Physical Activity Prescription Research Articles

Factors that influence the prescription of physical activity: a cross sectional survey

Factors that influence the prescription of physical activity: a cross sectional survey

Poster (Clinical/Best Practice Implementation) ID 1984967

Background Assessment of physical activity (PA) prescription recall and serum screening for dyslipidemia are critical to describe and mitigate Cardiometabolic Disease (CMD) risk among adults with spinal cord injury or disease (SCI/D). Objectives To report: 1) the frequency of PA prescription recall; and, 2) the frequency of lipid profile assessment and interpretation recall among inpatients with SCI/D during rehabilitation. Methods Adults with SCI/D completed the SCI-HIGH CMD intermediary outcome indicators. A Kinesiologist collected data via interview and chart abstraction among UHN inpatients. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics were used to characterize the participant’s age, sex, impairment characteristics, and report recall rates and the frequency of lipid screening/interpretation. Based on the participant’s needs, either educational materials to increase future adherence to PA guidelines and/or a Mediterranean diet were provided. Results Adult inpatients (n=124), mean age 59 years, 64% paraplegic, and 36% female participated. In total, 14% of participants (16/117) reported being taught the benefits of PA for their heart health; of whom 69% (11/16) recalled exercise instruction. Similarly, 15% of inpatients (17/114) recalled lipid screening during rehabilitation, although chart abstraction revealed that 30% (37/124) had completed lipid screening. Clinical interpretation of their lipid values was recalled by 30% of inpatients. Conclusion There is a significant opportunity to advance PA instruction and lipid profile education and management among inpatients with SCI/D to reduce CMD risk. Inclusion of PA and lipid management instructions in patient-oriented discharge summaries may enhance patient recall/adherence.

Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation?

Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.

It’s Time to Move: Integrating Physical Activity Assessment, Prescription, and Referral through Policy and Systems Change

It’s Time to Move: Integrating Physical Activity Assessment, Prescription, and Referral through Policy and Systems Change

Evaluation of a Nature Prescription Program in Schools to Increase Nature-Based Physical Activity and Time Spent Outdoors: Implementation of the Kids in Parks TRACK Rx Program by the School Nurse.

This study assessed the effectiveness of the TRACK Rx program. Track Rx is a program for healthcare professionals to counsel and prescribe outdoor physical activity (PA) to children. The program was implemented by a school nurse to increase children's time spent outdoors, increase a child's nature-based PA, and increase parents' intention for their child to spend time outdoors. Parents/guardians of children in 1st-3rd grade (intervention = 51; control = 27) completed a baseline and 3-month follow-up survey. Children's nature-based PA significantly increased on the weekend in the intervention group compared to the control group. There was no significant change in the other study variables. Parental trust in the school nurse was similar to parent trust in their child's primary health care provider. School nurses can implement TRACK Rx and other nature and nature-based PA prescription programs throughout the school (classroom, physical education, recess, and after-school programming).

Comparing physical activity prescription with verbal advice for general practice patients with cardiovascular risk factors: results from the PEPPER randomised controlled trial

BackgroundRegular physical activity improves health and quality of life for people with cardiovascular risk factors. However, few studies have demonstrated the applicability of strategies in health care to promote physical activity.ObjectiveTo evaluate if a written physical activity prescription combined with pedometer increases physical activity over one year compared with verbal advice in patients with cardiovascular disease risk in primary care.MethodsThe randomised-controlled, interventional, 12-month PEPPER study recruited patients aged 35 to 74 years, having quarterly followed-ups for hypertension, dyslipidaemia, or diabetes, and judged insufficiently active. Seventeen practices randomised patients into either the experimental group, who received a written, personalised prescription for daily step numbers, pedometer and logbook, or control group, who received verbal advice to do at least 15 min of rapid walking or equivalent daily. The primary outcome was the change in total weekly energy expenditure measured using an accelerometer at 3 months. The secondary outcomes were changes in step count, physical activity levels, quality of life, perceived obstacles to physical activity, and biomedical indicators at 3 and 12 months.ResultsOne hundred and twenty-one participants were randomised. Although, weekly energy expenditure did not differ between the prescription and verbal instruction group, the estimated time spent doing moderate-intensity activity was significantly higher in the prescription group than the verbal group by an average of four minutes/week (p = 0.018)(95% CI [0.7 – 7.4]) reaching 48 min after 12 months (95% CI: 8 – 89). Similarly, this was associated with a clinically, higher average step number of 5256 steps/week increase over a year (95% CI: 660 – 9852). Among the most sedentary subgroup, walking less than 5000 steps/day at baseline, an 8868 steps/week (95% CI [2988 – 14700]) increase was observed in the prescription group.ConclusionPrescribing physical activity did not significantly modify total weekly energy expenditure, but slightly increased moderate-intensity activity duration and step counts, particularly among the most sedentary participants. Prescribing personalised physical activity goals encourages sedentary patients to engage in physical activity.Trial registrationThe PEPPER trial is registered in the US National Institutes of Health Clinical Trials Registry under number NCT02317003 (15/12/2014).

