Brief Counseling and Exercise Referral Scheme: A Pragmatic Trial in Mexico

• Published in: American journal of preventive medicine Vol. 52; no. 2; pp. 249 - 259
• Main Authors: Gallegos-Carrillo, Katia, ScD, García-Peña, Carmen, PhD, Salmerón, Jorge, ScD, Salgado-de-Snyder, Nelly, PhD, Lobelo, Felipe, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2017; Elsevier Science Ltd
• Subjects: Adult; Aerobic exercise; Aged; Behavior; Blood Pressure - physiology; Clinical assessment; Compliance; Counseling; Counseling - methods; Exercise; Exercise - physiology; Female; Health Behavior; Health promotion; Health Promotion - methods; Humans; Hypertension; Hypertension - prevention & control; Inactive; Internal Medicine; Intervention; Male; Medical referrals; Mexico; Middle Aged; Outcome Assessment (Health Care); Patient Compliance; Physical activity; Primary care; Primary Health Care - methods; Proximity; Referral and Consultation; Self Efficacy; Self Report; Social security; Social Support; Treatment Outcome; Mexico
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2016.10.021

Introduction The effectiveness of clinical–community linkages for promotion of physical activity (PA) has not been explored in low- and middle-income countries. This study assessed the effectiveness of a primary care–based, 16-week intervention rooted in behavioral theory approaches to increase compliance with aerobic PA recommendations. Study design Pragmatic cluster randomized trial. Setting/participants Patients had diagnosed (<5 years) hypertension, were aged 35–70 years, self-reported as physically inactive, had a stated intention to engage in PA, and attended Primary Healthcare Centers in the Social Security health system in Cuernavaca, Mexico. Of 23 Primary Healthcare Centers, four were selected based on proximity (5 km radius) to a center. Intervention Each center was randomized to a brief PA counseling (BC, n =2) or an exercise referral (ER, n =2) intervention. The study was conducted between 2011 and 2012. Main outcome measures Change in objectively measured PA levels (ActiGraph GT3X accelerometers) at baseline, 16, and 24 weeks. Intention-to-treat analyses were used to assess the effectiveness of the intervention overall and according to ER intervention attendance. Longitudinal multilevel mixed-effects analyses considering the interaction (time by intervention) were conducted. Each model was also adjusted by baseline value of the outcome measure, demographic and health variables, social support, PA self-efficacy, and barriers. Results Minutes/week of objectively measured moderate to vigorous PA increased by 40 and 53 minutes in the ER and BC groups, respectively ( p =0.59). Participants attending >50% of ER program sessions increased their moderate to vigorous PA by 104 minutes/week and compliance with aerobic PA recommendations by 23.8%, versus the BC group (both p <0.05). Conclusions Both BC and ER led to modest improvements in PA levels, with no significant differences between groups. Adequate adherence with the ER program sessions led to significant improvements in compliance with aerobic PA recommendations versus BC. These results can help guide development and implementation of programs integrating standardized PA assessment, counseling, and referrals via clinical–community linkages in Mexico and other low- and middle-income countries in the region.