Tailored physical activity on prescription with follow-ups improved motivation and physical activity levels. A qualitative study of a 5-year Swedish primary care intervention.

OBJECTIVE: To explore how physically inactive patients, with metabolic risk factors, experienced long term treatment with physical activity on prescription. DESIGN: Qualitative content analysis of individual interviews after strategical sampling of respondents. SETTING: Fifteen primary health care centres in Gothenburg, Sweden. SUBJECTS: Twenty physically inactive patients, with one or more metabolic syndrome components, 9 women, 11 men, mean age 58 years (25-73); 10 patients were responders and 10 non-responders to the intervention. MAIN OUTCOME MEASURES: Categories describing treatment effect and successful intervention. RESULTS: The interviews revealed three categories of effect. First, individual adjustments contributed to increased physical activity. Second, follow-up and support were valuable aids for prioritising and maintaining lifestyle changes. Third, motivation could be higher if patients make their own choices and experienced positive health effects. The overarching emerging theme was 'tailored physical activity on prescription with regular follow-ups can contribute to increased and maintained motivation and physical activity levels.'Conclusion Physical activity on prescription in a Swedish primary care setting was successful when the recommended physical activity and follow up was individually adapted. KEY POINTS Individually adapted physical activity on prescription gave insight to increase physical activity levels in a 5-year Swedish primary care intervention directed towards inactive patients with the metabolic syndrome Motivation increased for patients designing their own routines for physical activity. Experiences of positive health effects helped maintain or increase physical activity levels, and follow-up and support from healthcare professionals helped to prioritise life style changes.

Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study.

BACKGROUND: Physical activity plays an important role in the prevention and treatment of chronic musculoskeletal pain, but chronic pain may implicate a poor rehabilitation outcome. The concept of physical activity on prescription (PAP) is a therapeutic option for various diseases, but there is a lack of knowledge about how patients with chronic musculoskeletal pain experience receiving the prescription. OBJECTIVES: The objective of this study was to describe the experiences of and thoughts about receiving a prescription for physical activity of people with chronic musculoskeletal pain. DESIGN: Interviews analysed using qualitative content analysis with an inductive approach. SETTING: Three primary healthcare centres in a mixed rural and suburban area in the vicinity of a large city in western Sweden. SUBJECTS: Fifteen individuals with chronic musculoskeletal pain. RESULTS: Four categories were identified with the overarching theme "Physical activity in chronic pain requires extra support". There were several barriers for increasing activity level and these patients suffered from the additional burden of pain. The categories were: "Important to identify needs", "Barriers and facilitators for physical activity", "Perceptions of PAP vary" and "Effects found of receiving PAP". CONCLUSIONS: Despite the many positive experiences of receiving PAP, patients described confusion about the role and execution of PAP. Chronic pain is an additional barrier for increasing activity level, and it is crucial to consider these patients' circumstances. This study suggests that patients with chronic musculoskeletal pain have a greater need for information and extra support to overcome existing barriers, before or when physical activity is prescribed. Key Points Physical activity is important for prevention and treatment of chronic pain and has earlier been shown to be increased by "physical activity on prescription". Patients with chronic musculoskeletal pain required the prescriber to listen and take the patients' circumstances, context, symptoms and current activity level into account to a greater extent. Patients with chronic musculoskeletal pain experienced more obstacles to increase their physical activity and, therefore, had a greater need for individually tailored information and support when prescribed physical activity. Patients with chronic musculoskeletal pain found it difficult to distinguish between physical activity on prescription and physiotherapy and perceived that also the physicians could not tell the difference.

Stress levels predict substantial improvement in pain intensity after 10 to 12 years in women with fibromyalgia and chronic widespread pain: a cohort study.

BACKGROUND: Previous studies of prognosis for women with Fibromyalgia (FM) or chronic widespread pain (CWP) show contradictory results. However, some women appear to improve in pain and other core symptoms over time. There is limited knowledge about predictors of substantial improvement in pain intensity over a longer period of time. The primary objective of this study was to investigate the natural course of pain intensity and distribution of pain over 10 to 12 years in a cohort of 166 women with FM or CWP. Secondarily we wanted to investigate predictors of substantial improvement (≥50%) in pain intensity after 10 to 12 years. METHODS: The study is a longitudinal prospective cohort study. 166 women with FM or CWP were followed up after 10 to 12 years. 126 women (76%) participated in the follow-up and completed a battery of questionnaires concerning pain intensity, pain distribution and other physical and mental aspects of health. Differences in symptoms within the cohort over 10 to 12 years and predictors of substantial improvement (≥50%) in pain intensity were calculated. RESULTS: Pain had improved at the 10 to 12 year follow-up (p < 0.001) with a mean change of - 9.2 mm (SD 23.3, 95% CI: - 13.3; - 5.0) for pain intensity and - 2.0 sites (SD 4.2, 95% CI: - 2.7; - 1.2) for pain distribution. Nine percent of the 126 women showed an individual moderate improvement in pain intensity while 16% showed a substantial improvement at the follow-up as compared to baseline. Lower symptoms of stress and higher pain intensity at baseline predicted higher probability of reporting at least 50% less pain intensity after 10 to 12 years as compared to baseline. CONCLUSIONS: A majority of women with FM and CWP appear to have a positive course of pain over time, which should be communicated to these patients in health care. Reducing stress levels might contribute to better chances of improvement over time. TRIAL REGISTRATION: Clinicaltrials.gov NCT02872129, registered 06/30/2016.