The Physical Activity Vital Sign and associations with cardiometabolic risks in people with bipolar disorder in a low-income country

BackgroundThe mortality gap compared with the general population is with 29 years of potential life lost for people with bipolar disorder (BD) highest in Africa. The most significant contributor to premature mortality are preventable cardiovascular diseases due to an unhealthy lifestyle. This study investigated if the Physical Activity Vital Sign (PAVS), i.e. two questions which clarify if someone meets the recommended 150 min of physical activity (PA) per week, can identify patients with BD at higher risk of cardiometabolic abnormalities and mental health symptoms in a low-income country from Sub-Sahara Africa. Methods99 (54♀) Ugandan in- and outpatients (mean age = 34.5 ± 9.4 years) with BD completed the PAVS and Brief Symptoms Inventory-18. Participants were screened for abdominal obesity (waist circumference > 90 cm), overweight (body mass index≥25) and hypertension (systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg). Results49.5 % (n = 49) met the PA recommendation. 43.4 % (n = 43) were overweight, 43.3 % (n = 43) had abdominal obesity and 20.2 % (n = 20) hypertension. Those who did not meet the PA recommendation were older (37.1 ± 10.4 versus 32.2 ± 7.7 years, p = 0.009), had a higher BSI-18 somatisation score (13.7 ± 4.5 versus 10.4 ± 4.2, p = 0.026), and a higher risk for overweight [relative risk (RR) = 2.99, 95 % confidence interval (CI) = 1.69–5.29], abdominal obesity (RR = 1.92, 95%CI = 1.19–3.09), and hypertension (RR = 2.23, 95%CI = 1.02–4.88). ConclusionsThe PAVS might be an important risk identification tool in patients with BD in low-income countries such as Uganda. The low-cost and brevity of the PAVS may help promote the importance of PA assessment and prescription as a core part of the treatment of patients with BD in low-income settings.

Association between physical activity education and prescription during prenatal care and maternal and fetal health outcomes: a quasi-experimental study

BackgroundPhysical activity (PA) during pregnancy is associated with healthy gestational weight gain (GWG) and a reduced risk of developing gestational diabetes (GD), gestational hypertension (GHT) and fetal macrosomia. However, in Canada, less than 20% of pregnant women meet PA recommendations. This study assessed associations between an intervention including PA education by prenatal nurses and a PA prescription delivered by physicians and fetal and maternal outcomes.MethodsThis is a quasi-experimental study. Two groups of women who received their prenatal care at the obstetrics clinic of a university hospital were created. In the first group, 394 pregnant women followed at the clinic received standard care. In the second group, 422 women followed at the clinic received standard care supplemented with education on the relevance of PA during pregnancy and a prescription for PA. Data for both study groups were obtained from the medical records of the mothers and their newborns. Logistic regressions were used to compare the odds of developing excessive GWG, GD, GHT, and fetal macrosomia between the two study groups.ResultsThe addition of PA education and PA prescription to prenatal care was associated with 29% lower odds of developing excessive GWG (adjusted odds ratios (OR) 0.71, 95% confidence intervals (CI) 0.51–0.99), 73% lower odds of developing GHT (0.27, 0.14–0.53), 44% lower odds of fetal macrosomia (> 4 kg) (0.56, 0.34–0.93), and 40% lower odds of being large for gestational age (0.60, 0.36–0.99). The intervention was not associated with a difference in odds of developing GD (0.48, 0.12–1.94).ConclusionsThe inclusion of education and prescription of PA as part of routine prenatal care was associated with improvements in maternal and fetal health outcomes, including significantly lower odds of GWG, GHT and macrosomia.

Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context

ABSTRACT Background Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important. Objective The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder. Method A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison. Results The analysis of the data was developed into the core category ‘trying to integrate physical activity into daily life in a sustainable way’, and three categories: ‘acceptance of being good enough’, ‘learning physical activity by doing’ and ‘advocation for physical activity in rehabilitation’. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was ‘good enough’ in terms of dose and intensity of physical activity, and how to listen to the body’s signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested. Conclusion Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.

Cardiovascular disease in South Asian Canadians: using risk factors to target primary and secondary prevention

Cardiovascular disease incidence and risk profiles vary substantially across ethnicities within Canada, with South Asians carrying a disproportionately high burden of disease. South Asians exhibit high incidences of modifiable risk factors that predispose them to cardiovascular disease: dyslipidemia, hypertension, diabetes, and physical inactivity. As well as a genetic predisposition through elevated lipoprotein(a) levels. Dietary and physical activity prescriptions must consider South Asian culture and barriers they face. These include culturally tailored dietary guidelines and women-only fitness centres. Lipoprotein(a), an atherogenic molecule, is genetically determined and elevated in South Asians but may be modified with antisense oligonucleotide therapy. This therapy warrants consideration as part of the treatment algorithms for South Asians with elevated lipoprotein(a) levels. Introducing these practices into primary and secondary prevention guidelines may reduce the cardiovascular disease burden seen in South Asians.

"Methods and Barriers to the Prescription of Physical Activity to Patients with Chronic Illness: The Viewpoint of General Practitioners"

"Methods and Barriers to the Prescription of Physical Activity to Patients with Chronic Illness: The Viewpoint of General Practitioners"

A Delphi-type study with medical doctors to develop a physical activity prescription

Breaking the capacity barrier in intercalation-type anode materials for lithium-ion batteries while preserving other essential electrochemical properties remains a significant challenge. Here, using perovskite SrVO3 as a model, we demonstrate the feasibility of employing defect engineering to provide extra active sites for electrochemical reactions. Defective SrxVO3-δ samples with a unique amorphous-crystalline dual-phase structure are successfully prepared by regulating the nonstoichiometric Sr/V ratio and using a non-equilibrium solution combustion strategy to alleviate nucleation. The dual-phase SrxVO3-δ electrodes, which take advantage of both the high defect concentration advantage of amorphous and the high electrical/ionic conductivity of crystalline, give a high specific capacity of 508 mAh/g at a safe potential of 1.0 V vs. Li/Li+, showing a 40% increase over SrVO3 electrodes and outperforming most state-of-the-art intercalation-based anodes. In addition, when coupling with LiFePO4 cathode, the SrxVO3-δ electrodes can operate over 10,000 cycles with 91% capacity retention, overcoming the limited structural stability exhibited in typical defective electrodes. The study demonstrates the viability of modulating the crystallinity in intercalation-based anodes to enhance electrochemical performance and paves the way for the advancement of Li-ion battery technology.

Survey of emergency medicine doctors in London physical activity characteristics, awareness of guidelines and prescribing behaviours

ObjectiveTo determine London emergency medicine (EM) doctors’ physical activity (PA) characteristics, awareness of PA guidelines and PA prescription practice from London emergency departments (EDs).MethodsAn anonymous online survey of EM doctors...

What are the physiologic effects of Resistance Exercise behind breast cancer-related lymphedema prevention?

Research in the last decades' haven driven a paradigm shift in the approach to physical activity and exercise prescription in breast cancer survivors. Clinical guidelines have moved from bedrest dogma and avoiding strenuous activity in the upper limb to recommending resistance exercise (RE). In recent years, scientific evidence has shown that RE in the upper extremities can even have a preventive effect on breast cancer-related lymphedema (BCRL). This knowledge was achieved thanks to systematic reviews with meta-analyses analyzing variables related to RE programs on lymphatic response and volumetry. However, other variables related, such as inflammation or acute responses, have been less addressed. The hypothesis presented in this paper is that there are both acute and chronic inflammatory and lymphatic response to exercise, systemic effects such as arm volume and body composition changes and unknown physiologic mechanics which contribute to BCRL prevention.

