A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes

Abstract

Background Physical activity is effective for the prevention and treatment of chronic disease, yet insufficient evidence is available to make comparisons regarding adherence to aerobic physical activity interventions among chronic disease populations, or across different settings. The purpose of this review is to investigate and provide a quantitative summary of adherence rates to the aerobic physical activity guidelines among people with chronic conditions, as physical activity is an effective form of treatment and prevention of chronic disease. Methods Randomized controlled (RCTs) trials where aerobic physical activity was the primary intervention were selected from PsychInfo, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Clinical Key, and SCOPUS from 2000 to 2018. Studies were included if the program prescription aligned with the 2008 aerobic physical activity guidelines, were at least 12 weeks in length, and included adult participants living with one of three chronic diseases. The data was extracted by hand and the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines were used to evaluate risk-of-bias and quality of evidence. Data were pooled using random-effect models. The primary outcome measure was program adherence and the secondary outcome measures were dropout and setting (e.g. home vs. clinic-based). Pooled effect sizes and 95% CiIs (confidence intervals) were calculated using random-effect models. Results The literature search identified 1616 potentially eligible studies, of which 30 studies (published between 2000 and 2018, including 3,721 participants) met the inclusion criteria. Three clinical populations were targeted: cancer ( n = 14), cardiovascular disease ( n = 7), and diabetes ( n = 9). Although not statistically significant, adherence rates varied across samples (65, 90, and 80%, respectively) whereas dropout rates were relatively low and consistent across samples (5, 4, and 3%). The average adherence rate, regardless of condition, is 77% (95% CI = 0.68, 0.84) of their prescribed physical activity treatment. The pooled adherence rates for clinic-based and home-based programs did not differ (74% [95% CI, 0.65, 0.82] and 80% [95% CI, 0.65, 0.91], respectively). Conclusions The current evidence suggests that people with chronic conditions are capable of sustaining aerobic physical activity for 3+ months, as a form of treatment. Moreover, home-based programs may be just as feasible as supervised, clinic-based physical activity programs.

Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes

“…Although PA is a key element in the management of T2D, adherence to PA is extremely poor. A meta-analysis indicted that patients with chronic diseases had 77% adherence to the prescribed PA [13]. Another study also showed that 39% of adults with diabetes reported being physically active compared to 58% of diabetes-free adults [14].…”

The Effect of Active Plus, a Computer-Tailored Physical Activity Intervention, on the Physical Activity of Older Adults with Chronic Illness(es)—A Cluster Randomized Controlled Trial

“…Increasing PA is a proven-effective strategy for both prevention as well as treatment of chronic illness [13][14][15][16]. PA has other health benefits as well, such as weight control, strengthening of muscles and bones, and improvements of physical and cognitive functioning, mental health and HRQoL-all factors negatively affected by chronic illnesses [16,17]. Despite these beneficial effects of PA, older adults are the least physically active age group, especially when they suffer from chronic illnesses [2,11].…”

“…Most of them do not reach the recommendation of 150 min per week of moderate-to-vigorous physical activity (MVPA) supplemented with muscle, bone, and balance improving activities at least twice a week [18,19]. This may be due to the many PA-related barriers (i.e., fatigue, pain) experienced by older adults with chronic illnesses [2,17]. However, meta-analyses by Bullard et al [17] and de Vries et al [10] suggest that adherence to the guidelines for PA (≥150 min of MVPA/week) is highly feasible and effective among chronic disease populations.…”

Physical activity on prescription by general practitioners in type 2 diabetes mellitus patients, practice and barriers in French Guiana.

“…A review of the literature by Bullard and al. showed a 77% average rate of adherence to programs 46 . As an example, the experience of the Biarritz Côte Basque Sport Health program showed that 90% pursued the practice of PA in a sports association after stopping the program 47 .…”