scholarly journals Critically appraised paper: A 12-week pedometer-based intervention, delivered in primary care, produces long-term gains in physical activity [synopsis]

2019 ◽  
Vol 65 (1) ◽  
pp. 54
Author(s):  
Kylie Hill
Keyword(s):  
Physical Activity ◽  
Primary Care

scholarly journals Long-term engagement with a practice-based exercise referral scheme: Patients’ perceptions of effectiveness

2015 ◽  
Vol 3 (3) ◽  
pp. 369
Author(s):  
Martyn Queen ◽  
Diane Crone ◽  
Andrew Parker
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Status ◽  
Physical Activity Intervention ◽  
Health Centre ◽  
Activity Levels ◽  
Activity Promotion ◽  
Self Assessed Health ◽  
Exercise Referral

Objectives Limited and contradictory evidence exists on the long-term effectiveness of exercise referral schemes (ERS) for physical activity promotion and its impact on perceived health status. The intention of this study was to investigate patients’ views of a physical activity intervention on their self-assessed health status.Methods A longitudinal qualitative study design was employed with 12 patients aged 55 – 74, attending a primary care physical activity intervention. Semi-structured interviews took place on three occasions over a 12 month period in a Primary Care Health Centre. Transcripts of recorded interviews were coded and thematically analysed using grounded theory techniques.Results The majority of patients believed that their engagement with the Scheme and resultant long-term increase in physical activity behaviour, helped to improve their health status. This was evident through improved perceptions of medical conditions, through stabilisation or reductions in medication and visits to medical services.Conclusion The findings show the value of a long-term physical activity intervention in a Primary Care setting, through increases in physical activity levels and patients self-assessed health status. These findings can serve as guide for future service commissioners of ERS.

scholarly journals Targeting exertional breathlessness to improve physical activity: the role of primary care

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Miguel Román-Rodríguez ◽  
Janwillem W. H. Kocks
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Holistic Approach ◽  
Pharmacological Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Downward Spiral

AbstractPrimary care physicians (PCPs) play a crucial role in the diagnosis and management of chronic obstructive pulmonary disease (COPD). By working together with patients to target exertional breathlessness and increase physical activity, PCPs have an important role to play, early in the disease course, in improving patient outcomes in both the short and long term. In this article, we consider how physical activity affects disease progression from the PCP perspective. We discuss the role of pharmacological therapy, the importance of an holistic approach and the role of PCPs in assessing and promoting physical activity. The complexity and heterogeneity of COPD make it a challenging disease to treat. Patients’ avoidance of activity, and subsequent decline in capacity to perform it, further impacts the management of the disease. Improving patient tolerance of physical activity, increasing participation in daily activities and helping patients to remain active are clear goals of COPD management. These may require an holistic approach to management, including pulmonary rehabilitation and psychological programmes in parallel with bronchodilation therapy, in order to address both physiological and behavioural factors. PCPs have an important role to optimise therapy, set goals and communicate the importance of maintaining physical activity to their patients. In addition, optimal treatment that addresses activity-related breathlessness can help prevent the downward spiral of inactivity and get patients moving again, to improve their overall health and long-term prognosis.

scholarly journals ‘Function First—Be Active, Stay Independent’—promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e035686
Author(s):  
Rebecca-Jane Law ◽  
Lynne Williams ◽  
Joseph Langley ◽  
Christopher Burton ◽  
Beth Hall ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Physical Function ◽  
Grey Literature ◽  
Ethics Committee ◽  
Realist Synthesis ◽  
Design Stage ◽  
Long Term Conditions ◽  
Physically Active

IntroductionPeople with long-term conditions typically have reduced physical functioning, are less physically active and therefore become less able to live independently and do the things they enjoy. However, assessment and promotion of physical function and physical activity is not part of routine management in primary care. This project aims to develop evidence-based recommendations about how primary care can best help people to become more physically active in order to maintain and improve their physical function, thus promoting independence.Methods and analysisThis study takes a realist synthesis approach, following RAMESES guidance, with embedded co-production and co-design. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. Stage 2 will involve focused literature searching, data extraction and synthesis to provide evidence to support or refute the initial programme theories. Searches for evidence will focus on physical activity interventions involving the assessment of physical function which are relevant to primary care. We will describe ‘what works’, ‘for whom’ and ‘in what circumstances’ and develop conjectured programme theories using context, mechanism and outcome configurations. Stage 3 will test and refine these theories through individual stakeholder interviews. The resulting theory-driven recommendations will feed into Stage 4 which will involve three sequential co-design stakeholder workshops in which practical ideas for service innovation in primary care will be developed.Ethics and disseminationHealthcare and Medical Sciences Academic Ethics Committee (Reference 2018-16308) and NHS Wales Research Ethics Committee 5 approval (References 256 729 and 262726) have been obtained. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.PROSPERO registration numberCRD42018103027.

scholarly journals A new model of exercise referral scheme in primary care: is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017211 ◽  
Author(s):  
Carme Martín-Borràs ◽  
Maria Giné-Garriga ◽  
Anna Puig-Ribera ◽  
Carlos Martín ◽  
Mercè Solà ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Support ◽  
Primary Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Community Resources ◽  
Randomised Controlled ◽  
Exercise Referral ◽  
Exercise Referral Scheme

