Efecto de un Programa de actividad física sobre la autoestima en sujetos con enfermedades crónicas. Ensayo de intervención comunitaria "Pas a Pas" / Effect of a Physical activity program on self-esteem in subjects with chronic diseases. 'Pas a Pas' community intervention trial

Objetivo: Evaluar la efectividad de un Programa de actividad física (AF) supervisado, con actividades socioculturales y de 9 meses de duración, sobre la autoestima y su asociación sobre el control de las enfermedades crónicas en adultos usuarios de atención primaria. Diseño: Ensayo de intervención comunitaria, aleatorizado, controlado y multicéntrico. Emplazamiento: Cuatro centros de atención primaria de Reus-Tarragona, España. Participantes: Un total de 364 sujetos, aleatorizados al grupo control (GC = 104) y grupo intervención (GI = 260). Intervención: Programa supervisado de caminatas de 120 min/semana con actividades socioculturales mensuales. Mediciones principales: En los momentos basal y postintervención se valoró: AF (IPAQ-S), autoestima (escala de Rosenberg) e indicadores cardiovasculares: tabaquismo, presión arterial sistólica (PAS) y diastólica (PAD), colesterol LDL y HDL séricos, y glucosa sérica. Se registran características sociodemográficas y diagnósticos de enfermedades crónicas. Resultados: El Programa incrementó la AF en el GI (p = 0,001), mientras que disminuyó en el GC (p = 0,002), y también la autoestima en el conjunto de participantes (1,28 puntos; p = 0,006) y en los grupos con diagnósticos de hipertensión (1,60 puntos; p = 0,005), dislipidemia (1,62 puntos; p = 0,012), exceso de peso (1,24 puntos; p = 0,011) o ansiedad/depresión (1,53 puntos; p = 0,045), valorados mediante modelos estadísticos multivariantes. El incremento de la autoestima durante la intervención disminuyó la PAS -0,5 mmHg (p = 0,030) en el grupo de hipertensos, independientemente de la PAS basal y del efecto de la intervención. Conclusión: El Programa de AF realizado incrementó la AF y la autoestima en adultos usuarios de atención primaria. El incremento de la autoestima mejoró el control de la PAS en hipertensos

Aim: To evaluate the effectiveness of a 9 months of supervised Physical Activity (PA) Program with sociocultural activities, on self-esteem and its association on the control of chronic diseases in adult primary care users. Design: Multicenter, randomized, controlled community intervention. Location: 4 Primary care centers in Reus-Tarragona, Spain. Participants: 364 subjects, randomized to the Control Group (CG = 104) and Intervention Group (IG = 260). Intervention: Supervised walking program of 120min/week with sociocultural activities once a month. Main measurements: At baseline and at post-intervention we assessed: PA (IPAQ-S), self-esteem (Rosenberg scale) and cardiovascular indicators: smoking, systolic (SBP) and diastolic (DBP) blood pressure, serum LDL and HDL cholesterol, and serum glucose. Sociodemographic characteristics and diagnostic of chronic diseases are recorded. Results: The Program increased the PA in the IG (P = .001), while it decreased in the CG (P = .002), and also the self-esteem in the group of participants (1.28 points, P = .006) and in the groups with diagnoses of hypertension (1.60 points, P = .005), dyslipidemia (1.62 points, P = .012), excess weight (1.24 points, P = .011) or anxiety/depression (1.53 points, P = .045), assessed by multivariate statistical models. The increase in self-esteem during the intervention decreased SBP -0.5 mmHg (P = .030) in the hypertension group, regardless of baseline SBP and the effect of the intervention. Conclusion: The PA program increased the PA and self-esteem in adult primary care users. The increase of self-esteem improved the control of SBP in hypertensive patients

[Effect of a Physical activity program on self-esteem in subjects with chronic diseases. 'Pas a Pas' community intervention trial]. / Efecto de un Programa de actividad física sobre la autoestima en sujetos con enfermedades crónicas. Ensayo de intervención comunitaria «Pas a Pas¼.