Exploring How Active and Insufficiently Active Individuals Respond to Specific and Non-Specific Physical Activity Goals

ABSTRACT Purpose: This study aimed to extend understanding of goal setting in physical activity (PA) by exploring qualitatively active and insufficiently active individuals’ experiences of pursuing specific and non-specific goals. Methods: Twelve active (M age = 25.00 years) and nine insufficiently active (M age = 24.33 years) adults were interviewed after participating in three 6-minute walking tests, during which they pursued specific and non-specific (open and DYB) goals and completed a no-goal control condition. Content analysis was used to examine each subgroup independently, before a between-group comparison to explore similarities and differences in experiences was undertaken. Results: Several strategies were employed to enhance trustworthiness. Our analysis was organised into seven categories: (1) perception of challenge; (2) perceived control; (3) performance satisfaction; (4) motivational intensity; (5) enjoyment; (6) self-efficacy; and (7) strategies for pursuing goals. Our findings suggest that active participants responded more positively to specific goals, with differences in the cognitions experienced before, during, and after the goal conditions. Conversely, insufficiently active participants responded more positively to non-specific goals, with differences in the cognitions experienced before, during, and after the goal conditions and more negatively to specific goals. Conclusion: Findings extend understanding of specific and non-specific goals in PA and underline the need to consider goal specificity in the prescription of PA for certain population groups most in need of intervention.

What do spontaneous coronary artery dissection survivors want to support their recovery? A qualitative study.

Spontaneous Coronary Artery Dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction predominantly affecting women aged under 50 years. There is limited research addressing female and male SCAD survivors' experience of, or requirements for, support post-SCAD. This study explored what SCAD survivors wanted to support recovery. A qualitative study using semi-structured video and telephone interviews. Data were analysed through thematic analysis using the framework approach. We interviewed 20 participants (19 females) with a mean age of 54.6 (+/-SD 8.5 years). Three overarching themes encapsulated participants' views about support requirements. 1) Education and information. Participants thought healthcare professionals involved in diagnosis and supporting recovery required greater awareness of SCAD and the psychological effect of SCAD. They wanted accessible SCAD information immediately post-event and during the educational component of cardiac rehabilitation. 2) Physical Activity. Requirements were for advice tailored to individuals' specific needs, physical capabilities, and physical activity preferences. Participants suggested that utilising wearable technology was helpful to encourage a safe return to activity. 3) Psychosocial Support. Participants wanted formal psychosocial support immediately post-event, during cardiac rehabilitation and in the longer term. Better healthcare professional training may improve diagnosis and increase support and awareness of SCAD. SCAD support programmes should provide early SCAD specific education utilising online sources, individually tailor physical activity prescription, offer wearable technology to support a return to being active, and provide short- and longer-term psychosocial support. As SCAD is predominately a female condition, programmes should consider female physical activity preferences.

Influence of smartphone-based physical activity intervention on executive functions and cardiometabolic disease risk in obese young adults: a pilot randomised controlled trial

PurposeSmartphone is an impending solution to influence long-term behavior change, including physical activity; however, the evidence regarding personalized prescription remains mixed in obese. We aimed to explore the influence of smartphone-based physical activity promotion on weight loss and cognitive functions in obese young adults.MethodsIn our pilot randomised controlled trial, 24 obese adults were randomized to two conditions: (1) EXI group receiving a smartphone-application based personalized physical activity prescription; (2) CONT group continuing their routine work for eight weeks. Executive functions and cardiometabolic risk variables [body and fat mass, waist circumference (WC), blood pressure (BP)] and executive functions were measured before and after eight weeks.ResultsOur study findings revealed a significant improvement in reaction times with overall (H = 7.71, p = 0.005), congruent stimuli (H = 4.43, p = 0.03) and incongruent stimuli (H = 5.35, p = 0.02) between groups. Though EXI participants reduced their fat mass by 5.07 kg more than CONT group users after eight weeks, the findings were statistically insignificant. Similarly, our study did not find significant differences in body mass, WC, BP or accuracy between EXI and CONT groups. There was a decreased user engagement (H = 5.80, p = 0.564) after the 3rd week of the study period.ConclusionShort-term smartphone-based physical activity programs may offer favourable cognitive benefits to young adults; however, the weight loss benefits remain unconvincing.Trial RegistrationThe study was registered prospectively with the Clinical Trials Registry of India (CTRI/2022/02/040202).

