Brief Counseling and Exercise Referral Scheme: A Pragmatic Trial in Mexico

Gallegos‐Carrillo, Katia; García-Peña, Carmen; Salmerón, Jorge; Salgado-de-Snyder, Nelly; Lobelo, Felipe

doi:10.1016/j.amepre.2016.10.021

Cited by 19 publications

(30 citation statements)

References 42 publications

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“…Three systematic reviews show that, compared with usual care, exercise referral schemes had a small effect in increasing the proportion of individuals achieving 90–150 min of at least moderate intensity activity per week (relative risk range: 1.12–1.20, 95% CI range: 1.03–1.35) (Campbell et al , 2015, Pavey et al , 2011, Williams et al , 2007). Whilst studies suggest exercise referral schemes may improve compliance with PA recommendations compared with brief interventions (Gallegos-Carrillo et al , 2017) and the rate of adherence to PA following PA prescription (effect size: 0.17, 95% CI: 0.09–0.24) (Arsenijevic and Groot, 2017), gaps in the evidence still exist (Pakravan and Jones, 2014). The lack of evidence of effectiveness may be linked to large variations in schemes including characteristics of the PA sessions (e.g.…”

Section: Approaches Of Pa Promotion Within Primary Carementioning

confidence: 99%

Physical activity promotion in primary care: a Utopian quest?

Lion

Vuillemin

Thornton

et al. 2018

Health Promotion International

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The health benefits of physical activity (PA) are acknowledged and promoted by the scientific community, especially within primary care. However, there is little evidence that such promotion is provided in any consistent or comprehensive format. Brief interventions (i.e. discussion, negotiation or encouragement) and exercise referral schemes (i.e. patients being formally referred to a PA professional) are the two dominant approaches within primary care. These cost-effective interventions can generate positive changes in health outcomes and PA levels in inactive patients who are at increased risk for non-communicable diseases. Their success relies on the acceptability and efficiency of primary care professionals to deliver PA counselling. To this end, appropriate training and financial support are crucial. Similarly, human resourcing and synergy between the different stakeholders must be addressed. To obtain maximum adherence, specific populations should be targeted and interventions adapted to their needs. Key enablers include motivational interviewing, social support and multi-disciplinary approaches. Leadership and lines of accountability must be clearly delineated to ensure the success of the initiatives promoting PA in primary care. The synergic and multisectoral action of several stakeholders, especially healthcare professionals, will help overcome physical inactivity in a sustainable way.

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Section: Approaches Of Pa Promotion Within Primary Carementioning

confidence: 99%

Physical activity promotion in primary care: a Utopian quest?

Lion

Vuillemin

Thornton

et al. 2018

Health Promotion International

View full text Add to dashboard Cite

show abstract

“…An exercise referral scheme (ERS) is one option for health professionals to promote PA for those with non-communicable diseases 13. Such schemes are internationally widespread, existing for example, in the UK,14 Denmark,15 Spain16 and Mexico 17. In the UK, leisure providers usually deliver ERSs, directing participants into 10–24 weeks of supervised PA.…”

Section: Introductionmentioning

confidence: 99%

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK

et al. 2019

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ObjectivesExercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such scheme in the UK.DesignThe study employed a qualitative longitudinal approach using semistructured interviews, with results reported using Consolidated criteria for Reporting Qualitative research guidelines.SettingTwo leisure centres providing an ‘emerging best-practice’ ERS in northeast England.ParticipantsReferred patients (n=11), who had not yet commenced the scheme, were recruited on a voluntary basis. Seven females and four males, with a range of non-communicable diseases, such as cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems, participated.Intervention24-weeks, two times per week, of supervised exercise sessions and three one-to-one assessments (prescheme, 12 weeks and 24 weeks) for patients referred from primary and secondary care.Primary outcome measuresTwo longitudinal semistructured interviews, prior to commencement and 12–20 weeks later, were thematically analysed using the framework approach. Analysis comprised seven stages: transcription, familiarisation, coding, development and application of an analytical framework, charting data using a matrix and interpretation of data. Interpretation went beyond descriptions of individual cases to develop themes, which identified and offered possible explanations for differing participant experiences.ResultsThree overarching themes emerged. First, ‘success’, with engaged participants focused on health outcomes and reported increases in physical activity. Second, ‘struggle’, with short-term success but concerns regarding continued engagement. Participants reported scheme dependency and cyclical needs. Finally, ‘defeat’, where ill health, social anxiety and/or poor participation experience made engagement difficult.ConclusionSome success in engaging those with non-communicable diseases was reported, resulting in positive effects on health and well-being. The study highlights complexity within ERSs and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for referrals finding engagement difficult.

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“…During the past several decades, several studies have evaluated single-level interventions to integrate physical activity into health care settings, such as physician counseling ( 12 , 13 ), assessing patient physical activity levels ( 14 , 15 ), and providing patients with a physical activity prescription ( 16 , 17 ). A small number of multilevel interventions have been conducted in health care settings to support physicians in their physical activity counseling efforts ( 18 , 19 ). Meta-analyses and systematic reviews show that physician counseling and exercise referral systems lead to improvements in patient physical activity levels for up to 12 months ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems

et al. 2018

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IntroductionExercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation.Purpose and ObjectivesThe purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM.Evaluation MethodsA working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings.ResultsThe Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting.Implications for Public HealthThe availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems.

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Brief Counseling and Exercise Referral Scheme: A Pragmatic Trial in Mexico

Cited by 19 publications

References 42 publications

Physical activity promotion in primary care: a Utopian quest?

Physical activity promotion in primary care: a Utopian quest?

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK

A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems

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