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Physical activity on prescription in primary care. Impact on physical activity level, metabolic health and health-related quality of life, and its cos [Elektronisk resurs]

Publicerad: 2020
Publicerad: Göteborgs universitet, 2020-10-08T12:03:28+02:00
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  • Non-communicable diseases (NCDs) are the leading cause of death globally
and one of the major health challenges of the 21st century. In Sweden, NCDs
are estimated to account for 90 % of all deaths. Strong evidence indicates a
relationship between regular physical activity (PA) and positive health effects,
and that PA can be used to prevent and treat diseases. In Sweden, licensed
healthcare professionals offer PA on prescription (PAP) as a method of supporting
patients to increase their PA level. PAP treatment includes three core
components: an individualized dialogue; an individually dosed PA recommendation,
including a written prescription; and a structured follow-up.
PAP treatment is underutilized in Swedish health care, and further studies
are needed to elucidate effective PAP treatment strategies. The Gothenburg
PAP study on which this thesis is based started in 2010 at 15 health care
centers (HCCs) that offered PAP to 444 patients (aged 27–85 years) who
were physically inactive with metabolic risk factors, between 2010 and 2014
and followed them for 5 years. The overall aim of this thesis was to evaluate the Swedish PAP treatment
regarding PA level, metabolic health, and health-related quality of life
(HRQOL) for patients who were physically inactive with metabolic risk
factors, and to explore factors that may predict an increased PA level. Furthermore,
this thesis aimed to evaluate two different PAP treatment strategies,
supported by either the HCC or a physiotherapist (PT), for patients who
still had not reached a sufficient PA level after a prior 6-month period of PAP
treatment. The cost-effectiveness of the two PAP strategies was also evaluated
in a health economics study.
A prospective observational study evaluated 6 months of PAP treatment in
daily clinical care at 15 HCCs in Gothenburg. During this 6-month period,
80 % of the patients received PAP support from caregivers once or twice,
73 % increased their PA level and 42 % moved from an inadequate PA level
to sufficient according to public health recommendations. Significant improvements were seen in a majority of the metabolic risk factors and HRQOL
components measured, and associations were found between changes in the
PA level and health outcomes (Paper I). We also identified potential predictive
factors for increased PA after a 6-month PAP intervention: positively
valued self-efficacy, preparedness, and physical health, and BMI < 30 kg/m2.
Among patients with the lowest PA levels at baseline, 84 % had increased
their PA level at the 6-month follow-up. In the patient group with 1 to 3
positively valued predictive factors included, 87–95 % had increased their
PA level. (Paper II).
In a randomized controlled trial, 190 patients who still had not achieved
sufficient PA levels after 6 months of PAP treatment, described in Papers I
and II, were randomized to continued, 2-year PAP intervention supported
either by a PT or the HCC. Both long-term PAP interventions increased
the PA level, metabolic health, and HRQOL with no difference between
groups. Results appeared to be independent of any changes in pharmacological
treatment. The study suggested that the continuous support and the
duration of the intervention may be most important factors for increasing PA
(Paper III).
Finally, in a health economic evaluation of 3 years of PAP treatment, a costeffectiveness
analysis compared the two PAP treatment strategies described
in Paper III. From the societal perspective, the cost per gained quality adjusted
life years (QALY) for the PT group compared to the HCC group was
147 250 SEK. The willingness to pay for a QALY needed to be > 150 000 SEK
for the PT strategy to be a cost-effective choice compared to the HCC strategy
indicating a moderate level of costs per QALY. Due to similar results in
both groups, it was not possible to draw certain conclusions about the most
cost-effective strategy; none of strategies could certainly be chosen before
the other (Paper IV).
In summary, this thesis shows that, in ordinary primary health care, both
short- and long-term PAP treatment can be a feasible intervention to increase
PA, metabolic health, and HRQOL in adult patients who are physically
inactive and have at least one metabolic risk factor. These results seem to be
most pronounced among patients with the lowest PA levels. Furthermore, improvement occurs in regards to metabolic risk factors, benefitting several
aspects of life for the patients and reducing the cost and strain for the public
health service. The identification of predictive factors for increased PA levels
(positively valued self-efficacy, preparedness, and physical health, and BMI
< 30 kg/m2) and the benefit of long-term PAP is essential. These findings
offer clinicians an opportunity to better support patients’ behavioral changes
and the individualization of PAP treatment. In optimizing the support
for patients, we need educated, skilled healthcare professionals with knowledge
about PAP, structured routines, and organizational support. The findings
in this thesis may also create the opportunity for more widespread use
of PAP as an important method of gaining health benefits for physically
inactive patients. 

Genre

government publication  (marcgt)

Indexterm och SAB-rubrik

Primary health care
Physical activity
Physical activity on prescription
Metabolic syndrome
Health related quality of life
Quality of life
Health behavior
Life style
Correlates of physical activity
Predictive factor
Health economics
Cost-effectiveness
Cost-Benefit Analysis
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