AIM: To evaluate the effectiveness of a 9 months of supervised Physical Activity (PA) Program with sociocultural activities, on self-esteem and its association on the control of chronic diseases in adult primary care users. DESIGN: Multicenter, randomized, controlled community intervention. LOCATION: 4 Primary care centers in Reus-Tarragona, Spain. PARTICIPANTS: 364 subjects, randomized to the Control Group (CG=104) and Intervention Group (IG=260). INTERVENTION: Supervised walking program of 120min/week with sociocultural activities once a month. MAIN MEASUREMENTS: At baseline and at post-intervention we assessed: PA (IPAQ-S), self-esteem (Rosenberg scale) and cardiovascular indicators: smoking, systolic (SBP) and diastolic (DBP) blood pressure, serum LDL and HDL cholesterol, and serum glucose. Sociodemographic characteristics and diagnostic of chronic diseases are recorded. RESULTS: The Program increased the PA in the IG (P=.001), while it decreased in the CG (P=.002), and also the self-esteem in the group of participants (1.28 points, P=.006) and in the groups with diagnoses of hypertension (1.60 points, P=.005), dyslipidemia (1.62 points, P=.012), excess weight (1.24 points, P=.011) or anxiety/depression (1.53 points, P=.045), assessed by multivariate statistical models. The increase in self-esteem during the intervention decreased SBP -0.5mmHg (P=.030) in the hypertension group, regardless of baseline SBP and the effect of the intervention. CONCLUSION: The PA program increased the PA and self-esteem in adult primary care users. The increase of self-esteem improved the control of SBP in hypertensive patients.

Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: randomized clinical trial.

BACKGROUND: Physical activity (PA) promotes cardiovascular health and health related quality of life (HRQoL), although the effect of that on blood pressure (BP) control has rarely been studied in hypertensive subjects. Our aim was to evaluate the effectiveness of a PA intervention programme on cardiovascular disease (CVD) risk, HRQoL and BP control in hypertensive subjects. METHODS: A randomized clinical trial, with a PA intervention programme of 9 months duration, comprising a walking group of 120 min/week, supervised, and with socio-cultural activities. Participants were 207 hypertensive subjects (68.2 years, 76.8% women). PA (IPAQ-s), diet, CVD risk, BP, BMI, smoking, and HRQoL (SF-36) were assessed at baseline and at the end of the intervention. Changes in CVD risk and in HRQoL during the intervention was calculated (end-baseline score). Multivariate models were applied. RESULTS: In multivariate models, the PA intervention programme, with no modification of the diet, decreased CVD risk (- 1.19 points) and the systolic BP (- 8.68 mmHg), and increased some areas of HRQoL (4.45 to 14.62 points). An increase in the percentage of subjects with controlled BP was observed by the PA programme itself (OR 5.395 to 5.785 according to multivariate models), and by the changes during the intervention in the decrease in CVD risk (OR 0.609) and in the increase in the HRQoL in physical component summary (OR 1.041), role physical (OR 1.010), and bodily pain (OR 1.014), independently of controlled BP at baseline. CONCLUSIONS: This PA intervention programme improved cardiovascular health and HRQoL, and favoured BP control in primary care users with hypertension. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT02767739 ; Trial registered on May 5th, 2016. Retrospectively registered.

Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the "Pas-a-Pas" community intervention trial.

