Abstract
BackgroundAlthough the benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited. Exercise-referral schemes have emerged as one effective approach to promote PA; however, there is uncertainty about the feasibility and effectiveness of these schemes in settings outside high-income countries. This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities (PHCU) of the Mexican social security institution to a group PA program offered in the same institution.Methods and designWe will describe the methods of a cluster randomized trial study designed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme. Four PHCU were selected for the study; the PHCU will take part as the unit of randomization and sedentary hypertensive patients as the unit of assessment. 2 PHCU of control group (GC) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely. 2 PHCU of intervention group (IG) will refer patients to sports facilities at the same institution, to follow a group-based PA program developed to increase the PA levels with a designed based on the Transtheoretical Model and Social Cognitive Theory. To evaluate the effects of the intervention as well as short-term maintenance of the intervention’s effects, PA will be assessed at baseline, at 24 and 32 weeks of follow-up.The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups. PA will be measured through self-report and with objective measure by accelerometer.DiscussionThis study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system. Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical populations in Mexico and Latin America.Trial registrationClinicaltrials.gov Identifier: NCT01910935. Date of registration: 07/05/2013.
Highlights
The benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited
The aim of this study is to evaluate the effectiveness of an Mexico’s Social Security Institution (MSSI) Primary Health Care (PHC)-based physician to a PA- referral scheme designed to help chronically ill patients to increase PA, in order to perform recommended levels of PA (150 minutes at week of moderate to vigorous intensity)
Based on previous experiences [20,21,22,23], the PA program will be considered effective if it achieves an increase of 20% in the proportion of hypertensive patients in the intervention group defined as active compared to control group, at the end of the intervention (24 weeks) to evaluate adherence and at 32 weeks to assess the sustainability of intervention effects
Summary
We will measure change over time in the following tests of functional capacity: walking distance (6 minute walk test) [37], maximum heart rate and 1 minute heart-rate recovery [38]; these measurements will be taken at baseline, 24 and 32 weeks too These variables will be used as a complementary assessment of participant’s functional capacity and not as the primary outcome of the study. Secondary outcomes Outcomes assessed in the intervention and control groups at 24 and 32 weeks will be: a) blood pressure levels; b) biochemical markers: triglycerides, total cholesterol and HDL, fasting glucose; c) anthropometric measures: weight, BMI, hip and waist circumference to calculate waist/hip ratio; d) social/psychological measures: attitude towards PA participation based on Prochaska’s stages of change model [29], PA self-efficacy [39] health related quality of. Measurement procedures are described here: Physical activity measurement Amount of PA will be measured with objective and selfreport instruments
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