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Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.ORCID iD: 0000-0003-3591-5123
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.ORCID iD: 0000-0002-8786-0438
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.ORCID iD: 0000-0002-3901-7833
Karolinska Institutet.ORCID iD: 0000-0001-7335-3796
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2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 687Article in journal (Refereed) Published
Abstract [en]

Background

The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults.

Methods

Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m 2 ; and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL.

Results

At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): −2.4 to 23.3]) vs (median: 0.0 [IQR: −4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95 % CI 1.00–5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: −1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL.

Conclusions

PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model.

Trial registration

ClinicalTrials.gov NCT02320760.

Place, publisher, year, edition, pages
2015. Vol. 15, 687
Keyword [en]
Clinical research; Health promotion; Intervention study; Older adults; Prescribed physical activity; Health related quality of life; Overweight
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-3957DOI: 10.1186/s12889-015-2036-3PubMedID: 26193882OAI: oai:DiVA.org:gih-3957DiVA: diva2:844281
Available from: 2015-08-04 Created: 2015-08-04 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Studies of physical activity in the Swedish population
Open this publication in new window or tab >>Studies of physical activity in the Swedish population
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cheap and effective tools for measuring patients’ physical activity (PA) level are needed. The first aim in this thesis was therefore to assess the validity of two PA -questions, and their three associated answer modes, that are used within the Swedish health care system. Sitting, light intensity PA (LIPA), and moderate and vigorous intensity PA (MVPA), are associated with health and longevity, but detailed population data assessed with objective methods is needed. The second aim was thus to assess the above with motion sensor technology, in a middle-aged Swedish sample. Low self-perceived health is a strong predictor of morbidity and mortality, but this association may vary over time with changes in the society and our lifestyle. The third aim was to assess secular trends in the interrelations between self-perceived health, physical fitness, and selected covariates. The effects of PA on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear, thus the fourth aim was to explore this.

Methods: All data was collected in the Swedish population. Data from the PA -questions and accelerometers, aerobic fitness, counter movement jump, and balance tests, blood samples, and self-rated general health were collected in 365 participants, 21–66 yrs. The PA pattern was assessed in 948 individuals, 50‒64 yrs, from the SCAPIS pilot study. Self-perceived physical health, and measured aerobic fitness, counter movement jump height, and balance, and demographic and lifestyle data, was assessed in three independent samples from 1990, 2000 and 2013, including 3564 adults, 20‒65 yrs. The effects of Swedish PAP on HRQoL was assessed in a randomized controlled trial including 101 men and women, 67‒68 yrs, that were inactive, overweight (BMI>25 kg/m2), and had a waist circumference ≥102 cm (men) or ≥88 cm (women), who were randomized to an intervention group or a control group. The 36-item Short Form Health Survey (SF-36) was used to assess HRQoL.

Results: The multiple choice answer mode of the two PA -questions was found to have the strongest validity, compared with the two other (an open mode, and one where PA minutes is specified per weekday). The validity is in line with many other established PA-questionnaires, but the open mode has limitations. The assessment of PA pattern showed that 61% of motion sensor wear time represented sitting, 35% LIPA, and 4% MVPA. Only 7% of the sample met the PA recommendations. The odds for describing perceived health as good was found to increase by 5% per each increment of 1 ml/kg/min in VO2max. This was stable across genders and all three LIV-samples (i.e. over time). Waist circumference, chronic disease, sleep problems, and level of satisfaction with one’s life, were also important correlates. The Swedish PAP group improved significantly more, and more participants displayed clinically relevant improvements (OR 2.43), in mental aspects of HRQoL, compared to the controls. Physical aspects of HRQoL improved in the PAP group, but not in the control group.

Conclusions: The multiple choice answer mode has the strongest validity and Open mode the weakest. The PA -questions may be used in populations, or in individuals to determine appropriateness for treatment. The questions’ advantages and limitations must be considered and further reliability and validity studies are needed. The results regarding sitting, LIPA, MVPA and fulfillment of PA recommendations, are of high clinical relevance. A great challenge remains to further implement methods to increase the level of PA in the Swedish population. Physical fitness is related to self-perceived health independently of changes in society and lifestyle over time, and simple questions may be useful for the clinical assessment of physical fitness. Swedish PAP has a positive effect on mental aspects of HRQoL, measured by the SF-36. This finding supports the clinical use of the Swedish PAP model.

Place, publisher, year, edition, pages
Stockholm: Gymnastik- och idrottshögskolan, GIH, 2016. 71 p.
Series
Avhandlingsserie för Gymnastik- och idrottshögskolan, 05
Keyword
physical activity, physical fitness, sedentary, questionnaire, validity, self-rated health, sensitivity, specificity, physical activity on prescription, accelerometry, the Ekblom-Bak test, answer modes, movement pattern, health-related quality of life, physical health
National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4309 (URN)978-91-980862-5-6 (ISBN)
Public defence
2016-02-19, Aulan, Lidingövägen 1, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Projects
LIV 2013
Available from: 2016-01-28 Created: 2016-01-27 Last updated: 2016-02-17Bibliographically approved

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