Primary Care Interventions Help Drive Increased Physical Activity in Adult Patients

Results of a new study demonstrate just how effective exercise interventions delivered to patients in primary care settings can be for helping patients reach recommended levels of physical activity.

A systematic review and meta-analysis with data from more than 16,000 individuals, results of the study suggest physical activity interventions delivered or prompted by health professionals in primary care was associated with a statistically significant increase in moderate- to vigorous-intensity physical activity by an average of 14 minutes per week.

“Intervention group participants were 33% more likely to meet guidelines for MVPA and achieved significantly more overall physical activity (total activity with all intensities combined) than controls. Multiple contacts with an intervenor, including one with a primary care health professional, are needed to increase participation in moderate to vigorous physical activity,” wrote investigators.

As attention paid towards the impact of modifiable lifestyle risk factors has grown in recent years, identifying the most effective avenues for encouraging increased physical activity stands to alleviate a substantial level of burden off health systems and on a societal level. With this in mind, investigators designed their study as systematic review and meta-analysis of randomized controlled trials examining the effects of physical activity interventions delivered in health care settings against a control group identified through a search of databases, trial registries, and grey literature sources from inception through September 2020.

Databases searched as part of the study included the Medline, Embase, PsycINFO, CINAHL, SPORTDiscus, Sports Medicine and Education Index, ASSIA, PEDro, Bibliomap, Science Citation Index, and the Conference Proceedings Citation Index databases. Trial registries included the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and TRoPHI. Open grey was the only grey literature source searched as part of the systematic review and meta-analysis.

Investigators identified a total of 25,170 reports from their initial search. From this 14,566 titles and abstracts remained after exclusion of duplicates. Of these, 405 full texts were assessed with 61 reports of 51 studies included in the review and 46 included in their meta-analysis. From these 46 studies, investigators obtained data related to a population of 16,198 participants with follow-ups ranging in length from 3-60 months.

Results of the meta-analysis suggested trials that measured physical activity with devices, such as accelerometers, did not produce a significant difference moderate to vigorous physical activity (mean difference, 4.1 min/week [95% CI −1.7 to 9.9, P=.17]; I2=56%, P=.008), but data from trials relying on self-reported physical activity showed an increase of 24 minutes per week among intervention groups (95% CI, 6.3 to 41.8, P=.008; I2 =72%, P <.001).

Further analysis demonstrated interventions were associated with increased likelihood of patients meeting guideline recommendations for moderate to vigorous physical activity by 33% compared with controls (OR, 1.33 [95% CI, 1.17 to 1.50]; P <.001).

In a linked editorial, Tobias Haseler, MB BChir, and Christine Haseler, GP, underline the importance of physical activity in attempts to alleviate the global burden of disease and the need for evidence-based interventions to address subpar rates of achieving recommended physical activity levels across the globe.

“Primary care is an essential partner in global efforts to increase physical activity to levels recommended by WHO, and we now have evidence to support primary care interventions. Future research should focus on identifying the most effective interventions, optimizing outcomes for all population groups, and evaluating how best to decrease sedentary time as well as increasing physical activity,” wrote the pair.

This study, "Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials,” was published in the BMJ.