The Effect of a Physical Activity Program on the Total Number of Primary Care Visits in Inactive Patients: A 15-Month Randomized Controlled Trial

Abstract Background: Effective promotion of exercise could result in substantial savings in healthcare cost expenses in terms of direct medical costs, such as the number of medical appointments. However, this is hampered by our limited knowledge of how to achieve sustained increases in physical activity. Objectives: To assess the effectiveness of a Primary Health Care (PHC) based physical activity program in reducing the total number of visits to the healthcare center among inactive patients, over a 15-month period. Research Design: Randomized controlled trial. Subjects: Three hundred and sixty-two (n = 362) inactive patients suffering from at least one chronic condition were included. One hundred and eighty-three patients (n = 183; mean (SD); 68.3 (8.8) years; 118 women) were randomly allocated to the physical activity program (IG). One hundred and seventy-nine patients (n = 179; 67.2 (9.1) years; 106 women) were allocated to the control group (CG). The IG went through a three-month standardized physical activity program led by physical activity specialists and linked to community resources. Measures: The total number of medical appointments to the PHC, during twelve months before and after the program, was registered. Self-reported health status (SF-12 version 2) was assessed at baseline (month 0), at the end of the intervention (month 3), and at 12 months follow-up after the end of the intervention (month 15). Results: The IG had a significantly reduced number of visits during the 12 months after the intervention: 14.8 (8.5). The CG remained about the same: 18.2 (11.1) (P = .002). Conclusions: Our findings indicate that a 3-month physical activity program linked to community resources is a shortduration, effective and sustainable intervention in inactive patients to decrease rates of PHC visits. Trial Registration: ClinicalTrials.gov NCT0071483

Cómo identificar la inactividad física en atención primaria: validación de las versiones catalana y española de 2 cuestionarios breves

Objetivo: El Brief Physical Activity Assessment Tool (BPAAT) y General Practice Physical Activity Questionnaire (GPPAQ) son instrumentos breves y válidos para identificar pacientes «físicamente inactivos» en consulta. Este estudio evalúa la fiabilidad y validez de su versión catalana (CBPAAT-CGPPAQ) y espa˜nola (CBPAAT-EGPPAQ) ante la inexistencia de instrumentos similares validados en nuestro medio. Dise˜no: Evaluación psicométrica de la adaptación cultural y lingüística al catalán/espa˜nol de 2 instrumentos de medida. Emplazamiento: centros de atención primaria. Participantes: La carga de administración de los cuestionarios se evaluó en 7 profesionales sanitarios y 44 pacientes. Su validez de constructo y fiabilidad test-retest se evaluó en 105 pacientes (58 a˜nos ± 20; 37% hombres) sin contraindicaciones para hacer actividad física (AF). Mediciones principales: Después de efectuar la traducción directa e inversa, la validez de constructo midió el grado de acuerdo de dichas versiones con el Cuestionario Internacional de AF (IPAQ) versión corta. La fiabilidad test-retest se evaluó repitiendo el cuestionario en un intervalo de 14-28 días.Resultados: El CBPAAT-EBPAAT mostró un grado de acuerdo moderado con el IPAQ coincidiendo en un 80 y 83% de los casos «inactivos». Presentaron una buena fiabilidad test-retest, coincidiendo en un 86 y un 88% de la clasificación. El CGPPAQ-EGPPAQ mostró un grado de acuerdo moderado con el IPAQ, coincidiendo en un 70 y 60% de los casos «inactivos». Presentaron una buena fiabilidad test-retest, coincidiendo en la clasificación de un 82 y 72% de los casos. Conclusiones: El CBPAAT-CGPPAQ y EBPAAT-EGPPAQ presentan una validez aceptable para identificar en consulta a pacientes físicamente inactivos.Objective: The Brief Physical Activity Assessment Tool (BPAAT) and the General Practice Physical Activity Questionnaire (GPPAQ) are valid and reliable assessment tools to identify ‘‘inactive’’ patients in primary care. No similar tools exist for the Spanish population. The study aimed to evaluate the reliability and validity of the Catalan and Spanish versions (CBPAAT-CGPPAQ; CBPAAT-EGPPAQ) of such tools. Design: Validation study of the linguistic and cultural adaptation of two questionnaires into Catalan/Spanish. Setting: Centres of Primary Care. Participants: The load for administering the questionnaires was evaluated by 7 general practitioners and 44 patients. Construct validity and reliability was assessed in 105 patients (58 years old ± 20; 37% men) without any contraindication for physical activity (PA). Main variables: After carrying out the translation and back-translation, construct validity was assessed against the International Physical Activity Questionnaire (IPAQ short form). Reliability was assessed administering the questionnaires again within 14 to 28 days. Results: The validity of the CBPAAT-EBPAAT showed a moderate percentage agreement, correctly classifying over 80% and 83% of the ‘‘inactive’’ cases. Reliability was also good, correctly classifying over 86% and 88% of the cases. The validity of the CGPPAQ-EGPPAQ showed a moderate percentage agreement, correctly classifying over 70% and 60% of the ‘‘inactive’’ cases. Reliability was good, correctly classifying over 82% and 72% of the cases. Conclusions: The CBPAAT-CGPPAQ and EBPAAT-EGPPAQ are valid instruments to identify ‘‘inactive’’ patients that should receive advice on PA