Physical Activity Interventions
Effects of interventions in health care settings on physical activity or cardiorespiratory fitness

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Abstract

Introduction:

This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions.

Methods: Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics.

Results: Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effects on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates.

Conclusion: Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.

Section snippets

Methods

We defined primary prevention interventions as those targeting patients without existing disease, and secondary prevention interventions as those targeting patients with known existing chronic or acute disease. Interventions delivered in primary care settings with no explicit patient selection based on disease were considered primary prevention. For secondary prevention, we focused on CVD because of the preponderance of physical activity studies in patients with CVD. Because we were interested

Primary prevention studies

We identified 12 randomized controlled or quasi-experimental studies that evaluated physical activity education or counseling in primary care settings (Table 1). We give sample sizes of providers as well as patients; sample sizes of patients ranged from 54 to over 6,000. We also describe the training and materials given to providers separately from the training and materials given to the patients.

The mean age of participants in most studies was 35 to 50 years; two included only older

Discussion and conclusions

Interventions to promote physical activity have a part to play within the continuum of patient care delivered in health care settings, including primary prevention programs for all patients and treatments for patients with existing disease. This review focuses on studies of physical activity interventions in primary care for primary prevention and controlled trials of secondary prevention with a physical activity component delivered to patients with CVD, although a review of physical activity

Acknowledgements

The authors thank John Fisher and Christine L. Ameika for their assistance in conducting and reviewing literature searches and Colleen Brown for manuscript preparation.

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