Any increment in physical activity reduces mortality risk of physically inactive patients: prospective cohort study in primary care.

BACKGROUND: It is unclear how engaging in physical activity after long periods of inactivity provides expected health benefits. AIM: To determine whether physically inactive primary care patients reduce their mortality risk by increasing physical activity, even in low doses. DESIGN AND SETTING: Prospective cohort of 3357 physically inactive patients attending 11 Spanish public primary healthcare centres. METHOD: Change in physical activity was repeatedly measured during patients' participation in the 'Experimental Program for Physical Activity Promotion' clinical trial between 2003 and 2006, using the '7-day Physical Activity Recall'. Mortality to 31 December 2018 (312 deaths) was recorded from national statistics, and survival time from the end of the clinical trial analysed using proportional hazard models. RESULTS: After 46 191 person-years of follow-up, compared with individuals who remained physically inactive, the mortality rates of those who achieved the minimum recommendations of 150-300 min/week of moderate- or 75-150 min/week of vigorous-intensity exercise was reduced by 45% (adjusted hazard ratio [aHR] 0.55; 95% confidence interval [95% CI] = 0.41 to 0.74); those who did not meet these recommendations but increased physical activity in low doses, that is, 50 min/week of moderate physical activity, showed a 31% reduced mortality (aHR 0.69, 95% CI = 0.51 to 0.93); and, those who surpassed the recommendation saw a 49% reduction in mortality (aHR 0.51, 95% CI = 0.32 to 0.81). The inverse association between increased physical activity and mortality follows a continuous curvilinear dose-response relationship. CONCLUSION: Physically inactive primary care patients reduced their risk of mortality by increasing physical activity, even in doses below recommended levels. Greater reduction was achieved through meeting physical activity recommendations or adopting levels of physical activity higher than those recommended.

Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial.

BACKGROUND: Physical activity promotion is a priority, but contribution of physicians' interventions is unclear. The effectiveness of the PEPAF ("Experimental Program for Physical Activity Promotion"), which was implemented exclusively by physicians in routine primary care from October 2003 to December 2004, was assessed. METHODS: Fifty-six Spanish family physicians were randomized to either the intervention (n = 29) or standard care (n = 27) arm of the trial. The physicians recruited 4317 physically inactive patients (2248 for intervention and 2069 for control protocols) from a systematic sample after assessing their physical activity in routine practice. Intervention physicians provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). The main outcome measure was the change in physical activity measured by blinded nurses using the 7-Day Physical Activity Recall. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. RESULTS: At 6 months, intervention patients increased physical activity more than controls (adjusted difference, 18 min/wk [95% confidence interval, 6-31 min/wk]; metabolic equivalent tasks x hours per week, 1.3 [95% CI, 0.4-2.2]). The proportion of the population achieving minimal physical activity recommendations was 3.9% higher in the intervention group (1.2%-6.9%; number needed to treat, 26). No differences were found in secondary outcomes. The effect of intervention was positively modified in subjects older than 50 years (P < or = .01) and in the prescription subgroup (P < .001). CONCLUSIONS: Family physicians were effective for increasing physical activity of primary care patients. Overall clinical effect was small but relevant for population public health. Within the intervention program, clinically relevant effects were seen in patients receiving a physical activity prescription. Trial Registration clinicaltrials.gov Identifier: NCT00131079.

Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change.

BACKGROUND: Counselling in routine general practice to promote physical activity (PA) is advocated, but inadequate evidence is available to support this intervention, and its sustainable implementation over time is difficult. OBJECTIVES: To describe the characteristics of physically inactive adults visiting GPs and the factors associated with their willingness to change PA. METHODS: A cross-sectional analysis of 4317 Spanish people aged 20-80 years, selected by systematic sampling among those attending 56 public primary health care practices identified as inactive by their GPs in 2003. PA (7-day PAR), PA stage of change, health-related quality of life (SF-36), cardiovascular risk factors, and social and demographic characteristics were measured. Multivariate mixed effects ordinal logistic models were adjusted to identify factors associated with motivational readiness to change. RESULTS: At least 70% (95% CI: 67.6% to 72.8%) of patients assessed by GPs did not achieve minimal PA recommendations. In addition, 85% (95% CI: 83% to 86.3%) had at least an additional cardiovascular risk factor. Only 30% (95% CI: 25.8% to 33.5%) were prepared for or attempting a change. A younger age; retirement or work at home; higher education and social class levels; obesity; and hypertension were associated with a higher motivational readiness to change (p < 0.05). CONCLUSION: The overburden that would result from counselling such a high proportion of inactive primary care patients justifies a targeted strategy for PA promotion in family practice. Selection of a target population based on readiness to change, the combination of risk factors and socio-demographic characteristics of patients is suggested in order to prioritise promotion efforts.

Influencia de la carrera a pie sobre el hábito tabáquico

Objetivo. Investigar si la carrera a pie influye sobre el hábito tabáquico. Diseño. Estudio de casos y controles, con emparejamiento 1:1. Observación longitudinal retrospectiva. Emplazamiento. Atención primaria. Ciudad de Toledo. Participantes. Casos: 48 corredores voluntarios sanos de 47± 7,8 años de edad. Controles: 48 sujetos sanos, emparejados por sexo y año de nacimiento, elegidos al azar entre la población adscrita al médico investigador. Mediciones principales. Hábito tabáquico y gramos semanales de alcohol mediante cuestionario, peso, talla, presión arterial y frecuencia cardíaca de reposo. Se obtuvieron las odds ratio (OR) de las proporciones de sujetos que fumaban o habían fumado aguna vez, de los que seguían fumando y de las probabilidades de abandono do tabaco en cada grupo. Resultados. La OR de la proporción de sujetos que fumaban o habían fumado entre los grupos de corredores (54,2 por ciento) y controles (70,9 por ciento) era de 0,486 (intervalo de confianza [IC] del 95 por ciento, 0,205-1,149; x² = 2,8; p = 0,093). La OR para continuación del hábito entre los grupos de corredores (8,4 por ciento) y de controles (41,7 por ciento) era de 0,127 (IC del 95 por ciento, 0,035-0,456; x = 14,0; p = 0,0002). En el grupo de corredores había abandonado el tabaco el tabaco el 45,8 por ciento y en el de controles, el 31,2 por ciento (OR = 7,85; IC del 95 por ciento, 1,89-32,52; x = 11,8; p = 0,0007). El 50 por ciento de los corredores que fumaban lo había dejado desde que comenzó a correr y el 76,9 por ciento de estos lo había dejado justo en el momento de comenzar a correr. Conclusiones. Hay una asociasión negativa entre carrera a pie y tabaco. Si un fumador decide comenzar a correr regularmente, tiene muchas probabilidades de dejar de fumar y mantenerse así.(AU)