Recomendaciones preventivas cardiovasculares / Recommendations on prevention of cardiovascular disease

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Predictors of long-term change of a physical activity promotion programme in primary care.

BACKGROUND: Further research is needed to improve the evidence regarding determinants of physical activity (PA) as a crucial step to plan higher effective intervention strategies. The goal of the present study is to identify socio-demographic and clinical characteristics of primary care (PHC) insufficiently active patients that are associated with longitudinal changes in the level of physical activity. METHODS: Longitudinal analysis of baseline socio-demographic and clinical predictors of physical activity change in insufficiently active PHC patients who participated in a PA-promoting multi-centre randomized clinical trial conducted from October 2003 through March 2006. The primary outcome measure was the self-reported physical activity assessed with the 7-day Physical Activity Recall (PAR), at baseline, 6, 12 and 24 months. Baseline covariates included sex, age, social class, anthropometric measures and other cardiovascular risk factors or associated diseases (Diabetes, HTA, tobacco use, etc.), and stage of readiness to change PA. Generalized linear mixed models were used to estimate longitudinal association of studied variables on PA change over the three follow-up measurements. RESULTS: A total of 3691 patients (85% of the 4317 recruited in the trial) with at least one follow-up measurement were included in the longitudinal analysis. At baseline, analysed patients (mean age: 50.6 years; 64.6% women) devoted 34.7 minutes and 2.36 metabolic equivalent hours per week (MET.h/week) to moderate and vigorous physical activity. Older age, male gender, higher social class, lower BMI, diagnosis of diabetes or hypertension, and measurement season were significant predictors of PA longitudinal change. The effect of baseline readiness to change on PA dose was modified by time, showing a positive gradient in favour of those with more readiness to change that increases significantly at 12 and 24 months (p-value interaction < .0001). CONCLUSIONS: Identified baseline characteristics such as readiness to change and risk factors can guide physicians to prioritize time and intervention efforts for maximizing their impact on insufficiently active PHC patients.

Two-year longitudinal analysis of a cluster randomized trial of physical activity promotion by general practitioners.

BACKGROUND: We evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care. METHODS AND FINDINGS: Pragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p<0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%). CONCLUSIONS: General practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention but this effect wears off at 12 and 24 months. Only in the subgroup of patients receiving repeat prescriptions of physical activity is the effect maintained in long-term. TRIAL REGISTRATION: clinicaltrials.gov NCT00131079.

Sobre la prescripción del ejercicio físico / On prescription of physical exercise

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[Running and its influence on smoking habits]. / Influencia de la carrera a pie sobre el hábito tabáquico.

OBJECTIVE: To investigate whether running influences smoking habits. DESIGN: Study of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study. SETTING: Primary care. City of Toledo, Spain. CASES: 48 healthy volunteer runners of 47+/-7.8 years of age. CONTROLS: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher. PRINCIPAL MEASUREMENTS: Smoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group. RESULTS: The OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; chi(2)=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; chi(2)=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; chi(2)=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run. CONCLUSIONS: There is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so.

Influencia de la carrera a pie sobre el hábito tabáquico / Running and its influence on smoking habits

Objetivo. Investigar si la carrera a pie influye sobre el hábito tabáquico. Diseño. Estudio de casos y controles, con emparejamiento 1:1. Observación longitudinal retrospectiva. Emplazamiento. Atención primaria. Ciudad de Toledo. Participantes. Casos: 48 corredores voluntarios sanos de 47 ± 7,8 años de edad. Controles: 48 sujetos sanos, emparejados por sexo y año de nacimiento, elegidos al azar entre la población adscrita al médico investigador. Mediciones principales. Hábito tabáquico y gramos semanales de alcohol mediante cuestionario, peso, talla, presión arterial y frecuencia cardíaca de reposo. Se obtuvieron las odds ratio (OR) de las proporciones de sujetos que fumaban o habían fumado alguna vez, de los que seguían fumando y de las probabilidades de abandono del tabaco de cada grupo. Resultados. La OR de la proporción de sujetos que fumaban o habían fumado entre los grupos de corredores (54,2%) y controles (70,9%) era de 0,486 (intervalo de confianza [IC] del 95%, 0,205-1,149; *2 = 2,8; p = 0,093). La OR para continuación del hábito entre los grupos de corredores (8,4%) y controles (41,7%) era de 0,127 (IC del 95%, 0,035-0,456; *2 = 14,0; p = 0,0002). En el grupo de corredores había abandonado el tabaco el 45,8% y en el de controles, el 31,2% (OR = 7,85; IC del 95%, 1,89-32,52; *2 = 11,8; p = 0,0007). El 50% de los corredores que fumaban lo había dejado desde que comenzó a correr y el 76,9% de éstos lo había dejado justo en el momento de comenzar a correr. Conclusiones. Hay una asociación negativa entre carrera a pie y tabaco. Si un fumador decide comenzar a correr regularmente, tiene muchas probabilidades de dejar de fumar y mantenerse así

Objective. To investigate whether running influences smoking habits. Design. Study of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study. Setting. Primary care. City of Toledo, Spain. Participants. Cases: 48 healthy volunteer runners of 47±7.8 years of age. Controls: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher. Principal measurements. Smoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group. Results. The OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; *2=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; *2=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; *2=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run. Conclusions. There is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so