Prescribing physical activity through primary care: does activity intensity matter?

Exercise referral schemes increase Patients' cardiorespiratory Endurance: A systematic review and Meta-Analysis

Introduction

The efficacy of exercise referral schemes (ERS) involving primary care providers to an exercise specialist on patients' physical activity is uncertain and primarily based on self-report outcomes. Cardiorespiratory endurance carries clinically relevant information and is an objective outcome measure that has been used to evaluate ERS, but this literature has not been amalgamated. We determined the effectiveness of ERS involving qualified exercise professionals (QEPs) on patients' cardiorespiratory endurance.

Methods

A systematic review with between-group and within-group meta-analyses was performed to examine the effects of ERS on cardiorespiratory endurance. We searched Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier databases from their inception to February 2023 to find ERS interventions (randomized/non-randomized, controlled/non-controlled). To be included, studies required an adult patient referral from a primary care provider to a QEP.

Results

Twenty-nine articles comprising 6326 (3684 females) unique patients were included. Patients were primarily older (62 ± 9 years; range: 48-82) and overweight (body mass index: 28.9 ± 7.5 kg/m2; range: 22.5-37.1). Improvements in patients' cardiorespiratory endurance were observed in 20 of the 29 studies. Among controlled studies (n = 14), the meta-analysis exhibited a favorable effect on cardiorespiratory endurance between the intervention and the comparator groups (Hedge's g: 0.31, 95 % CI: 0.09 to 0.52). The ERS interventions also improved cardiorespiratory endurance when comparing pre- and post-intervention effects (all studies, Cohen's d: 0.57, 95 % CI: 0.45 to 0.69).

Conclusion

ERS that incorporate a QEP lead to improvements in patients' cardiorespiratory endurance, providing support for the creation of these programs to help patients lead healthier lifestyles.

Smartphone Proficiency in Community-Dwelling Older Adults is Associated With Higher-Level Competence and Physical Function: A Population-Based Age-Specific Cross-Sectional Study

With the rapid development of information and communication technology, smartphone ownership has increased among older adults. While previous research has examined the impact of smartphone use on the health of older adults, this study focuses on the less-explored relationship between smartphone use, proficiency, and health-related outcomes including higher-level competence. The study was a cross-sectional survey of 208 community-dwelling older adults who used smartphones daily. Smartphone use, including years of use and applications, was assessed and categorized by age group. Health-related outcomes were measured, including cognitive and psychological function, higher-level competence, basic daily abilities, and physical function. The results indicated that smartphone proficiency decreased with age, with older adults primarily using basic smartphone applications. Notably, higher smartphone proficiency was positively associated with higher-level competence and physical functions. The study underscores the importance of considering smartphone proficiency when assessing older adults' life skills and physical performance in our digital society.

Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review

BACKGROUND

Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries.

METHODS

An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied.

CONCLUSIONS

Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.

ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients

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.

Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis

Background

High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living.

Objective

We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults.

Methods

We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment.

Results

Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness.

Conclusions

mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.

Peripheral Blood Mononuclear Cells Antioxidant Adaptations to Regular Physical Activity in Elderly People

Regular physical activity prescription is a key point for healthy aging and chronic disease management and prevention. Our aim was to evaluate the antioxidant defense system and the mitochondrial status in peripheral blood mononuclear cells (PBMCs) and the level of oxidative damage in plasma in active, intermediate and inactive elderly. In total, 127 healthy men and women >55 years old participated in the study and were classified according on their level of declared physical activity. A more active lifestyle was accompanied by lower weight, fat mass and body mass index when compared to a more sedentary life-style. Active participants exhibited lower circulating PBMCs than inactive peers. Participants who reported higher levels of exercise had increased antioxidant protein levels when compared to more sedentary partakers. Carbonylated protein levels exhibited similar behavior, accompanied by a significant raise in expression of cytochrome c oxidase subunit IV in PBMCs. No significant changes were found in the activities of antioxidant enzymes and in the expression of structural (MitND5) and mitochondrial dynamic-related (PGC1α and Mitofusins1/2.) proteins. Active lifestyle and daily activities exert beneficial effects on body composition and it enhances the antioxidant defenses and oxidative metabolism capabilities in PBMCs from healthy elderly.

