EFFICACY OF PHYSICAL ACTIVITY COUNSELLING INTERVENTIONS DELIVERED IN PRIMARY CARE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Overwhelming success has been achieved in disease control through environmental interventions such as vaccinations and improved hygiene to increase life expectancy, many authorities in the field of preventative healthcare are of the opinion that too little has been done to target behavioral factors, particularly physical inactivity. Research suggests that the impact PA counselling in primary care could have at a population level is tremendous. However, gaps still exist between the science and the practice when it comes to prescribing exercise in the healthcare context. Objectives: To compare the effectiveness of health provider delivered interventions for physical activity (PA) promotion verses placebos or no or minimal intervention among community dwelling adults Search methods: We searched Cochrane Central Register of Controlled Trials in the Cochrane Library, Ovid MEDLINE(R), Embase Ovid, Web of Science, CINAHL (EBSCOhost) and SPORTDiscus (earlier dates to 10 January, 2020) electronic databases regardless of language or publication status using the optimal sensitive search strategy developed by The Cochrane Collaboration. We used Medical Subject Headings (MeSH) [1], Looked up words in text word, abstract, title [2], then Combined [1] with [2] using Boolean logic (OR) and then Set up proper filters. Selection criteria: Randomised controlled trials (RCTs) and cluster randomised trials. We excluded quasi-RCTs and cross-over trials. We will include studies comparing health provider counselling intervention to placebo or no counselling/exercise prescription. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to treat analysis. The studies were considered if the outcomes were measured on a continuous scale and results reported in terms on mean change, confidence intervals of change, standard deviations or standard error and mean. Studies with dichotomous outcomes were excluded. Data collection and analysis: Two review authors (EKW and MW) independently carried out data extraction for each included record using a pro forma specifically designed for the purpose. We resolved differences in data extraction by discussion. We plotted the results of each trial as point estimates, using means and standard deviations for the continuous outcomes. Since studies reported different outcome measures but measured the same concept, we calculated the standardised mean difference (SMD) with 95% confidence interval (CI) using a random-effects models. Main results: There were 15,269 apparently healthy adults who participated in the 24 included studies. All studies recruited both genders. The stated age range of participants was from 18 to 80 years. Meta-analysis of data from these trials suggests that health provider-led physical activity counselling interventions in primary care may lead to increased self-report physical activity (SMD 0.11, 95% CI 0.04 to 0.17; participants = 13211; studies = 16; I² = 50%), total energy expenditure (SMD 0.20, 95% CI 0.13 to 0.27; participants = 3376; studies = 8; I² = 2%; overall effect P=0.00001) and systolic blood pressure at six showed a mean difference (MD) favouring health provider-led physical activity counselling interventions compared to usual care of -0.10 mmHg (SMD 0.27 95% CI 0.72 to 0.18;I² = 0%, overall effect P = 0.006) among patients. However meta-analysis showed that health provider-led physical activity counselling interventions in primary care did not lead to increased aerobic fitness (SMD 0.06, 95% CI -0.01 to 0.12; I² = 35%), body mass index (SMD -0.04, 95% CI -0.15 to 0.07) and total cholesterol (SMD -0.27, 95% CI -0.72 to 0.18 and Waist circumference (SMD -0.05, 95% CI-0.15 to 0.06; I² = 0%;overall effect P=0.24). Although there were limited data, there was no evidence of an increased risk of adverse events. Authors' conclusions: Counselling delivered by health providers, probably leads to similar or better physical activity outcomes for patient conditions (moderate-certainty evidence). However, these results must be interpreted with a degree of caution, recognising the variation in interventions reported within studies and the complex interplay of factors affecting outcomes. Several studies included multiple intervention methods, which made it difficult to tease apart which intervention components were the active ingredients

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