Long-term physical activity on prescription intervention for patients with insufficient physical activity level-a randomized controlled trial

Abstract

Background: Physical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting.

Methods: We included 190 patients, 27-77 years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups.

Results: At the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups.

Conclusion: During long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies.

Trial registration: ClinicalTrials.gov NCT03012516 . Registered on 30 December 2016-retrospectively registered.

Keywords: Health behaviour; Metabolic syndrome; Physical activity; Physical therapy; Primary health care; Quality of life.

Fig. 1

Flow of patients involved in the study. ^aMajority of the patients in the PT-group not receiving allocated intervention or discontinuing intervention was attended to 1- and 2-year follow-up. ^bThe number of patients in the HCC group not receiving or discontinuing intervention is not known dependent on non-access to the patient’s medical record with the current information

Fig. 2

Physical activity level and health outcomes over time for the PT and HCC group^a. ^aAnalysed with linear mixed effects models. TotalMET is presented with the estimated marginal geometric mean and 95% CI. HDL, MCS, and BMI are presented with the estimated marginal arithmetic mean and 95% CI. PT, physiotherapist; HCC, health care centre; MET, metabolic equivalent; CI, confidence interval; HDL, high-density lipoprotein; MCS, mental component summary; BMI, body mass index