IntroductionStudies had not yet overcome the most relevant barriers to physical activity (PA) adherence. An exercise referral scheme (ERS) with mechanisms to promote social support might enhance adherence to PA in the long term.SettingA randomised controlled trial in 10 primary care centres in Spain.ObjectiveTo assess the effectiveness of a primary care-based ERS linked to municipal resources and enhancing social support and social participation in establishing adherence to PA among adults over a 15-month period.Participants422 insufficiently active participants suffering from at least one chronic condition were included. 220 patients (69.5 (8.4) years; 136 women) were randomly allocated to the intervention group (IG) and 202 (68.2 (8.9) years; 121 women) to the control group (CG).InterventionsThe IG went through a 12-week standardised ERS linked to community resources and with inclusion of mechanisms to enhance social support. The CG received usual care from their primary care practice.OutcomesThe main outcome measure was self-report PA with the International Physical Activity Questionnaire and secondary outcomes included stages of change and social support to PA practice.Data collectionParticipant-level data were collected via questionnaires at baseline, and at months 3, 9 and 15.BlindingThe study statistician and research assessors were blinded to group allocation.ResultsCompared with usual care, follow-up data at month 15 for the ERS group showed a significant increase of self-reported PA (IG: 1373±1845 metabolic equivalents (MET) min/week, n=195; CG: 919±1454 MET min/week, n=144; P=0.009). Higher adherence (in terms of a more active stage of change) was associated with higher PA level at baseline and with social support.ConclusionsPrescription from ordinary primary care centres staff yielded adherence to PA practice in the long term. An innovative ERS linked to community resources and enhancing social support had shown to be sustainable in the long term.Trial registration numberNCT00714831; Results.

scholarly journals Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design

2021 ◽  
Vol 9 (16) ◽  
pp. 1-104
Author(s):  
Rebecca-Jane Law ◽  
Joseph Langley ◽  
Beth Hall ◽  
Christopher Burton ◽  
Julia Hiscock ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Physical Function ◽  
Care Service ◽  
Evidence Synthesis ◽  
Physical Activity Promotion ◽  
Programme Theory ◽  
Long Term Conditions ◽  
Activity Promotion

Background As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain. Objectives To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention. Data sources Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews. Design Realist evidence synthesis and co-design for primary care service innovation. Setting Primary care in Wales and England. Participants Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers. Methods The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation. Results Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change. Limitations Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts. Conclusions We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention. Future work A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial. Study registration This study is registered as PROSPERO CRD42018103027. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.

scholarly journals Health status, lifestyle habits, and perceived social support in long-term cancer survivors: a cross-sectional study

2020 ◽  
Author(s):  
Beatriz León-Salas ◽  
Edurne Zabaleta-del-Olmo ◽  
Joan LLobera ◽  
Bonaventura Bolíbar-Ribas ◽  
Tomas López-Jiménez ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Support ◽  
Primary Care ◽  
Cancer Survivors ◽  
Perceived Social Support ◽  
Perceived Health ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background: The purpose of this study was to compare health status, lifestyle habits, and perceived social support between cancer survivors and people who have never had cancer. Methods: Descriptive, cross-sectional multicenter study nested in phases II and III of the cluster randomized clinical trial ERIA, designed to analyze the effects of a complex primary care intervention compared with care as usual on smoking cessation, improved adherence to the Mediterranean diet, and increased physical activity. For the cross-sectional study, patients were divided into two groups: cancer survivors and people who had never had cancer (controls). Thirty eight Primary care centers Spanish provinces of Barcelona, Girona, Balearic Islands, Malaga, Seville, Salamanca, Soria, Toledo, Vigo, Vizcaya, and Zaragoza. Adults aged between 45 and 75 years with at least two risk behaviors. Patients being treated for active cancer or in end-of-life care were excluded.Primary outcomes: Sociodemographic variables, diet, physical activity, smoking, body mass index, Charlson Comorbidity Index, and self-perceived health and social support.Results: Of the 4259 people included, 190 (4.46%) were cancer survivors. Their mean±SD age was 62.8±7 years versus 58.7±8 years (P<0.01) for people who had never had cancer. Long-term sick leave was also more common in this group (11.9% vs 3.5%, P<0.001). No between-group differences were observed for smoking, adherence to the Mediterranean diet, physical activity, obesity, or perceived social support. Cancer survivors reported worse health (OR 1.82; IC95% 1.02–2.75) and were more likely to have two or more comorbid conditions (OR 1.68; 95% CI 1.18–2.39), chronic pulmonary obstructive disease (OR 2.17; 95% CI 1.25–3.78), and depression (OR 1.65; 95% CI 1.06–2.57). In the multiple regression analysis, older age and worse self-perceived health continued to be significantly associated with having survived cancer.Conclusions: Cancer survivors have more chronic diseases, a greater likelihood of being on long-term sick leave, and worse self-perceived health than people without a history of cancer, regardless of age. The two groups perceived similar levels of social support.

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