Diabetes Research Centre, University of Leicester, Leicester.
NIHR Applied Research Collaboration East Midlands, Leicester.
Br J Gen Pract. 2021 Nov 25;71(713):e921-e930. doi: 10.3399/BJGP.2021.0172. Print 2021 Dec.
Targeted self-management programmes may improve health and increase physical activity (PA) in people with multimorbidity.
To investigate the impact of a structured, theoretically driven, self-management group education programme on habitual PA levels in people with multimorbidity.
Individually randomised controlled trial with 12-month follow-up, involving nine primary care practices in Leicestershire, UK.
In total, 353 adults with multimorbidity (age 67.8 years [±9 years], 161 male sex) were randomised to intervention ( = 180) or control ( = 173) groups. Intervention participants were invited to attend four group-based self-management sessions, centred primarily on increasing PA, and received motivational text-message support. The primary outcome measure was change in overall volume (time and intensity) of daily PA at 12 months, as measured by the GENEActiv wrist-worn accelerometer device.
At baseline, the total sample achieved 22 min of moderate-vigorous intensity PA per day (mean/participant). At 12 months, in the complete-case analysis, a reduction in daily mean PA volume was seen in the intervention group relative to control (-0.80 milligravity [m ]; 95% confidence interval [CI] = -1.57 to -0.03; = 0.04). Reductions were also seen in the intervention group in time spent in moderate-vigorous PA (-3.86 min per day; 95% CI= -6.70 to -1.03; = 0.008) and time spent at an intensity equivalent to a slow walk (-4.66 min per day; 95% CI = -8.82 to -0.51; = 0.028). However, the per-protocol analysis (excluding participants who did not attend at least one education session) found no between-group differences in overall daily PA at 12 months (-0.65 mg; 95% CI = -1.46 to 0.15; = 0.11).
The self-management programme elicited a slight reduction in PA levels in people with multimorbidity. Future research should identify and target subgroups of those with multimorbidity in greatest need of PA promotion in order to maximise potential capacity for benefit, and also focus on refining the intervention in order to increase efficacy in increasing PA.
目标性自我管理方案可能会改善患有多种疾病人群的健康状况并增加其身体活动量（PA）。
调查结构化、基于理论的自我管理小组教育方案对患有多种疾病人群习惯性 PA 水平的影响。
在英国莱斯特郡的 9 个基层医疗实践中进行了为期 12 个月的随访的个体随机对照试验。
共有 353 名患有多种疾病的成年人（年龄 67.8 岁[±9 岁]，男性 161 名）被随机分配到干预组（n=180）或对照组（n=173）。邀请干预组参与者参加四次以增加 PA 为重点的小组自我管理课程，并提供动机性短信支持。主要结局指标是使用 GENEActiv 腕戴式加速度计设备测量的 12 个月时日常 PA 总量（时间和强度）的变化。
在基线时，总样本的中高强度 PA 每日达到 22 分钟（每位参与者的平均值）。在完整病例分析中，与对照组相比，干预组的日常平均 PA 量减少（-0.80 毫重力[mg]；95%置信区间[CI] = -1.57 至 -0.03； = 0.04）。干预组的中高强度 PA 时间（-3.86 分钟/天；95%CI=-6.70 至 -1.03； = 0.008）和相当于慢走强度的时间（-4.66 分钟/天；95%CI=-8.82 至 -0.51； = 0.028）也减少。然而，意向性治疗分析（排除未参加至少一次教育课程的参与者）发现 12 个月时两组间的总体日常 PA 无差异（-0.65mg；95%CI=-1.46 至 0.15； = 0.11）。
自我管理方案使患有多种疾病的人群的 PA 水平略有下降。未来的研究应确定并针对最需要促进 PA 的多种疾病患者亚组进行针对性干预，以最大限度地提高潜在获益能力，同时还应注重改进干预措施，以提高增加 PA 的效果。
