Provision of physical activity advice for patients with chronic diseases in Shenzhen, China

Background Physical activity (PA) may best be promoted to patients during clinical consultations. Few studies investigated the practice of PA advice given by physicians, especially in China. This study aimed to investigate the prevalence and contents of PA advice given by physicians in China and its association with patients’ characteristics. Methods Face-to-face questionnaire asking the prevalence and contents of PA advice given by physicians was administered to adult patients in three major hospitals in Shenzhen, China. Attitude of compliance, stature, PA level, and socio-demographic information were also collected. Data was analyzed via descriptive statistics and binary logistic regression. Results Of the 454 eligible patients (Age: 47.0 ± 14.4 years), only 19.2% (n = 87) reported receiving PA advice, whereas 21.8%, 23.0%, 32.2%, and 55.2% of patients received advices on PA frequency, duration, intensity, and type, respectively. Male patients were more likely to receive PA advice from physicians [odds ratio (OR): 1.81; 95% confidence interval (CI): 1.08–3.05], whereas patients who were unemployed (OR: 0.16; 95% CI: 0.04–0.67), and who already achieved adequate amount of PA (OR: 0.29; 95% CI: 0.12–0.71) were less likely to receive PA advice. Conclusions Prevalence of physicians providing physical activity advice to patients is low, there is a pressing need to take intervention measures to educate healthcare providers.

Barriers and facilitators to the use of digital systems in primary care to deliver physical activity advice using COM-B and theoretical domains framework

Background: Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes and cancer; increasing physical activity (PA) is therefore a public health priority. Healthcare professionals (HCPs) in primary care have been identified as being pivotal in addressing physical inactivity, yet few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including a lack of time, confidence or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital systems are used to deliver physical activity advice in primary care consultations, and what factors influence their use.The aim of this study was to understand the use of digital systems to support primary care consultations and to identify the barriers and facilitators to using these systems.Methods: 25 semi-structured interviews were conducted with HCPs in primary care. Professionals were sampled purposively based on profession (general practitioners, practice nurses and healthcare assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. Data were analysed using thematic analysis to identify influences on the use of digital systems. Themes were categorised using COM-B and the theoretical domains framework (TDF) to identify the barriers and facilitators to using digital systems to support the delivery of PA advice in primary care consultations.Results: Identified themes fell within eight TDF domains (linked COM-B component follows in parentheses): Knowledge (Psychological Capability), Skills (Psychological Capability), Environmental Context and Resources (Physical Opportunity), Social Influence (Social Opportunity), Beliefs about Capabilities (Reflective Motivation), Beliefs about Consequences (Reflective Motivation), Reinforcement (Automatic Motivation), and Emotions (Automatic Motivation). The most prominent barrier/facilitator within psychological capability was ‘having the skills to use digital systems’. ‘Training in the use of digital systems’ was also mentioned several times. The most notable barriers/facilitators within physical opportunity were ‘time constraints’, the ‘efficiency of digital systems’, the ‘simplicity and ease of use’ of digital systems, and ‘integration with existing systems’. Other physical opportunity barriers were ‘lack of access to digital systems’ and ‘technical support in the use of digital systems’. With respect to social opportunity, a notable barrier was the sense that ‘digital systems reduce interpersonal communications’ with patients. ‘Patient preference’ was also mentioned as a barrier/facilitator. Several important barriers and/or facilitators were within reflective motivation, including ‘confidence to use digital systems’, ‘beliefs about the usefulness of digital systems’, the ‘belief that digital systems ‘are the way forward’’, ‘beliefs related to data privacy and security concerns’, and ‘perceptions about patient capabilities’. With respect to automatic motivation, barriers/facilitators included ‘familiarity and availability’ regarding digital systems, and the fact that digital systems ‘prompt behaviour’. Conclusions: A variety of influences were identified on the use of digital systems to support primary care consultations. These findings provide a foundation to design a digital system that addresses the barriers and leverages the facilitators to support PA advice provision within primary care, to elicit patient behaviour change and increase PA.

Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain: interventions and promising long-term outcomes

Background There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed. Aim To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period. Methods All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014–2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured ‘clinical reasoning’ using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients’ medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge. Results In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up. Conclusions A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.

Physical Activity Advice for Prevention and Rehabilitation of Low Back Pain- Same or Different? A Study on Device-Measured Physical Activity and Register-Based Sickness Absence