BACKGROUND: Physical activity is a major, modifiable, risk factor for cardiovascular disease (CVD) that contributes to the prevention and management of CVD. The aim of this study was to assess the short- and medium-term effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults. METHODS: Multicentered, randomized, controlled community intervention involving 364 patients in four primary care centers. The participants were randomly assigned to a Control Group (CG = 104) or Intervention Group (IG = 260); mean age 65.19 years; 76.8% women. The intervention consisted of 120 min/week walking (396 METs/min/week) and sociocultural gathering once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose) and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. Incidence of adverse cardiovascular events and continued adherence to the physical activity were assessed 2 years after intervention. RESULTS: At the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity (774.81 METs/min/week), a significant change during the intervention period in systolic blood pressure (-6.63 mmHg), total cholesterol (-10.12 mg/dL) and LDL-cholesterol (-9.05 mg/dL) even after adjustment for potential confounders. At 2 years after the intervention, in the IG, compared with the CG, tthe incidence of adverse cardiovascular events was significantly lower (2.5% vs. 10.5%) and the adherence to regular physical activity was higher (72.8% vs 27.2%) in IG compared to CG. CONCLUSIONS: This community-based physical activity program improved cardiovascular health in the short- as well as medium-term, and promoted regular physical activity in the medium-term in older Spanish adults. TRIALS REGISTRATION: Clinicaltrials.gov ID NCT02767739 . Trial registered on May 5th, 2016. Retrospectively registered.

The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving Home Care: A randomized controlled trial.

OBJECTIVE: To assess the effect of a nutrition education intervention included in the Home Care Program for caregivers to prevent the increasing risk of malnutrition of dependent patients at risk of malnutrition. DESIGN: Randomized controlled multicenter trial of 6 months of duration and 12 months follow-up. SETTINGS: 10 Primary Care Centers, Spain. PARTICIPANTS: Patients enrolled in the Home Care Program between January 2010 and March 2012, who were dependent and at risk of malnutrition, older than 65, and had caregivers (n=190). INTERVENTION: The nurses conducted initial educational intervention sessions for caregivers and then monitored at home every month for 6 months. MEASUREMENTS: The nutritional status was assessed using the Mini Nutritional Assessment test (primary outcome), diet, anthropometry, and biochemical parameters (albumin, prealbumin, hemoglobin and cholesterol). Other descriptive and outcome measures were recorded: current medical history, Activities of daily living (Barthel test), cognitive state (Pfeiffer test), and mood status (Yesavage test). All the measures were recorded in a schedule of 0-6-12 months. RESULTS: 173 individuals participated after exclusions (intervention n=101; control n=72). Mean age was 87.8±8.9years, 68.2% were women. Difference were found between the groups for Mini Nutritional Assessment test score change (repeated measures ANOVA, F=10.1; P<0.001), the intervention improved the Mini Nutritional Assessment test score of the participants in the intervention group. The egg consumption (F=4.1; P=0.018), protein intake (F=3.0; P=0.050), polyunsaturated fatty acid intake (F=5.3; P=0.006), folate (F=3.3; P=0.041) and vitamin E (F=6.4; P=0.002) showed significant group×time interactions. CONCLUSION: A nutrition education intervention for caregivers halted the tendency of nutritional decline, and reduced the risk of malnutrition of older dependent patients. TRIAL REGISTRATION: Clinical Trial Registration-URL: www.clinicaltrials.gov. Identifier: NCT01360775.

Nutrition education intervention for dependent patients: protocol of a randomized controlled trial.

BACKGROUND: Malnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions.The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition. METHODS/DESIGN: Intervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain). These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0-6-12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA), food intake, dentures, degree of dependency (Barthel test), cognitive state (Pfeiffer test), mood status (Yesavage test), and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin.Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits) up to 6 months. The North American Nursing Diagnosis Association (NANDA) methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient's nutritional status using the MNA test, diet, anthropometry, and biochemical parameters.Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention.The SPSS/PC program will be used for statistical analysis. DISCUSSION: The nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of view: diet, anthropometry and biochemistry in dependent patients at nutritional risk and to assess the effect of a nutritional education intervention. The design with random allocation, inclusion of all patients, validated methods, caregivers' education and standardization between nurses allows us to obtain valuable information about nutritional status and prevention. TRIAL REGISTRATION NUMBER: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360775.