The Effectiveness of a General-Practice-Based Physical Activity Intervention on Patient Physical Activity Status

Abstract

Physical inactivity is a risk factor for a number of chronic diseases, including cardiovascular disease. Interventions designed to reduce the prevalence of physical inactivity have focused primarily on either adoption of physical activity or noncompliance and relapse, and no interventions have been reported which cover adoption, compliance, maintenance, and relapse, particularly within the clinical setting. TheFresh Startprogram, a multiple risk factor intervention program for the reduction of cardiovascular disease risk factors in general practice patients, was developed to cover all aspects of the adoption and maintenance of habitual physical activity, using Prochaska and DiClemente's Transtheoretical model. The evaluation of the program on cardiovascular disease risk factors and behaviours provided the opportunity to evaluate the impact of a staged program on patient physical activity behaviour. The program was evaluated in a randomised controlled trial in Sydney's Western, South-western, and Wentworth regions with 80 volunteer general practitioners and 758 volunteer patients between January 1991 and January 1993. Self-reported physical activity data were used as the basis for estimating energy expenditure due to leisure-time physical activity. The results failed to show any differences between groups over time, as a function of patients' baseline stages of change, and as a function of baseline activity levels. There were some indications, however, that the least active would respond to doctor-based advice to increase their physical activity, and that doctor advice would lead to a progression inintention to changein approximately 20% of patients. Limitations of the study, the program, and physical activity intervention in the clinical setting are discussed.

The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease

“…The Change of Heart Study is a randomized controlled trial that compares brief behavioral counseling with usual health promotion advice among patients at increased risk of coronary heart disease in a primary care setting, 7 where there is limited evidence regarding the effects of stage-oriented programs. [8][9][10] The behavioral and biological risk factor results of this study, which have been described elsewhere, show greater reductions in fat intake and the number of cigarettes smoked and greater increases in physical activity in the behavioral intervention group than in the control group at 4 and 12 months. 11 In this article, we present stage of change outcomes in the study and address (1) whether behavioral intervention was more effective than normal practice in achieving the target stage (action/maintenance), (2) whether the likelihood of achieving the target stage for each behavior varied with initial stage, and (3) whether any advantage of behavioral intervention was equally evident for patients at different stages of readiness at baseline.…”

“…One study involving short interventions of 3 to 5 minutes coupled with written information targeted dietary fat consumption, 20 as did a nonrandomized study of physical activity counseling by physicians. 9 A more extensive trial of physical activity counseling by general practitioners in Australia did not demonstrate any advantage of stage-based programs over routine care, 8 while a recent study of tailored physical activity counseling also showed no differences between intervention subjects and controls in activity levels at 6 weeks or 8 months. 21 None of these investigations focused on patients at increased risk for cardiovascular disease, but it can be argued that such patients may be more motivated to change and more likely to receive benefit from lifestyle intervention.…”

Are activity promotion interventions based on the transtheoretical model effective? A critical review

“…but "which TTM based activity promotion interventions are effective?". Only one of the studies reviewed 12 attempted to compare different methods of delivering TTM based interventions. More comparative studies of TTM based interventions of known effectiveness should be made.…”

An Extended Theory of Planned Behavior Intervention for Older Adults With Type 2 Diabetes and Cardiovascular Disease

“…As with the general population, individuals with diabetes and CVD are advised to undertake 30 min or more of moderate physical activity during their leisure time on 5 or more days of the week (Australian Government Department of Health and Ageing, 2005). Numerous interventions to improve physical activity levels (Dishman & Buckworth, 1996;Hillsdon, Foster, & Thorogood, 2005;Kahn et al, 2002;Müller-Riemenschneider, Reinhold, Nocon, & Willich, 2008), including some specifically aimed at people diagnosed with diabetes or CVD (Furber et al, 2008;Gleeson-Kreig, 2006;Graham-Clarke & Oldenburg, 1994;Richardson et al, 2007;Steptoe et al, 1999;Wing, Vendetti, Jakicic, Polley, & Lang, 1998), have been developed using a number of different approaches (e.g., pedometer wearing/diary recording, behavior therapy, self-monitoring) to encourage positive changes in people's physical activity levels. However, although some improvements in people's physical activity levels have been observed (Page, Harnden, Cook, Turner, 1992;Simons-Morton, Calfas, Oldenburg, & Burton, 1998;Steptoe et al, 1999;Wing et al, 1998), they have typically been, at best, only modest and often not maintained.…”