Effectiveness of physical activity prescription by primary care nurses using health assets: A randomized controlled trial

• Published in: Journal of advanced nursing Vol. 77; no. 3; pp. 1518 - 1532
• Main Authors: Riera‐Sampol, Aina, Bennasar‐Veny, Miquel, Tauler, Pedro, Aguilo, Antoni
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.03.2021
• Subjects: Activity level; Adherence; Assets; Cardiovascular diseases; Clinical outcomes; Clinical research; Clinical trials; Control groups; Exercise; Health promotion; Health status; Intervention; Interviews; nurse prescribing; Nurses; Nursing; Physical activity; Physical fitness; Primary care; randomized controlled trials; Risk factors; Sense of coherence; Sleep; Sociodemographics; randomized controlled trials; primary care; nurse prescribing
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14649

Aim To evaluate the effectiveness of a 12‐month multifactorial intervention by primary care nurses using health assets in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors. Background Physical activity promotion is a priority and helps to decrease mortality risk due to cardiovascular diseases. However, adherence to the habitual physical activity prescription in primary healthcare settings is low. Design Multicentre, single‐blind, parallel randomized (in two different branches) clinical trial. Methods In total, 263 participants from 20 primary healthcare centres in Mallorca completed the randomized controlled trial study (intervention group N = 128, control group N = 135). The intervention consisted in four visits and included a motivational interview and an individualized prescription of physical activity using health assets. Primary outcome measure was the number of participants performing at least 150 min of weekly physical activity. Secondary outcomes included physical activity level and physical fitness, Sense of Coherence, cardiovascular risk, sociodemographic data, trans‐theoretical stage of change, sleep quality, and depression. Results Adherence to the recommendation of at least 150 min of physical activity was higher in the intervention than in the control group (χ2 = 3.951, p = .047). However, this higher adherence did not suppose higher physical activity levels because no differences between groups were found in the total physical activity performed after intervention (t=−0.915, p = .361). At the end of the intervention participants randomized to the intervention group spent more time walking than participants in the control group (t = 2.260, p = .025). Conclusion The multifactorial intervention performed by primary care nurses induced a higher adherence to the 150‐min of weekly physical activity recommendation. Impact Adherence to the usual physical activity prescription in primary care is low. Physical activity prescription performed by primary care nurses and based on health assets and motivational interview can help to increase physical activity levels of patients. The main finding of the present study was that prescription using this approach was shown to be effective, leading to a higher adherence in the intervention group. This intervention is feasible in the nurse's primary healthcare setting, thus it could be implemented as the main tool when exercise is prescribed. Trial Registration International Standard Randomized Controlled Trial Number: ISRCTN76069254. 摘要 目的 评估初级护理护士利用健康资产对有两个或两个以上心血管危险因素的患者进行为期12个月的多重危险因素干预, 以提高对体力活动处方 (150分钟/周) 依从性的有效性。 背景 应优先提升体力活动, 其有助于降低心血管疾病而死亡的风险。然而, 在初级保健机构中, 很少有人能坚持习惯性体力活动处方。 设计 多中心、单盲、平行随机 (两个分支) 临床试验。 方法 总共有来自马略卡岛20个初级保健中心的263名参与者完成了随机对照试验研究 (干预组N=128, 对照组N=135) 。干预包括四次视察, 包括动机访谈和使用健康资产的体力活动的个性化处方。主要结果是参与者每周至少进行150分钟体力活动的人数。次要结果包括体力活动水平和身体素质、连贯性、心血管风险、社会人口统计学数据、跨理论变化阶段、睡眠质量和抑郁。 结果 干预组对至少150分钟体力活动的坚持程度高于对照组 (χ2=3.951,p=.047) 。然而, 这种更高的依从性并不意味着更高的体力活动水平, 原因是未在干预后进行的总体力活动发现组间差异 (t=‐0.915,p=.361) 。干预结束时, 随机分入干预组的参与者比对照组的参与者花在步行上的时间更长(t=2.260,p=0.025) 。 结论 由初级护理护士实施的多因素干预导致使患者更依从每周150分钟体力活动建议。 影响 在初级护理中, 很少有人坚持通常体力活动处方。由初级护理护士根据健康资产和动机访谈制定的体力活动处方有助于提高患者的体力活动水平。本研究的主要发现是, 使用该方法的处方被证明是有效的, 导致干预组的依从性更高。这种干预在护士的初级保健机构中是可行的, 因此在规定运动时, 其可以作为主要实施工具。 试验注册 国际标准随机对照试验编号:ISRCTN76069254.