Herens Marion, Bakker Evert Jan, van Ophem Johan, Wagemakers Annemarie, Koelen Maria
Health and Society, Social Sciences Group, Wageningen University, Hollandseweg 1, PO Box 8130, 6700 EW, Wageningen, the Netherlands.
Mathematical and Statistical Methods, Plant Sciences Group, Wageningen University, Droevendaalsesteeg 1, PO Box 16, 6700 AA, Wageningen, the Netherlands.
PLoS One. 2016 Feb 24;11(2):e0150025. doi: 10.1371/journal.pone.0150025. eCollection 2016.
Physical inactivity is most commonly found in socially vulnerable groups. Dutch policies target these groups through community-based health-enhancing physical activity (CBHEPA) programs. As robust evidence on the effectiveness of this approach is limited, this study investigated whether CBHEPA programs contribute to an increase in and the maintenance of physical activity in socially vulnerable groups. In four successive cohorts, starting at a six-month interval, 268 participants from 19 groups were monitored for twelve months in seven CBHEPA programs. Data collection was based on repeated questionnaires. Socio-economic indicators, program participation and coping ability were measured at baseline. Physical activity, health-related quality of life and on-going program participation were measured three times. Self-efficacy and enjoyment were measured at baseline and at twelve months. Statistical analyses were based on a quasi-RCT design (independent t-tests), a comparison of participants and dropouts (Mann-Whitney test), and multilevel modelling to assess change in individual physical activity, including group level characteristics. Participants of CBHEPA programs are socially vulnerable in terms of low education (48.6%), low income (52.4%), non-Dutch origin (64.6%) and health-related quality of life outcomes. Physical activity levels were not below the Dutch average. No increase in physical activity levels over time was observed. The multilevel models showed significant positive associations between health-related quality of life, self-efficacy and enjoyment, and leisure-time physical activity over time. Short CBHEPA programs (10-13 weeks) with multiple trainers and gender-homogeneous groups were associated with lower physical activity levels over time. At twelve months, dropouts' leisure-time physical activity levels were significantly lower compared to continuing participants, as were health-related quality of life, self-efficacy and enjoyment outcomes. BMI and care consumption scored significantly higher among dropouts. In conclusion, Dutch CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socio-economic and health-related quality of life outcomes. Our findings suggest that CBHEPA programs particularly contribute to physical activity maintenance in socially vulnerable groups, rather than to an increase in physical activity behaviour over time.
身体活动不足在社会弱势群体中最为常见。荷兰的政策通过基于社区的促进健康身体活动（CBHEPA）项目来针对这些群体。由于关于这种方法有效性的有力证据有限，本研究调查了CBHEPA项目是否有助于提高社会弱势群体的身体活动水平并维持这一水平。在四个连续的队列中，每隔六个月开始一组，对来自19个群体的268名参与者在7个CBHEPA项目中进行了为期十二个月的监测。数据收集基于重复问卷调查。在基线时测量社会经济指标、项目参与情况和应对能力。身体活动、与健康相关的生活质量和持续的项目参与情况测量了三次。自我效能感和愉悦感在基线时和十二个月时进行了测量。统计分析基于准随机对照试验设计（独立t检验）、参与者与退出者的比较（曼-惠特尼检验）以及多水平模型，以评估个体身体活动的变化，包括群体层面的特征。CBHEPA项目的参与者在低教育程度（48.6%）、低收入（52.4%）、非荷兰裔（64.6%）以及与健康相关的生活质量结果方面属于社会弱势群体。身体活动水平并不低于荷兰平均水平。未观察到身体活动水平随时间增加。多水平模型显示，随着时间推移，与健康相关的生活质量、自我效能感和愉悦感与休闲时间身体活动之间存在显著的正相关。训练师众多且性别同质化群体的短期CBHEPA项目（10 - 13周）与随时间推移较低的身体活动水平相关。在十二个月时，退出者的休闲时间身体活动水平显著低于继续参与者，与健康相关的生活质量、自我效能感和愉悦感结果也是如此。退出者的体重指数和护理消费得分显著更高。总之，就社会经济和与健康相关的生活质量结果而言，荷兰的CBHEPA项目覆盖了社会弱势群体，但这些群体不一定缺乏身体活动。我们的研究结果表明，CBHEPA项目尤其有助于维持社会弱势群体的身体活动，而不是随着时间推移增加身体活动行为。
