Levels of Adherence of an Exercise Referral Scheme in Primary Health Care: Effects on Clinical and Anthropometric Variables and Depressive Symptoms of Hypertensive Patients.

Katia Gallegos-Carrillo,Nelly Salgado-De-Snyder,Felipe Lobelo,Jorge Salmerón,Carmen Garcia-Peña

doi:10.3389/fphys.2021.712135

Abstract

Among the modifiable health behaviors, physical activity (PA) promotion has been one of the challenges in primary care, particularly how to translate the results of proven interventions and implement them in the real world. This study was aimed to compare whether two programs designed for hypertensive patients achieve changes in clinical and anthropometric variables, quality of life, and depressive symptoms; and if higher levels of adherence to one of the interventions using an exercise referral (ER) approach achieved better health outcomes. Pragmatic cluster randomized trials were carried out in four Primary Health Care Units (PHCUs). Physicians in the PHCUs identified hypertensive patients and assessed whether they were eligible to be part of this trial. Each center was randomized to a brief PA counseling (BC, n = 2) or an exercise referral (ER, n = 2) intervention to conducted PA programs among hypertensive patients aged 35–70 years, self-reported as physically inactive. Outcome variables included changes in blood pressure levels, triglycerides, HDL cholesterol, fasting glucose, body mass index, waist/hip ratio, abdominal obesity, and metabolic syndrome risk score, health-related quality of life, and depressive symptoms. Longitudinal multilevel analyses assessed the effects of the BC and ER programs and the level of adherence of the ER on clinical, anthropometric, and mental health variables, models were linear for continuous variables, and logistic for dichotomous variables. Differences were observed in triglycerides, BMI, metabolic risk scores variables, and depressive symptoms among ER and BC programs. In addition, differences in the ER group were observed according to the level of adherence in blood pressure levels, waist circumference and waist/hip ratio, depressive symptoms, and the mental health component of health-related quality of life. An ER program in comparison to a BC intervention is promoting changes in some specific health indicators of hypertensive patients, showing the usefulness of these PA programs in primary health care facilities.

Highlights

In the global health community, one of the greatest challenges is how to translate the results of proven interventions and implement them in the real world
The proportion of participants in the exercise referral schemes (ERs) and brief counseling (BC) group who met physical activity (PA) recommendations in both T1 and T2 was higher in the ER group (32.4%) than in the BC (25.4%), Body Mass Index (BMI) values were lower in participants meeting PA recommendations in T1 and T2 in comparison with those meeting PA recommendations in T1 only, BMI = 32.6 vs. 28.2 in the ER and BMI = 28.5 vs. 28.2 for the BC group
The percentage change observed in systolic and diastolic blood pressure was not statistically significantly different in longitudinal multilevel analyses, blood pressure levels decreased in the BC group and remained at the same levels in the ER group

Summary

Introduction

In the global health community, one of the greatest challenges is how to translate the results of proven interventions and implement them in the real world. Part of this challenge resides on the individuals themselves who are responsible for making these recommendations. Among the strategies to increase PA levels exercise referral schemes (ERs) provide a promising alternative to PA promotion, facilitating changes in behavior in the at-risk population (Dugdill et al, 2005; Pavey et al, 2011)

Objectives

Results

Discussion

Conclusion