Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors--the Dalby lifestyle intervention cohort (DALICO) study.

BACKGROUND: The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. METHODS/DESIGN: The study is designed as a long-term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients' health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. DISCUSSIONS: By helping patients to overcome practical, social and cultural obstacles and increase their internal motivation for physical activity we aim to improve their physical health in a long-term perspective. The targeted patients belong to a patient category that is supposed to benefit from increased physical activity in terms of improved physiological values, mental status and quality of life, decreased risk of complications and maybe a decreased need of medication.

Who is not adhering to physical activity referrals, and why?

OBJECTIVE: To analyse patients' self-reported reasons for not adhering to physical activity referrals (PARs). DESIGN AND SETTING: Data on 1358 patients who did not adhere to PARs were collected at 38 primary health care (PHC) centres in Sweden. INTERVENTION: PHC providers issued formal physical activity prescriptions for home-based activities or referrals for facility-based activities. SUBJECTS: Ordinary PHC patients whom regular staff believed would benefit from increased physical activity. MAIN OUTCOME MEASURE: Reasons for non-adherence to PARs: "sickness", "pain", "low motivation", "no time", "economic factors", and "other". RESULTS: Sickness and pain were the most common motives for non-adherence among older patients. The youngest patients blamed economic factors and lack of time more frequently than those in the oldest age group. Economic factors was a more common reason for non-adherence among those referred for facility-based activities compared with those prescribed home-based activities. Low motivation was a more frequent cause of non-adherence among those prescribed home-based activities compared with those referred for facility-based activities. Furthermore, lack of time was a more common reason for non-adherence among patients issued with PARs due to high blood pressure than other patients, while low motivation was a more common reason among patients issued with PARs because of a BMI of > 25. CONCLUSION: The reasons for non-adherence differ between patients prescribed home-based activities and referred for facility-based activities, as well as between patients with different specific characteristics. The information obtained may be valuable not only for the professionals working in PHC, but also for those who work to develop PARs for use in different contexts.

Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care.

BACKGROUND: Written prescriptions of physical activity have increased in popularity. Such schemes have mostly been evaluated in terms of efficacy in clinical trials. This study reports on a physical activity prescription referral scheme implemented in routine primary health care (PHC) in Sweden. The aim of this study was to evaluate patients' self-reported adherence to physical activity prescriptions at 3 and 12 months and to analyse different characteristics associated with adherence to these prescriptions. METHODS: Prospective prescription data were obtained for the general population in 37 of 42 PHC centres in Ostergötland County, during 2004. The study population consisted of 3300. RESULTS: The average adherence rate to the prescribed activity was 56% at 3 months and 50% at 12 months. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline and with prescriptions including home-based activities. CONCLUSIONS: Prescription from ordinary PHC staff yielded adherence in half of the patients in this PAR scheme follow-up.

Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey.

BACKGROUND: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity. METHODS: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Ostergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities. RESULTS: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support. CONCLUSIONS: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.

Self-reported adherence: a method for evaluating prescribed physical activity in primary health care patients.

BACKGROUND: Physical activity on prescription, as a method for increasing physical activity, has attracted attention in recent years. However, few studies have examined adherence as a primary outcome variable. The aim of this article was to examine self-reported adherence to individualized prescribed physical activity in a routine primary health care setting. METHODS: Patients receiving an individualized physical activity on prescription (FaR) for prevention or treatment of disease were recruited from 13 Swedish primary health care units. Self-reported adherence, physical activity level, readiness to change to a more physically active lifestyle, and well-being were measured with questions at baseline and after 6 months in 240 patients (mean age 51, range 12 to 80, 75% women). RESULTS: At the 6-month follow-up a majority (65%) of the patients reported adherence to the prescription. Partial adherence was reported by 19% and nonadherence by 16%. There was a relationship between adherence and well-being and stages of action or maintenance. CONCLUSIONS: The results demonstrate that adherence to physical activity on prescription is as good as adherence to other treatments for chronic diseases. This is significant because even a small increase in physical activity is important both on an individual level and for public health.