scholarly journals ‘Function First’: how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046751
Author(s):  
Rebecca-Jane Law ◽  
Joseph Langley ◽  
Beth Hall ◽  
Christopher Burton ◽  
Julia Hiscock ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Behaviour Change ◽  
Physical Activity Promotion ◽  
Programme Theory ◽  
Long Term Conditions ◽  
Practice Staff ◽  
Physical Activity Interventions ◽  
Activity Promotion

ObjectivesTo develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.DesignRealist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.ResultsA taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions.Abridged realist programme theoryRoutinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.Co-designThe programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change.ConclusionsPrevious physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.

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

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Alvaro Sanchez ◽  
Gonzalo Grandes ◽  
Ricardo Ortega Sánchez-Pinilla ◽  
Jesus Torcal ◽  
Imanol Montoya
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Physical Activity Promotion ◽  
Term Change ◽  
Promotion Programme ◽  
Activity Promotion

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

scholarly journals Effectiveness of physical activity promotion and exercise referral in primary care: protocol for a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jean-Pierre Laake ◽  
Joanna Fleming
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Sedentary Behaviour ◽  
Physical Activity Promotion ◽  
Self Report ◽  
Activity Promotion ◽  
Randomised Controlled ◽  
The Uk ◽  
Exercise Referral

Abstract Background Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity; however, sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this, most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. This is a protocol for a systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care. Methods A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), Scopus, CINAHL, PsycINFO, and The Cochrane Library (CENTRAL) will be conducted for studies with a minimum follow-up of 12 months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. The authors will screen papers, first by title and abstract and then by full text, independently assess studies for inclusion, appraise risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12 months. Pooled effects will be calculated using random effects models. Results will be submitted for publication in a peer-reviewed journal and for presentation at UK national primary care conferences. Discussion This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long-term plan on preventive medicine, those making policy decisions. Systematic review registration The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831

scholarly journals Improving Physical Activity mHealth Interventions: Development of a Computational Model of Self-Efficacy Theory to Define Adaptive Goals for Exercise Promotion

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Dario Baretta ◽  
Fabio Sartori ◽  
Andrea Greco ◽  
Marco D’Addario ◽  
Riccardo Melen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Computational Model ◽  
Behaviour Change ◽  
Self Efficacy ◽  
Protective Factor ◽  
Cognitive Theory ◽  
Physical Activity Promotion ◽  
Physical Activity Guidelines ◽  
Model Based ◽  
Activity Promotion

The practice of regular physical exercise is a protective factor against noncommunicable diseases and premature mortality. In spite of that, large part of the population does not meet physical activity guidelines and many individuals live a sedentary life. Recent technological progresses and the widespread adoption of mobile technology, such as smartphone and wearables, have opened the way to the development of digital behaviour change interventions targeting physical activity promotion. Such interventions would greatly benefit from the inclusion of computational models framed on behaviour change theories and model-based reasoning. However, research on these topics is still at its infancy. The current paper presents a smartphone application and wearable device system called Muoviti! that targets physical activity promotion among adults not meeting the recommended physical activity guidelines. Specifically, we propose a computational model of behaviour change, grounded on the social cognitive theory of self-efficacy. The purpose of the computational model is to dynamically integrate information referring to individuals’ self-efficacy beliefs and physical activity behaviour in order to define exercising goals that adapt to individuals’ changes over time. The paper presents (i) the theoretical constructs that informed the development of the computational model, (ii) an overview of Muoviti! describing the system dynamics, the graphical user interface, the adopted measures and the intervention design, and (iii) the computational model based on Dynamic Decision Network. We conclude by presenting early results from an experimental study.

scholarly journals Physical activity modification in youth with congenital heart disease: a comprehensive narrative review

2020 ◽  
Author(s):  
Arend W. van Deutekom ◽  
Adam J. Lewandowski
Keyword(s):  
Physical Activity ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Physical Activity Intervention ◽  
Large Range ◽  
Physical Activity Promotion ◽  
Activity Levels ◽  
Activity Promotion

Abstract Congenital heart disease (CHD) affects nearly 1% of births. As survival rates have dramatically improved, the majority of individuals with CHD now live into adulthood. As these patients age, they become prone to a large range of complications, such as chronic heart failure and acquired cardiovascular disease. Promotion of a healthy and active lifestyle from childhood onwards has been suggested as a sustainable and effective strategy to enhance cardiovascular health, improve quality of life and reduce immediate and long-term risk in people with CHD. Well-established physical activity consensus statements for youth with CHD have now been published. In this article, we review how increasing physical activity in youth with CHD may offer immediate and long-term cardiovascular benefits, what is known about physical activity in children with CHD, describe the unique factors that contribute to achieving sufficient and insufficient physical activity levels and summarize the evidence of trials on physical activity promotion in youth with CHD. Furthermore, we discuss some of the challenges that need to be addressed by further research regarding the optimal strategy, timing and format of physical activity intervention programmes in children and adolescents with CHD. Impact Congenital heart disease (CHD) affects nearly 1% of births, with the majority of individuals with CHD now living into adulthood due to improved survival. As CHD patients age, they become prone to a large range of cardiovascular complications. This article discusses how and why increasing physical activity in youth with CHD may offer immediate and long-term cardiovascular benefits, the barriers to achieving sufficient physical activity levels and the evidence from trials on physical activity promotion in youth with CHD. The optimal strategy, timing and format of physical activity intervention programmes in children and adolescents with CHD are discussed.

scholarly journals Evaluation of a physical activity promotion program in primary care

2010 ◽  
Vol 27 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Z. Sabti ◽  
M. Handschin ◽  
M. K. Joss ◽  
E. Allenspach ◽  
M. Nuscheler ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Physical Activity Promotion ◽  
Promotion Program ◽  
Activity Promotion ◽  
Physical Activity Promotion Program
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