Effectiveness of a supervised physical activity programme on physical activity adherence in patients with cardiovascular risk factors

Introduction Physical activity referral schemes (PARS) in primary care centres increase the level of physical activity (PA) in the general population. However, few studies assess PA adherence after interventions. This study aimed at: (i) to assess PA adherence after a six-month PARS, and at 12-months (after six months of a follow-up period without intervention), (ii) and to assess the impact of PARS on health-related quality of life (HRQL) in patients with cardiovascular risk factors (CVRF). Materials and methods A six-month PARS decrease the number of inactive patients and improves PA level and HRQL. Improvements in physical functioning, social functioning, and emotional component were retained up to one year. PARS appear to be an adequate treatment to improve the health of patients with CVRF. El 75% de los pacientes (n = 242; 62,6 ± 8,5 años; 75% mujeres) completaron el PPAFS (asistencia media del 84,1%). Los PPAFS aumentan el nivel de AF y mejoran la CVRS (p < 0,01). A los 12 meses, el número de pacientes físicamente inactivos sigue siendo inferior a los datos basales, el nivel de AF disminuye pero se mantienen los efectos positivos en la CVRS, especialmente en la funcionalidad social (26,4), la funcionalidad física (18,2) y el componente emocional (18,3) (p < 0,01). Longitudinal design. A total of 323 patients with ≥2 CVRF, in contemplative stage of change, from 27 primary care centres in Catalonia, were referred during 2010–2011 to a six-month PARS (three sessions/week of 60 min of moderate-intensity PA (MPA)). PA level and HRQL were analysed at baseline, at six-months, and at 12-months follow-up measurement, with the International Physical Activity Questionnaire (short version), and the SF-12, respectively. Results Out of the total number of patients (323), 75% (n = 242; 62.6 ± 8.5 years; 75% women) completed the PARS, with a mean attendance of 84.1%. A six-month PARS increased PA level, especially MPA and improved HRQL (p < 0.01). At 12-months, the number of physically inactive patients remained lower than baseline; MPA level decreased, and the positive effects on HRQL were retained, especially in social functioning (26.4), physical functioning (18.2), and emotional component (18.3) (p < 0.01). Out of the total number of patients (323), 75% (n = 242; 62.6 ± 8.5 years; 75% women) completed the PARS, with a mean attendance of 84.1%. A six-month PARS increased PA level, especially MPA and improved HRQL (p < 0.01). At 12-months, the number of physically inactive patients remained lower than baseline; MPA level decreased, and the positive effects on HRQL were retained, especially in social functioning (26.4), physical functioning (18.2), and emotional component (18.3) (p < 0.01). Conclusions A six-month PARS decrease the number of inactive patients and improves PA level and HRQL. Improvements in physical functioning, social functioning, and emotional component were retained up to one year. PARS appear to be an adequate treatment to improve the health of patients with CVRF

Promoting physical activity through primary health care: the case of Catalonia

Background: In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors). Methods: The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance). Results: PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a “healthy route” (Reach). The proportion of patients with at least one cardiovascular risk factor who were “sufficiently active” increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance). Conclusions: In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system

Implementación del día mundial de la actividad física en Cataluña

Fundamentos: Aunque la práctica de actividad física (AF) tiene múltiples beneficios, el 30% de personas son inactivas. Cataluña impulsó el Día Mundial de la actividad física (DMAF) como parte de una estrategia más amplia de promoción de la AF. Este trabajo tuvo como objetivo presentar la implementación y evolución 2010- 2016. Métodos: Estudio transversal de tendencias. Se impulsó la celebración del DMAF mediante la web www.pafes.cat, un formulario de registro y un plan de comunicación. Las variables estudiadas fueron número de entidades, tipos de eventos y participantes, el porcentaje de eventos coordinados, el número de visitas web y el coste. Se realizó un análisis descriptivo univariado y de frecuencias. Resultados: Se realizó la difusión a >9000 direcciones electrónicas/año. Entre 2010 y 2016 se multiplicaron por cinco las entidades organizadoras, eventos y participantes (en 2016 2,8% de la población), durante marzo y abril aumentaron las visitas a la web. Los eventos (caminatas, AF dirigida, deporte y difusión) presentaron coordinación y movilizaron de 25 a 500 personas desde diversos ámbitos. El coste estimado medio fue de 1 céntimo por participante. Conclusiones: El DMAF consiguió llegar a un gran volumen de población con un coste mínimo

Implementación del día mundial de la actividad física en Cataluña

Background: Even though physical activity (PA) has multiple benefits, 30% of the population is inacti- ve. Catalonia impulse the World Physical Activity Day (WPAD), as a part of a broader strategy of PA promotion. The objetive of this work was to present the implementa- tion and evolution of WPAD from 2010 to 2016. Methods: Repeated cross-sectional study. WPAD celebration was promoted through the web www.pafes. cat, a registry form, and a communication plan. Studied variables were: n. of entities, events (type) and partici- pants, % of coordinated events, number of web visits and cost. A descriptive univariate analysis and calculation of frequencies was done. Results: Spreading was done to >9000 electronic addresses per year. Between 2010 and 2016 organizing entities, events and participants (2,8% of population in 2016) multiplied by 5. Organized events (walks, super- vised PA, sport and diffusion) were done in coordination and mobilized 25 to 500 people, from a variety of set- tings. Estimated mean cost was 1 cent of euro by par- ticipant. Conclusions: WPAD managed to reach an important amount of population at a minimum cost.Fundamentos: Aunque la práctica de actividad física (AF) tiene múltiples beneficios, el 30% de personas son inactivas. Cataluña impulsó el Día Mundial de la acti- vidad física (DMAF) como parte de una estrategia más amplia de promoción de la AF. Este trabajo tuvo como objetivo presentar la implementación y evolución 2010- 2016. Métodos: Estudio transversal de tendencias. Se im- pulsó la celebración del DMAF mediante la web www. pafes.cat, un formulario de registro y un plan de comu- nicación. Las variables estudiadas fueron número de entidades, tipos de eventos y participantes, el porcentaje de eventos coordinados, el número de visitas web y el coste. Se realizó un análisis descriptivo univariado y de frecuencias. Resultados: Se realizó la difusión a >9000 direccio- nes electrónicas/año. Entre 2010 y 2016 se multiplicaron por cinco las entidades organizadoras, eventos y parti- cipantes (en 2016 2,8% de la población), durante mar- zo y abril aumentaron las visitas a la web. Los eventos (caminatas, AF dirigida, deporte y difusión) presentaron coordinación y movilizaron de 25 a 500 personas desde diversos ámbitos. El coste estimado medio fue de 1 cén- timo por participante. Conclusiones: El DMAF consiguió llegar a un gran volumen de población con un coste mínimo

Promoting physical activity through primary health care: the case of Catalonia

Background: In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors). Methods: The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance). Results: PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a “healthy route” (Reach). The proportion of patients with at least one cardiovascular risk factor who were “sufficiently active” increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance). Conclusions: In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system