Do Primary Care Interventions to Promote PA Work? A Systematic Review of the Literature

AIM: To determine whether interventions undertaken with patients in primary care settings can be effective in increasing their physical activity participation. METHODS: A systematic review of physical activity intervention studies was conducted. Studies included were those undertaken with adul t primary care patients which used a randomised controlled trial (RCT) or controlled quasi - experimental design and reported physical activity participation as a primary outcome. The methodological quality of studies was appraised using the criteria develop ed by the United States Preventive Services Task Force and the potential public health impact of the interventions tested was assessed using the RE - AIM model. RESULTS: Twenty studies were included in the review. In eight studies physical activity was addr essed as part of a multiple risk factor intervention, and these included a total of 17565 subjects. Six of these studies were RCTs but all were given a methodological rating of ‘fair’. Twelve studies tested interventions focused solely on physical activity , with 7984 subjects enrolled in total. Eight of these were RCTs, two of which were given a methodological rating of ‘good’ while the remainder were given a rating of ‘fair’. The two multiple risk factor intervention studies which measured short - term effec ts reported significant outcomes, and four of the seven measuring long - term effects found significant improvements in physical activity. Six of the eight studies testing single risk factor interventions which measured short - term outcomes reported significa nt improvements in physical activity. Three of the six studies which undertook medium - term follow - up found significant effects while two of the five which undertook long - term follow - up reported significant outcomes. The small number and diverse nature of the interventions associated with increases in physical activity made it difficult to identify the characteristics of interventions that were associated with a greater likelihood of producing increases in physical activity. Brief and intensive intervention s appeared to be equally effective and the greatest effects were achieved when interventions were targeted to the sedentary or insufficiently active. Appraisal of the public health significance of this literature was undertaken to determine whether these interventions should be recommended to public health policy makers. It was found that most studies used selected samples and that few provided data to enable assessment of the generalisability of study findings, hence the applicability of the findings to t he wider population was not known. Furthermore, few interventions have been tested which could be readily implemented in routine primary care settings. CONCLUSIONS: There is evidence of ‘fair’ quality that interventions conducted with primary care patient s which address physical activity alone can achieve improvements in this behaviour. In light of this limited evidence, a reasonable approach for primary care practitioners to adopt is to undertake brief interventions with inactive patients who have health conditions which could be reduced by physical activity participation. Interventions in primary care will not be sufficient to increase physical activity levels in the population and need to be incorporated within multi - faceted, community - wide strategies to address this risk factor