Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support

Andersen, Pia; Holmberg, Sara; Årestedt, Kristofer; Lendahls, Lena; Nilsen, Per

doi:10.3390/ijerph17165679

Cited by 5 publications

(9 citation statements)

References 41 publications

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“…Studies suggest the importance of social support for patients receiving PAP [ 29 – 31 ]. Previous studies by the researchers behind the present study have indicated that counselor support in association with delivery of PAP is beneficial for increased physical activity [ 28 , 32 ]. However, the association between counselor support and other factors has not been elucidated.…”

Section: Introductionmentioning

confidence: 82%

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Factors associated with increased physical activity among patients prescribed physical activity in Swedish routine health care including an offer of counselor support: a 1-year follow-up

et al. 2022

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Background The study addresses knowledge gaps in research regarding influences of routine health care delivery of physical activity on prescription (PAP). The aim was to investigate if patient and health care characteristics are associated with increased physical activity 1 year after prescription among patients offered counselor support in addition to health care professionals’ prescription. The study was conducted in primary and secondary care in a Swedish health care region. Methods All PAP recipients during 1 year were invited (N = 1503) to participate in this observational prospective study. Data were collected from medical records and questionnaires (baseline and follow-up). Descriptive statistics and multiple logistic regression analysis were used. The outcome variable was increased physical activity after 1 year. Study variables were patient and health care characteristics. Results Three hundred and fifty-five patients with complete follow-up data were included. The mean age was 62 years (SD = 14; range, 18–90) and 68% were females. Almost half (47%) had increased physical activity 1 year after PAP. Multiple logistic regression analysis showed that increased physical activity at follow-up was positively associated with lower baseline activity, counselor use, and positive perception of support. Counselor users with low baseline activity had higher odds ratio for increased physical activity at follow-up than non-users (OR = 7.2, 95% CI = 2.2–23.5 vs. OR = 3.2, 95% CI = 1.4–7.5). Positive perception of support was associated with increased physical activity among counselor users but not among non-users. Conclusions An increase in physical activity after PAP was related to low baseline activity, positive perception of support, and use of counselor support after PAP. Qualified counseling support linked to PAP seems to be important for achieving increased physical activity among patients with lower baseline activity.

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Section: Introductionmentioning

confidence: 82%

“…The baseline responders were sent a follow-up questionnaire after 1 year. The recruitment process has been described previously by the authors of this study [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Factors associated with increased physical activity among patients prescribed physical activity in Swedish routine health care including an offer of counselor support: a 1-year follow-up

et al. 2022

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“…The studies collectively investigated 36 PARS models, and seven schemes were researched by multiple studies. The Swedish Physical Activity on Prescription (PAP) model was investigated the most [ 35 – 38 , 40 – 44 , 58 , 70 – 72 , 89 – 91 ], with some studies examining schemes with the standard core components of this model [ 35 – 38 , 41 , 58 , 72 ] and others focusing on enhanced variations [ 40 , 42 , 43 , 70 , 71 ]. The second most investigated model was the Green Prescription (GRx), originating from New Zealand, including the standard scheme [ 48 , 62 , 92 ] and variations [ 47 , 53 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most studies did not report added benefits for an enhanced intervention over standard provisions [ 42 – 45 , 73 , 85 ]. However, two trials [ 64 , 65 ] and one observational study [ 70 ] reported that more intensive PARS offer added benefits for participants, and one study reported inconsistent results [ 55 ]. Observational and pre-post studies consistently reported an increase in PA levels for PARS participants [ 35 , 37 , 68 , 71 , 72 , 75 , 76 , 78 – 80 , 84 , 86 ], with the exception of one study [ 77 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review and narrative synthesis of physical activity referral schemes’ components

Mino,

Hanson,

Naber

et al. 2023

Int J Behav Nutr Phys Act

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Background Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. Methods Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. Results We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2–13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7–100.0%) and adherence rates (8.5–95.0%). Conclusions Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.

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“…The 48% adherence rate at 5 years obviously increased the risk of selection bias. However, similar PAP studies with shorter follow-up times have shown dropout rates of between 30–38% at 6–12 months of follow-up [ 57 – 59 ], and 41–48% at 2 years of follow-up [ 60 , 61 ]. Additionally, the large LOOK-ahead study reported very low compliance even after only 2 years of the 10-year follow-up, as indicated by the fitness values and metabolic risk factors returning to normal [ 24 ].…”

Section: Discussionmentioning

confidence: 96%

The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors

Lundqvist

Cider²,

Larsson³

et al. 2022

PLoS ONE

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Background Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients’ PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare. Methods This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27–85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes. Results The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary. Conclusion This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.

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Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support

Cited by 5 publications

References 41 publications

Factors associated with increased physical activity among patients prescribed physical activity in Swedish routine health care including an offer of counselor support: a 1-year follow-up

Factors associated with increased physical activity among patients prescribed physical activity in Swedish routine health care including an offer of counselor support: a 1-year follow-up

A systematic review and narrative synthesis of physical activity referral schemes’ components

The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors

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