Two-year longitudinal analysis of a cluster randomized trial of physical activity promotion by general practitioners

Gonzalo Grandes, Alvaro Sanchez, Imanol Montoya, Ricardo Ortega Sanchez-Pinilla, Jesús Torcal, PEPAF Group, Gonzalo Grandes, Jesús Torcal, Ricardo Ortega Sánchez-Pinilla, Alvaro Sanchez, Kepa Lizarraga, Javier Serra, Imanol Montoya, Angel Fernández, Victor Manuel López, Lourdes Marijuán, Begoña Etxeguren, Victor Landa, Jesús Martínez, Ma Mercedes Díez, Juan Ramón Lejarza, Judith González, Vidal Salcedo, Idoia Ibáñez, Agurtzane Ortego, Pedro Iraguen, Pilar Echevarria, Virginia Villaverde, Amaia Ecenarro, Ma Teresa Uribe, Carmen Moral, Eguskiñe Iturregui, Ana Belén Fernández, José María Páez, Ma Ángeles Tarilonte, Concepción Molina, Vicente Rodríguez, Isabel Villafuente, Mercedes Álvarez, Andreu Estela, Jose María Coll, Angels Llach, Josep Ma Masuet, Ana Moll, Monica Pons, Bonaventura Bolibar, Agusti Guiu, Amadeu Díaz, Xavier Martínez, Ma Dolores Hernández, José Ignacio Olivares, Francisco Hernansanz, Rita Ayala, Ana Cascos, Vicente Martínez, Ma del Carmen García, Ma Ángeles Gabriel, Ma Luscinda Velázquez, Natividad Ortega, Ma Jesús Segura, Rodrigo Cerrillo, Patricia López, Carmen Fernández, Amparo Gómez, Miguel Angel Díez, Ruperto Sánz, Luis Miguel Quintero, Jose Ignacio Recio, Luis García, José Antonio Iglesias, Manuel Gómez, Emilio Ramos, Pilar Moreno, Yolanda Castaño, Nadia Carrillo, Pilar Ganoso, Luciano Casariego, Manuel Domínguez, Jose Ramón Moliner, Fernando Lago, Ma Concepción Cruces, Marisa Enríquez, Tomás Gómez Gascón, Javier Martínez, José Antonio Granados, Ma Ángeles Fernández, Ma Isabel Gutiérrez, Carlos San Andrés, Concepción Vargas-Machuca, Cristina Díaz, Gonzalo Grandes, Alvaro Sanchez, Imanol Montoya, Ricardo Ortega Sanchez-Pinilla, Jesús Torcal, PEPAF Group, Gonzalo Grandes, Jesús Torcal, Ricardo Ortega Sánchez-Pinilla, Alvaro Sanchez, Kepa Lizarraga, Javier Serra, Imanol Montoya, Angel Fernández, Victor Manuel López, Lourdes Marijuán, Begoña Etxeguren, Victor Landa, Jesús Martínez, Ma Mercedes Díez, Juan Ramón Lejarza, Judith González, Vidal Salcedo, Idoia Ibáñez, Agurtzane Ortego, Pedro Iraguen, Pilar Echevarria, Virginia Villaverde, Amaia Ecenarro, Ma Teresa Uribe, Carmen Moral, Eguskiñe Iturregui, Ana Belén Fernández, José María Páez, Ma Ángeles Tarilonte, Concepción Molina, Vicente Rodríguez, Isabel Villafuente, Mercedes Álvarez, Andreu Estela, Jose María Coll, Angels Llach, Josep Ma Masuet, Ana Moll, Monica Pons, Bonaventura Bolibar, Agusti Guiu, Amadeu Díaz, Xavier Martínez, Ma Dolores Hernández, José Ignacio Olivares, Francisco Hernansanz, Rita Ayala, Ana Cascos, Vicente Martínez, Ma del Carmen García, Ma Ángeles Gabriel, Ma Luscinda Velázquez, Natividad Ortega, Ma Jesús Segura, Rodrigo Cerrillo, Patricia López, Carmen Fernández, Amparo Gómez, Miguel Angel Díez, Ruperto Sánz, Luis Miguel Quintero, Jose Ignacio Recio, Luis García, José Antonio Iglesias, Manuel Gómez, Emilio Ramos, Pilar Moreno, Yolanda Castaño, Nadia Carrillo, Pilar Ganoso, Luciano Casariego, Manuel Domínguez, Jose Ramón Moliner, Fernando Lago, Ma Concepción Cruces, Marisa Enríquez, Tomás Gómez Gascón, Javier Martínez, José Antonio Granados, Ma Ángeles Fernández, Ma Isabel Gutiérrez, Carlos San Andrés, Concepción Vargas-Machuca, Cristina Díaz

Abstract

Background: We evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care.

Methods and findings: Pragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p<0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%).

Conclusions: General practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention but this effect wears off at 12 and 24 months. Only in the subgroup of patients receiving repeat prescriptions of physical activity is the effect maintained in long-term.

Trial registration: clinicaltrials.gov NCT00131079.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of the PEPAF…
Figure 1. Flow chart of the PEPAF trial.
Figure 2. Two years longitudinal change in…
Figure 2. Two years longitudinal change in physical activity by comparison groups and subgroups.

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