10.1080/09581599808402907] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Coleman P. I'll take the health benefits of exercise without the risks please. Lancet 1998; 352:492. [PMID: 9708790 DOI: 10.1016/s0140-6736(05)79235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Practice nurses and theprevention of cardiovascular disease and stroke: a literature review to promote evidence-based practice. Part II: hypertension, raised blood cholesterol, lack of exercise and obesity. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1361-9004(97)80006-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Oakley A, Dawson MF, Holland J, Arnold S, Cryer C, Doyle Y, Rice J, Hodgson CR, Sowden A, Sheldon T, Fullerton D, Glenny AM, Eastwood A. Preventing falls and subsequent injury in older people. Qual Health Care 1996; 5:243-9. [PMID: 10164150 PMCID: PMC1055423 DOI: 10.1136/qshc.5.4.243] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Oakley
- Social Science Research Unit, University of London, UK
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29
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Nicholl JP, Coleman P, Williams BT. The epidemiology of sports and exercise related injury in the United Kingdom. Br J Sports Med 1995; 29:232-8. [PMID: 8808535 PMCID: PMC1332232 DOI: 10.1136/bjsm.29.4.232] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A national study of exercise related morbidity (ERM) in England and Wales was carried out using a postal questionnaire sent to 28,857 adults aged 16-45 years. The questionnaire asked about regular participation in sports or other recreational fitness activities involving physical exercise, and for details of any injuries occurring during a 28 d reference period. A return rate of 68% was achieved. Comparisons with other national data sources indicated that the information obtained was reliable. It is estimated that each year there are 29 million incidents resulting in new or recurrent injuries, however minor, of which 9.8 million (95% confidence interval 8.1 to 11.4 million) result in new 'substantive' injuries which are potentially serious, result in treatment, or in participants being unable to take part in their usual activities. Soccer accounted for more than 25% of all ERM, but the risk of a substantive injury in rugby was three times that in soccer. Over one third of ERM occurred in men aged 16-25 years. The most frequently reported injuries were sprains and strains of the lower limbs. Treatment was sought in approximately 25% of ERM incidents and 7% of all new ERM incidents involved attendance at a hospital accident and emergency department. The treatment provider most likely to be consulted was a general practitioner, but physiotherapists and complementary medicine practitioners were also consulted frequently. To maximize the health benefits of exercise, research strategies to reduce the volume and severity of ERM and to identify the most appropriate ways of managing ERM should be set.
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Affiliation(s)
- J P Nicholl
- Medical Care Research Unit, University of Sheffield, UK
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