Physios play key role in delivering physical activity interventions in primary care settings
Physiotherapists deliver many of the exercise programmes that have been shown to help people to lose weight and exercise more, according to a paper published in the latest issue of The BMJ.
It was written by a UK-based team led by Victoria Kettle, a research associate at the centre for lifestyle medicine and behaviour at Loughborough University’s school of sport, exercise and health sciences. One of her co-authors is Amanda Daley, who is professor of behavioural medicine at the centre.
The researchers found that exercise interventions delivered to adults in primary care settings boost activity levels deemed to be of a ‘moderate to vigorous intensity’ by an average of 14 minutes a week. As well as physios, GPs and nurses delivered many of the interventions in the trials the team considered, with others also involving health educators, counsellors, exercise specialists, dietitians and researchers.
Small gains are important
Acknowledging that the effect they detected might seem modest, the researchers stress that even small increases in moderate to vigorous intensity physical activity help to reduce the risk of disease and death.
World Health Organization (WHO) guidance, which was updated in 2020, recommends that adults clock up from 150 to 300 minutes of ‘moderate intensity’ physical activity each week. They might, for example, walk briskly, dance or mow the lawn. Alternatively, adults might log from 75 to 150 minutes every week undertaking a physical activity at a ‘vigorous intensity’ level (such as running, swimming or climbing stairs). The WHO encourages people to exceed these targets.
But Dr Kettle and her colleagues point out that many physical activity programmes have been ineffective, with one adult in four failing to reach the required levels of physical activity. Participation rates do not appear to have improved during the past two decades, they note.
As most adults visit their general practice once a year, primary care-based health professionals are well placed to prompt patients and provide them with physical activity interventions on a routine basis. However, previous studies of physical activity interventions delivered in primary care have reported mixed results and few have investigated their effect on increasing moderate to vigorous intensity physical activity (MVPA).
Weight loss achieved
The team reviewed 51 trials involving more than 16,000 adults comparing aerobic based physical activity interventions delivered in primary care with usual care (controls). MVPA was measured using self-reported feedback in 37 trials and via a device in 14 trials. The length of trial follow-up ranged from one month to five years. Overall, the researchers found that participants in the intervention groups increased MVPA by a modest 14 minutes a week on average relative to controls and were also more likely than controls to meet guideline targets for MVPA.
Trials that measured physical activity with devices, found no significant difference in MVPA between groups, while trials relying on self-reported activity showed an increase of 24 minutes a week in intervention groups. Interventions involving five or more contacts with health professionals, longer follow-up, or those delivered by primary care plus other professionals were associated with greater improvements.
Finally, in trials that measured weight, intervention participants weighed 1 kg less than controls at follow-up. While this gain might appear modest, the researchers point out it is important because adults typically gain about 0.5-1 kg a year, which can contribute to the development of obesity over time.
This large, comprehensive review means that direct comparisons can be made with the WHO physical activity guidelines to inform health policy decisions internationally. The researchers acknowledge that their study had some limitations, such as differences in the design and quality of the included trials, but say these were adjusted for in the analyses. While they acknowledge that self-reporting might overestimate physical activity, they say their results do not appear to be implausibly inflated. The National Institute for Health Research provided funds towards the study.
Conclusions
These data could help health professionals, policy makers, and healthcare commissioners make evidence based decisions about implementing physical activity interventions during consultations delivered in primary care [Victoria Kettle et al.]
Dr Kettle and her colleagues conclude: ‘Physical activity interventions delivered by health professionals in primary care settings appear effective in increasing participation in physical activity as measured by self-report and reducing weight in adults.’
They add: ‘These data could help health professionals, policy makers, and healthcare commissioners make evidence based decisions about implementing physical activity interventions during consultations delivered in primary care.'
To read the full version of the paper, titled Research: Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials, visit: https://www.bmj.com/content/376/bmj-2021-068465
Author: Ian A McMillan
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