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis

BackgroundIn 2020, the World Health Organization (WHO) released the first global physical activity and sedentary behaviour guidelines for children and adults living with disability. The evidence informing the guidelines though is not specific to people living with traumatic brain injury (TBI), but rather comes from other disabling conditions such as Parkinson’s disease, and stroke. There remains a clear lack of direct evidence of the effects of physical activity for people living with TBI. The objective of this rapid review was to identify direct evidence of the effect of physical activity on health outcomes in people with moderate-to-severe TBI to inform adaptation of the WHO physical activity guidelines into clinical practice guidelines.MethodsWe conducted a rapid systematic review with meta-analysis of randomised controlled trials, including people of any age with moderate-to-severe TBI, investigating physical activity interventions compared to either usual care, a physical activity intervention with different parameters, or a non-physical activity intervention. Four databases (CENTRAL, SPORTDiscus, PEDro, Ovid MEDLINE) were searched from inception to October 8, 2021. The primary outcomes were physical function, cognition, and quality of life.ResultsTwenty-three studies were included incorporating 812 participants (36% females, majority working-age adults, time post-TBI in studies ranged from 56 days (median) to 16.6 years (mean)). A range of physical activity interventions were evaluated in rehabilitation (n = 12 studies), community (n = 8) and home (n = 3) settings. We pooled data from the end of the intervention for eight outcomes. Participation in a virtual reality physical activity intervention improved mobility, assessed by the Community Balance and Mobility Scale (range 0 to 96; higher score indicates better mobility) more than standard balance training (two studies, 80 participants, Mean Difference = 2.78, 95% CI 1.40 to 4.16; low certainty evidence). There was uncertainty of effect for the remaining outcomes, limited by small sample sizes, diverse comparators and a wide range of outcome measures.ConclusionThis review consolidates the current evidence base for the prescription of physical activity for people with moderate-to-severe TBI. There remains a pressing need for further rigorous research in order to develop practice guidelines to support clinical decision-making when prescribing physical activity in this population.

Knowledge, Attitudes and Practices of Healthcare Provider’s Regarding Physical Activity during Pregnancy

Objective: To assess knowledge, attitudes, and clinical practices of healthcare providers (HCP) regarding physical activity (PA) during pregnancy. Methodology: A convenient sample of 132 HCP, including General Practitioners, Obstetricians/Gynaecologists and Registered Nurses participated in this cross sectional, descriptive study. Data pertaining to their knowledge, beliefs, and practices regarding PA during pregnancy was collected using interviewer-administered 36 item questionnaire. Descriptive statistics and frequency tables were calculated and compared for the responses. Result: Overall 97% of participants believed that PA during pregnancy is beneficial but 58.3% agreed that advising patients regarding PA during pregnancy is not a major component of their antenatal care and 63.5% doesn’t include any individualized recommendation on exercise for pregnant women. Although HCPs beliefs and attitude responses were largely positive regarding exercise in pregnancy however there was misalignment between the published recommendations and clinical practice. Conclusion: HCPs can serve an important role in women's health behaviours through promotion of physical activity adherence during and after pregnancy by providing appropriate advice and counselling regarding PA during pregnancy. The current study found that HCPs lacked adequate knowledge and awareness of the optimal PA during pregnancy and were unable to provide proper counselling for the same despite of majority of them having positive belief and attitude towards PA during pregnancy. In order to effectively promote prenatal PA in clinical or community settings, more research is required to study the PA prescription and counselling practices of HCPs and knowledge of challenges impeding successful delivery of the aforementioned.

Latent profile analysis of physical activity motivation during behavioral weight loss treatment

Participants in behavioral weight loss (BWL) treatment often struggle to meet and maintain physical activity (PA) prescriptions; improving participants’ motivation for the behavior is a potential intervention strategy. Self-Determination Theory (SDT) outlines a continuum of qualitatively different dimensions of motivation, suggesting that more self-determined forms of motivation should predict more PA, whereas less self-determined forms of motivation should be unrelated or negatively related to PA. Although SDT has ample empirical support, most existing research in this area has used statistical analyses that oversimplify the complex, interdependent relationships between dimensions of motivation and behavior. This study’s purpose was to explore commonly occurring motivational “profiles” for PA based on the SDT dimensions of motivation (amotivation, external, introjected, integrated/identified, and intrinsic motivation) and how these profiles relate to PA behavior among participants with overweight/obesity (N = 281, 79.4% female) at baseline and six months into BWL treatment. Latent profile analysis determined that three motivational profiles fit the data best at both timepoints and the profile characterized by high self-determined (i.e., integrated/identified and intrinsic) motivation and moderate introjected motivation was by far the most common. There were no differences in physical activity behavior across motivational profiles, which contrasts previous literature. Findings suggest that participants who take the initiative to sign up for intensive BWL programs may have sufficiently high PA motivation, which may be a poor predictor of their actual behavior. Future research should examine these relationships later in treatment, when motivation may have more variability, as well as among participants who initiate lower-commitment weight loss programs (e.g., self-help).