Review of Primary Care-Based Physical Activity Intervention Studies

1. Review of Primary Care-Based Physical Activity Intervention Studies 組員：游麗芬 王錦雲 日期：91.7.26

2. Clinical Question What strategies are practical and effective to use in family practice settings to enhance levels of patient physical activity？

3. Exercise Prescription American College of Sports Medicine and Prevention state recommendations • Aerobic exercise • 30minutes a day • Moderate intensity activity ﹙40-85%Vo2max﹚ • 5 or more days per week

4. Factually • Only 32% of U.S. adult achieve that level. • 48% and 36% studies reported having received advice regarding physical activity from their physicians. • Barriers：efficacy？Competing demands？Lack of time？reimbursement？Standardized assessment？Procedure protocol？

5. Objective • To summarize the literature on primary activity-based interventions for and increasing physical activity • Recommendations for future research and for integrating successful strategies into practice

6. RE-AIM Framework • For evaluating the public health impact of health promotion activity • Practice-oriented research and real world concerns than other evaluation models • Emphasis on external validity and internal validity

7. Search Strategies • MEDLINE﹙1980-1998﹚，psychological abstract，ERIC and Health Star databases • Limited to English language • Three expert of physical activity were contacted

8. Selection Criteria • Randomized controlled trial or quasiexperimental study • Comparison group • Intervention delivered • In a Primary care setting • Reported resulted on at least 1 measure of physical activity

9. Sample • Sample Size range from 63 to 6124 • Age from 18 to 75 y/0

10. Excluded population • Cardiovascular disease patient • Because they are generally considered to comprise a separate body of literature and not be representative of the large population of patient

11. Methodology Rating 6 criteria： • Study design﹙0-3 point﹚ • Analyses﹙0-1 point﹚ • Dependent variable﹙0-1 point ﹚ • Reach﹙0-1 point ﹚ • Implementation﹙0-2 point ﹚ • Attrition﹙0-2 point ﹚-折損率 ﹙指個案因時間而流失的比率﹚ ？？

12. OR – odds ratio • 指有暴露族群與無暴露族群的得病機率 • 若95%信賴區間中若OR不包含1，表示有顯著差異

13. OR：odds ratio ，若95%信賴區間不包含1，表示有顯著差異

15. Results • Total 15 studies report • 10studies report 0-11 month outcomes 7 reports statistically significant physical activity outcomes • 7 reporting over 12months or longer 3 reported significant physical activity outcomes

16. Results • Methodology Rating scores ranged frame 4 to 9. The study designs were strong • Theory –based physical activity interventions were not any more effective than those not based on explicit theories of behavior change

17. Results • Physical activity-only interventions faired better in the short term than multiple risk factor interventions • Walking was the most common activity recommendation

18. Discussion • Primary care-based physical activity counseling is moderately effective in short time • Longer interventions on multiple risk factor that did not include written patient materials did not achieve result

19. Discussion • None of studies focused on older adults ﹙≧50y/0﹚，achieved positive short-term results

20. Future • Maintenance of short-term intervention issue for future research • Assisting patient in using community physical activity resources • Smoking and dietary change intervention… • Use of nonphysicans delivery model • Cost-effective ways to older patient

21. Recommendations • Only physical activity • Tailored interventions and written materials enhance success rates • Variety of health care team members﹙consistently、given time、training 、interest﹚

22. Thanks your attention