Influence of a physical exercise program on VO2max in adults with cardiovascular risk factors

OBJECTIVE

The aim of the study was to assess the influence of a physical exercise program on VO₂max in sedentary subjects with cardiovascular risk factors.

MATERIALS AND METHODS

The sample was composed of 214 patients (80 males, 134 females) with an average age of 52 years, who were referred to a physical exercise program from 2 primary care centres of Spanish southeast. It was implemented a 10 week program (3 training×1h/week) combining strength with cardiorespiratory fitness. TheVO₂max was analyzed through the Rockport Walk Test (RWT) comparing the pre and post program measurements.

RESULTS

The results show significant improvements on VO₂max for both genders (p<0,05). The most pronounced increase in VO₂max was among males in the highest age band (56-73 years).

CONCLUSIONS

Prescribing and referral exercise programs from primary care centers must be considered as a resource for improving cardiorespiratory fitness in the population studied.

Biomarkers associated with sedentary behaviour in older adults: A systematic review

OBJECTIVE

Pathomechanisms of sedentary behaviour (SB) are unclear. We conducted a systematic review to investigate the associations between SB and various biomarkers in older adults.

METHODS

Electronic databases were searched (MEDLINE, EMBASE, CINAHL, AMED) up to July 2015 to identify studies with objective or subjective measures of SB, sample size ≥50, mean age ≥60years and accelerometer wear time ≥3days. Methodological quality was appraised with the CASP tool. The protocol was pre-specified (PROSPERO CRD42015023731).

RESULTS

12701 abstracts were retrieved, 275 full text articles further explored, from which 249 were excluded. In the final sample (26 articles) a total of 63 biomarkers were detected. Most investigated markers were: body mass index (BMI, n=15), waist circumference (WC, n=15), blood pressure (n=11), triglycerides (n=12) and high density lipoprotein (HDL, n=15). Some inflammation markers were identified such as interleukin-6, C-reactive protein or tumor necrosis factor alpha. There was a lack of renal, muscle or bone biomarkers. Randomized controlled trials found a positive correlation for SB with BMI, neck circumference, fat mass, HbA1C, cholesterol and insulin levels, cohort studies additionally for WC, leptin, C-peptide, ApoA1 and Low density lipoprotein and a negative correlation for HDL.

CONCLUSION

Most studied biomarkers associated with SB were of cardiovascular or metabolic origin. There is a suggestion of a negative impact of SB on biomarkers but still a paucity of high quality investigations exist. Longitudinal studies with objectively measured SB are needed to further elucidate the pathophysiological pathways and possible associations of unexplored biomarkers.

Prescribing physical activity for healthy aging: longitudinal follow-up and mixed method analysis of a primary care intervention

BACKGROUND

There is a shortage of literature describing the experience of individuals who have participated in a physical activity and mobile health (mHealth) intervention. Many physical activity interventions are of short duration and do not report long-term changes in clinical measures or adoption of prescribed health behaviors. Previously, we have reported the clinical and behavioral outcomes from the first phase of a physical activity prescription and mHealth intervention delivered through the primary care setting. The purpose of this next phase is to perform a longitudinal follow-up 6-months postintervention.

METHODS

Mixed methods analysis including repeated measures ANOVA of functional aerobic capacity (VO2max) at preintervention, postintervention, and follow-up clinic visits, and whole text analysis of semistructured interviews discussing the participant experience in a health behavior intervention.

RESULTS

Twenty participants, mean age 63 ± 5 years, participated. Gains made in VO2max were maintained at 6 months (P < 0.05). Participants reported engaging in sustained and routine physical activity, yet some identified a need for additional support to adopt the prescribed health behaviors. Emergent themes included the desire for short-term mHealth intervention to educate individuals about prescribed health behaviors without need for ongoing management by clinicians, leveraging mHealth to build social networks around prescribed health behaviors and to connect individuals to build a sense of community, and participant views of physical activity as medicine.

CONCLUSIONS

The present study investigated both the long-term adoption of physical activity behaviors as well as the participant experience in a physical activity and mHealth intervention. Findings from the current study may be used to inform the development of user-centered lifestyle interventions.