Effectiveness of physical activity prescription by primary care nurses using health assets: A randomized controlled trial

Abstract

Aim: To evaluate the effectiveness of a 12-month multifactorial intervention by primary care nurses using health assets in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors. Background: Physical activity promotion is a priority and helps to decrease mortality risk due to cardiovascular diseases. However, adherence to the habitual physical activity prescription in primary healthcare settings is low. Design: Multicentre, single-blind, parallel randomized (in two different branches) clinical trial. Methods: In total, 263 participants from 20 primary healthcare centres in Mallorca completed the randomized controlled trial study (intervention group N = 128, control group N = 135). The intervention consisted in four visits and included a motivational interview and an individualized prescription of physical activity using health assets. Primary outcome measure was the number of participants performing at least 150 min of weekly physical activity. Secondary outcomes included physical activity level and physical fitness, Sense of Coherence, cardiovascular risk, sociodemographic data, trans-theoretical stage of change, sleep quality, and depression. Results: Adherence to the recommendation of at least 150 min of physical activity was higher in the intervention than in the control group (χ2 = 3.951, p = .047). However, this higher adherence did not suppose higher physical activity levels because no differences between groups were found in the total physical activity performed after intervention (t=-0.915, p = .361). At the end of the intervention participants randomized to the intervention group spent more time walking than participants in the control group (t = 2.260, p = .025). Conclusion: The multifactorial intervention performed by primary care nurses induced a higher adherence to the 150-min of weekly physical activity recommendation. Impact: Adherence to the usual physical activity prescription in primary care is low. Physical activity prescription performed by primary care nurses and based on health assets and motivational interview can help to increase physical activity levels of patients. The main finding of the present study was that prescription using this approach was shown to be effective, leading to a higher adherence in the intervention group. This intervention is feasible in the nurse's primary healthcare setting, thus it could be implemented as the main tool when exercise is prescribed. Trial registration: International Standard Randomized Controlled Trial Number: ISRCTN76069254.