Adults, Health Behavior, Metabolic Syndrome, Physical Activity, Primary Health Care
Conditions
Keywords
Physical activity on prescription, Mediators of physical activity change
Brief summary
A sufficient level of physical activity (PA) positively affects health and longevity. In Swedish healthcare, insufficiently physically active patients are offered physical activity on prescription (PAP) treatment, an individual support to increase physical activity level. This study investigates the influence of possible mediators and factors associated with a PA level change in primary care patients during a 5-year PAP intervention. The study population includes 444 patients (56% females), aged 27 to 85 years, with metabolic risk factors and being physically inactive. The patients receive individualized PAP-treatment including PA-consultations, agreed PA recommendations with a written prescription, and structured follow-ups. Associations between 10 theoretical important mediators and factors of PA change, measured at 6 occasions, are analysed against PA level at 5 years and PA level change during the 5-year intervention.
Detailed description
Aim: To investigate the influence of possible mediators and factors associated with a physical activity (PA) level change in primary care patients during a 5-year physical activity on prescription (PAP) intervention. Study design: This is a longitudinal prospective observational cohort study with a 5-year follow-up of PAP-treatment. The treatment is carried out as part of a daily clinical primary care practice. Study population: The 444 patients (56% females), aged 27 to 85 years, are selected from 15 primary health care centres in Gothenburg, being physically inactive, having at least one component of the metabolic syndrome present and receiving PAP-treatment. The patients have to understand the Swedish language to fill in the questionnaires. Intervention: The PAP-treatment is offered by authorized personnel, educated in PA-effects and PAP-intervention and consists of an individual-based dialogue with the patient, an individually tailored recommendation of PA including a written prescription, and customized, structured support during 5 years. The patients health status, previous respectively current PA level, preferences for different physical activities, motivation, self-efficacy and readiness to change PA behavior are evaluated. An agreed individually dosed PA is written down and the support during the 5-year intervention is individually structured either by revisits or by telephone contacts. Measurements: The following measurements are conducted on 6 occasions during the 5-year intervention, at baseline and at the 6-month-, 1.5-, 2.5-, 3.5-, and 5-year follow-ups: PA-level, outcome expectations, enjoyment, confidence in readiness to change, self-efficacy, social support, health related quality of life, body mass index (BMI), age and sex. Statistical analysis: Differences between baseline and the 5-year follow-up, within the group, are analyzed using the paired sample t-test or Wilcoxon sign-rank test, based on the data level. A change score (PA at 5 year - PA at baseline) of PA is conducted, thereafter associations between theoretical important mediators of PA change (i.e., outcome expectation and confidence at baseline, and enjoyment, self-efficacy, family positive support, friends positive support and family negative support at 5 year) and PA level at 5 years and PA level change are analyzed using a linear regression. In a final step a mediation model of the mediators of PA change: enjoyment, self-efficacy, and social support and PA level at 5 years and PA level change is conducted using the lavaan package in RStudio version 1.4.1106.
Interventions
None listed
Sponsors
Vastra Gotaland Region
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
27 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Physically inactive according to ACSM/AHA public health recommendation from 2007. Having at least one component of the metS present according to the National Cholesterol Education Program (NCEP) classification. Receiving PAP-treatment. Understanding the Swedish language.
Exclusion criteria
* The patient decline to participate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in self-reported PA-level according to the public health recommendation. | From enrollment to the end of treatment at 5 years. | Self-assessment of PA-level according to American college of sports medicine (ACSM) and American heart association (AHA) public health recommendation 2007. The patient responds to two PA questions, where 30 minutes of moderate-intensity PA per day results in 1 point and 20 minutes of more vigorous-intensity PA per day results in 1.7 point during each specific day of the week. A value of \<5 points indicates an inadequate PA level corresponding to \<150 min/week at a moderate intensity level alternatively 75 min/week at a high intensity level. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Outcome expectations - Outcome Expectations for Exercise-2 Scale (OEE-2) | From enrollment to the end of treatment at 5 years | Including 13 positively- (e.g. Helps me feel less tired), or negatively- (e.g. Is something I avoid because it causes me to be short of breath) worded items rated on a 5-point Likert scale (1: Strongly agree, 5: Strongly disagree). After a reverse-scoring of the positive OEE items, the numerical values for each response were summarised and divided by the number of items where a highly valued outcome expectation from the patient gave a high total score. |
| Enjoyment - Physical Activity Enjoyment Scale (PACES) | From enrollment to the end of treatment at 5 years. | Including 16 positively- (e.g. I think it´s fun, It gives me energy), or negatively- (e.g. I feel bored, I don´t like it) worded items rated on a 5-point Likert scale (1: Does not apply at all, 5: Truly applies). The negative PACES items were reversed-scored, and the responses were added to a score ranging from 16 to 80 where higher scores indicated higher estimated enjoyment. |
| Confidence in readiness to change | From enrollment to the end of treatment at 5 years. | Was assessed with the question How confident are you about succeeding with changing PA level? (36, 54) via a 100-mm visual analogue scale (VAS) anchored at each end with words that describe the minimum (Not at all) and maximum (Very) extremes. |
| Social support - Social support for exercise scale (SSES) | From enrollment to the end of treatment at 5 years. | Including 13 items - 11 positively-worded (participation and involvement) and 2 negatively-worded (rewards and punishments) rated on a 5-point Likert scale (1: None, 5: Very often). The item scores were summarised in three subgroups: Family support - positive, Friend support - positive, and Family support - negative. |
| Health related quality of life - the Swedish version of the Short Form 36 (SF-36 Standard Swedish Version 1.0) | From enrollment to the end of treatment at 5 years. | Includes 36 questions generating 8 health concepts that were grouped into a physical component summary (PCS) and mental component summary (MCS). The PCS and MCS are converted to 0 to 100 points, with higher values representing better HRQoL. |
| Body mass index - BMI | From enrollment to the end of treatment at 5 years. | Measured body weight in kilograms (kg), with light clothing and without shoes to the nearest 0.1 kg using an electric scale (Carl Lidén AFW D300, Jönköping, Sweden) and measured body height in meters (m), measured in an upright position without shoes to the nearest 0.5 cm using a scale fixed to the wall (PEM 136, Hultafors, Sweden). Weight and height will be combined and calculated to report BMI in kg/m2. |
| Self-efficacy expectations - Self-Efficacy for Exercise Scale (SEE) | From enrollment to the end of treatment at 5 years. | The patient´s self-efficacy in being able to exercise 3 times a week for 20 min despite obstacles was measured with a questionnaire including 9 items (e.g. The weather was bothering you, You had to exercise alone) rated on an ordinal 10-point scale (1: Not confident, 10: Very confident) where the item scores were summarised and divided by the numbers of responses. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Socio demographic data. | From enrollment to the end of treatment at 5 years. | Age (years), sex (female-male) were also measured. |
Outcome results
None listed