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

Abstract

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.

Personalized remotely guided preventive exercise therapy for a healthy heart (PRIORITY): protocol for an assessor-blinded, multicenter randomized controlled trial

“…The effect size of 2.7 is a weighted average of the expected effects in the three stages i.e., 0.20 × 1 ml/kg/min (Stage C) ( 20 , 21 ) +0.30 × 2.5 ml/kg/min (Stage B) +0.50 × 3.5 ml/kg/min (Stage A) ( 22 , 23 ). A common standard deviation of 5, a correlation between baseline and 12 months equal to 0.50 and a drop-out rate at 12 months as high as 40% were assumed ( 24 ). However, the sample size will be increased to 312 patients in total (156 per group) such that for two key secondary outcomes standardized effect sizes as small as 0.45 and 0.40 can be detected with more than 90% and 80% power, respectively (using a cLDA model assuming—as for the primary outcome—a baseline-year correlation of 0.50% and 40% dropout at 12 months).…”

Physical activity on prescription in Swedish primary care: a survey on use, views, and implementation determinants amongst general practitioners

“…Swedish PAP has been shown to increase PA levels and lead to positive health effects among physically inactive patients [ 14 , 20 , 21 ]. Sustained effects of PAP have been shown on PA level, metabolic health, and health-related quality of life five years after a PAP intervention in Swedish primary care [ 22 ]. Patients with metabolic risk factors have described increased motivation for PA and that they experienced many health benefits after having received a tailored prescription for PA [ 23 ].…”