长期开具运动处方对体力活动不足患者的干预作用：一项随机对照试验
Long-term physical activity on prescription intervention for patients with insufficient physical activity level-a randomized controlled trial.
机构信息
Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Centrum för fysisk aktivitet Göteborg, Gothenburg, Region Västra Götaland, Sweden.
出版信息
Trials. 2020 Sep 15;21(1):793. doi: 10.1186/s13063-020-04727-y.
BACKGROUND
Physical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting.
METHODS
We included 190 patients, 27-77 years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups.
RESULTS
At the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups.
CONCLUSION
During long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03012516 . Registered on 30 December 2016-retrospectively registered.
背景
身体活动（PA）可用于预防和治疗疾病。在瑞典，持照的医疗保健专业人员会开具身体活动处方（PAP），以支持患者增加其身体活动水平。本随机对照试验的目的是评估在初级保健环境中进行了 6 个月普通 PAP 治疗之后，对身体活动水平不足的患者进行为期 2 年的两种不同 PAP 治疗策略的干预效果。
方法
我们纳入了 190 名年龄在 27-77 岁之间、身体活动不足且存在代谢危险因素的患者，这些患者对之前 6 个月的增加身体活动水平的 PAP 治疗没有反应。将患者随机分为接受物理治疗师强化支持的治疗组（PT 组）或继续在医疗保健中心接受普通 PAP 治疗的对照组（HCC 组）。PAP 治疗包括个体化对话、个体化剂量的身体活动建议，包括书面处方和结构化随访。除了 PAP 治疗外，PT 组还接受了有氧健身测试和更频繁的预约随访。在基线和 1 年及 2 年随访时，测量患者的身体活动水平、代谢健康和健康相关生活质量（HRQOL）。
结果
在 2 年随访时，PT 组有 62.9%的患者增加了身体活动水平，HCC 组有 50.8%的患者增加了身体活动水平，PT 组有 31.4%的患者达到了每周至少 150 分钟的中等强度身体活动，HCC 组有 38.5%的患者达到了每周至少 150 分钟的中等强度身体活动（组间差异无统计学意义）。2 年内，两组高密度脂蛋白（HDL）均升高（与基线相比，p=0.004），心理健康状况评分（MCS）均升高（p=0.036），体质指数（BMI）均降低（p=0.001），但组间差异无统计学意义。
结论
在长期 PAP 干预期间，代谢风险患者的身体活动水平、代谢健康和 HRQOL 均有所改善，两组间无显著差异。结果表明，这与药物治疗的任何变化无关。我们证明了 PAP 治疗在普通初级保健中是可行的。患者和医疗保健系统均受益于代谢危险因素的改善。未来的研究应阐明有效的长期 PAP 治疗策略。
试验注册
ClinicalTrials.gov NCT03012516。于 2016 年 12 月 30 日注册——回顾性注册。
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