Purpose We lack knowledge on whether the advice of “being physically active” should be the same for prevention and rehabilitation of low back pain (LBP). Sickness absence is a key outcome for LBP prevention and rehabilitation. We investigated the associations between physical activity and long-term sickness absence (LTSA) among employees with and without LBP. Methods Between 2011 and 2013, 925 Danish employees wore a Actigraph GTX3 accelerometer for 1–5 workdays to measure physical activity and reported LBP in past 7 days. Employees were followed for 4 years to determine their first register-based LTSA event (≥ 6 consecutive weeks). Results Among employees with LBP, increasing moderate-to-vigorous-intensity physical activity at work by 20 min and decreasing the remaining behaviors at work (ie., sitting, standing and light-intensity activity) by 20 min was associated with 38% (95% CI 17%; 63%) higher LTSA risk. Increasing light-intensity activity at work by 20 min and decreasing 20 min from the remaining behaviors was associated with 18% (95% CI 4%; 30%) lower risk. During leisure, increasing moderate-to-vigorous-intensity activity by 20 min or standing by 40 min was associated with 26% (95% CI 3%; 43%) lower and 37% (95% CI 0%; 87%) higher risk, respectively. Among employees without LBP, we found no such associations. Conclusions The physical activity advice ought to be different for LBP prevention and rehabilitation to reduce LTSA risk, and specified by domain and activity intensity. At work, employees with LBP should be advised to spend time on light-intensity physical activity and limit their time on moderate-to-vigorous-intensity physical activity. During leisure, employees should spend time on moderate-to-vigorous-intensity physical activity.

Recruitment, Retention and Compliance of Overweight Inactive Adults with Intermediate Hyperglycaemia to a Novel Walking Intervention

This study evaluated the effectiveness of strategies used to recruit and retain overweight, inactive adults with intermediate hyperglycaemia (IHG) to a novel walking programme. Participant compliance to the nine-month randomised controlled trial (RCT) is also presented. Inactive overweight (BMI ≥ 25 kg/m2) adults (N = 42; n = 19 male, n = 23 female) aged between 18–65 years, with IHG were identified via three recruitment strategies (NHS database reviews, diabetic clinics, and a University population). Participants were randomly assigned to either Intervention Group (IG n = 22; n = 11 male, n = 11 female) or Usual Care (UC n = 20; n = 8 male, n = 12 female). IG followed a nine-month novel behaviour change intervention where they walked in accordance with physical activity guidelines using the beat of music to maintain appropriate cadence. UC received standard physical activity advice. Recruitment, retention, and intervention compliance were calculated using descriptive statistics (means or frequencies). Recruiting from a University population was the most successful strategy (64.2% response rate) followed by NHS database reviews (35.8%) and then diabetic clinics (0%). Study retention was ≥80% in both groups throughout the RCT. Intervention compliance was highest from baseline to four months (70.1 ± 39.2%) and decreased as the study progressed (43.4 ± 56.1% at four to six months and 37.5 ± 43.5% at follow-up). In total, 71.4% of IG walking completed throughout the study was at least moderate intensity. A novel walking intervention incorporating the use of music along with behaviour change techniques appears to positively influence the recruitment, retention, and walking compliance of this population.

Provision of Physical Activity Advice for Patients with Chronic Diseases in Shenzhen, China

Background: Physical activity (PA) may best be promoted to patients during clinical consultations. Few studies investigated the practice of PA advice given by physicians, especially in China. This study aimed to investigate the prevalence and contents of PA advice given by physicians in China and its association with patients’ characteristics. Methods: Face-to-face questionnaire asking the prevalence and contents of PA advice given by physicians was administered to adult patients in three major hospitals in Shenzhen, China. Attitude of compliance, stature, PA level, and socio-demographic information were also collected. Data was analyzed via descriptive statistics and binary logistic regression. Results: Of the 454 eligible patients (Age: 47.0 ± 14.4 years), only 19.2% (n = 87) reported receiving PA advice, whereas 21.8%, 23.0%, 32.2%, and 55.2% of patients received advices on PA frequency, duration, intensity, and type, respectively. Male patients were more likely to receive PA advice from physicians [odds ratio (OR): 1.90; 95% confidence interval (CI): 1.13-3.21], whereas patients who were unemployed (OR: 0.16; 95% CI: 0.04-0.67), and who already achieved adequate amount of PA (OR: 0.29; 95% CI: 0.12-0.70) were less likely to receive PA advice. Conclusions: Prevalence of physicians providing physical activity advice to patients is low, there is a pressing need to take intervention measures to educate healthcare providers.

Laying the Foundation for Pregnancy Physical Activity Profiling: A Framework for Providing Tailored Physical Activity Advice and Guidance to Pregnant Women

The aim of this study was to examine the predictive utility of the theory of planned behaviour (TPB) in explaining pregnant women’s physical activity (PA) intentions and behaviour and to scrutinise the role of past behaviour within this context. Pregnant women (n = 89) completed the pregnancy physical activity questionnaire (PPAQ) and newly developed TPB questionnaire on two separate occasions during their pregnancy. Analyses were carried out in relation to three scenarios. Firstly, when considering the original TPB, intention emerged as the strongest determinant of pregnant women’s PA behaviour. Secondly, controlling for past behaviour attenuated the influence of intention and perceived behavioural control on behaviour, with neither of the original variables providing a unique influence. Finally, the addition of past behaviour added significantly to the prediction of intention with the model as a whole, explaining 85% of the variance in pregnant women’s PA intention, and with past behaviour uniquely contributing 44.8% of the variance. Pregnancy physical activity profiling based on intention and behaviour status is subsequently introduced as a novel and practical framework. This provides healthcare professionals with the opportunity and structure to provide tailored advice and guidance to pregnant women, thereby facilitating engagement with PA throughout motherhood.

Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review

Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010–2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.