Promoting physical activity through primary health care: the case of Catalonia.

BACKGROUND: In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors). METHODS: The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance). RESULTS: PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a "healthy route" (Reach). The proportion of patients with at least one cardiovascular risk factor who were "sufficiently active" increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance). CONCLUSIONS: In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.

Certificació de l'aptitud esportiva en l'edat pediàtrica / Certificación de la aptitud deportiva en la edad pediátrica / Preparticipation physical evaluation in children

Fonament: la certificació medicoesportiva té com a objectiu prevenir i diagnosticar possibles alteracions que poguessin condicionar la pràctica esportiva en l'infant i l'a-dolescent. L'aspecte més important és la prevenció de lamort sobtada, situació dramàtica que ha generat gran in-terès i al mateix temps ansietat, tant entre la població general com entre les diferents institucions esportives. Objectiu: establir un criteri de certificació medicoesportivaen l'edat pediàtrica, analitzant i argumentant la disparitatde criteris entre la proposta europea i l'americana. Mètode: revisió bibliogràfica. Conclusions: la pràctica esportiva en infants i adolescentsexigeix un control de salut portat a terme pel pediatre i unarevisió medicoesportiva que ha de fer l'especialista enmedicina de l'esport, i que permetrà la certificació de l'ap-titud esportiva. En aquesta revisió incidirem en l'historialclínic i en l'exploració dels aparells locomotor i cardiovascular, d'acord amb l'algoritme d'actuació de la propostacatalana de prevenció de la mort sobtada de l'esportista. Laresta de l'exploració mèdica per aparells no difereix de laque fa el pediatre de capçalera en els controls de salu

Fundamento. La certificación médico-deportiva tiene como objetivo prevenir y diagnosticar posibles alteraciones que pudieran condicionar la práctica deportiva en el niño/a y adolescente. El aspecto más importante radica en la prevención de la muerte súbita, situación dramática que ha generado gran interés y al mismo tiempo ansiedad, tanto en la población general como en las diferentes instituciones deportivas. Objetivo. Establecer un criterio de certificación médico-deportiva, analizando y argumentando la disparidad de criterios entre la propuesta europea y la americana. Método. Revisión bibliográfica. Conclusiones. La práctica deportiva en niños/as y adolescentes exige un control de salud llevado a cabo por el pediatra y una revisión médico-deportiva realizada por el especialista en medicina del deporte, que permitirá la certificación de la aptitud deportiva. En esta revisión, incidiremos en el historial clínico, la exploración de los aparatos locomotor y cardiovascular, según el algoritmo del consenso catalán de prevención de la muerte súbita en deportistas. El resto de la exploración médica por aparatos no difiere de la que realiza el pediatra de cabecera en los controles de salud (AU)

Background. The aim of preparticipation physical evaluation for thletics is to prevent and diagnose conditions that would contraindicate the practice of sports for children and adolescents. The most important objective is to prevent sudden death, a dramatic situation that has generated great interest and anxiety in the general population as well as among athletic institutions. Objective. To define consensus criteria for preparticipation physical evaluation, considering the disparities between the European and the American proposals. Method. Literature review. Conclusions. The practice of sports in children and adolescents requires a medical evaluation for fitness by the pediatrician and by sports medicine. In this review, we focus on medical history and musculoskeletal and cardiovascular examination, following the guidelines of the Catalan consensus for prevention of sudden death in athletes. The rest of the medical examination does not differ from the exploration performed by the pediatrician in the routine health checks (AU)

Beneficios de la actividad física para la salud en la infancia y la adolescencia / Beneficial effects of physical activity for the health of children and adolescents

Fundamento. La actividad física es necesaria durante la infancia y la adolescencia para promover un desarrollo saludable tanto físico, psíquico como social. El sedentarismo va en aumento y condicionará la aparición de enfermedades prevalentes en la infancia y la adultez. Muchas de estas se podrían prevenir, retrasar o mejorar con dieta y/o actividad física. Objetivo. Argumentar y brindar datos para combatir el sedentarismo y promover la práctica de actividad física en las edades pediátricas, desde la consulta de atención primaria(AU)

Background. Physical activity is necessary during childhood and adolescence to promote a healthy physical, psychological, and social development. Sedentary lifestyles are becoming more prevalent and may result in an increase in the incidence of common diseases during childhood and adulthood. Some of these diseases could be prevented, delayed, or improved with changes in the dietary or physical activity habits. Objective. To provide evidence-based recommendations that may help the primary health care provider in promoting physical activity and combating sedentary lifestyles in children. Method. Literature review. Conclusions. We describe the benefits of physical activity in different aspects of children and adolescents health (growth and development, cardiovascular and respiratory systems, body composition, metabolism, and psychosocial development), and review the problems generated by sedentary lifestyles in our environment. We also provide information on the different components of physical fitness that have an impact on health, and provide recommendations to avoid sedentary lifestyles and to promote physical activity. Finally, we emphasize the criteria of intensity, time, and type of activity that are recommended for each age group(AU)