The English meta-analysis of Foster and colleagues published in the journal Cochrane Collaboration in 2009 compared, on the basis of 29 randomized controlled trials, different intervention strategies that engage physical activity in sedentary adults. The main result of this ongoing commitment is the fact that programs are needed to be supervised by professionals.
The Study Rationale
Regular physical activity helps to prevent and to treat cardiovascular disease, hypertension, diabetes, obesity, cancer and osteoporosis. For example, regular physical activity reduces by 30% the risk of coronary or cardiovascular disease compared to individuals who have sedentary habits. Physical inactivity is the cause of 22% of ischemic heart disease. Health organizations recommend at least 30 minutes of physical activity of moderate intensity (5 to 7.5 kcal / min), 5 days a week minimum to get a health benefit. Despite these recommendations known to all, only 37% of men and 25% of women follow in England.
How to encourage sedentary adults to practice more physical activity and more regularly?
The meta-analysis Cochrane type retained 29 randomized controlled trials involving people over 18 without previous medical problems. The analysis compares interventions that encourage involvement in a practice of regular physical activity. The monitoring of the intervention is of 6 months minimum. The meta-analysis compiles 11 513 participants, men and women in good health. Age between 18 and 95 years. Participants were recruited from four types of institutions, primary care structures (eg general practitioner), workplaces, universities and associations. The main measures concern the level of adherence to the intervention between the beginning and end of the intervention, the level of physical activity reported by questionnaire and cardiorespiratory fitness. Interventional groups were compared with control groups receiving a report on general health and / or minimal physical activity intervention.
The Non-Pharmacological Intervention (NPI) assessed
The duration of the interventions was 6 months minimum. They were led by health professionals: doctors, nurses, health educators, counselors, and / or professionals in physical activity. Physical activity was of moderate intensity endurance type and / or intense 150 minutes per week. The intervention could be of three types:
– Unsupervised and independent in which the selected entrant himself he prefers physical activity practice without monitoring by a health professional,
– Mixed corresponding to an individual choice of participant for physical activity combined with counseling and monitoring by health professionals,
– Structured and supervised in which the Participant prescribed physical activity and followed by a medical professional.
The meta-analysis shows a moderate positive effect of interventions on the level of physical self-reported by individuals compared to control group activity. The earned weekly exercise time is on average 90 minutes after the procedure, regardless of its type. Telephone follow-up is beneficial to maintain behavior change related to physical activity. The results show a significant benefit but average on short and medium term cardiorespiratory fitness. For cons, the long-term effectiveness of these interventions could not be evaluated because the majority of studies stopped at 12 months. Moreover, the interventions were too heterogeneous to show the differences between the 3 types analyzed.
What it means for Patients
Reaching the 150 minutes of weekly physical activity of moderate intensity for any adult as recommended by major health organizations is not as easy as that. A program supervised by a professional for a period of six months increases by 90 minutes per week of physical activity sedentary. This benefit lasts at least a year. It considerably reduces the risk of chronic diseases, including cardiovascular and coronary heart disease.
What it means for Healthcare Professionals
Reaching the 150 minutes of weekly physical activity of moderate intensity for any adult as recommended by major health organizations is not as easy as that. A supervised program for a period of six months increased by an average of 90 minutes of physical activity after one year. If the current data do not identify a more favorable scheme than another, however they show the need to direct practitioners to qualified and specialized professionals.
What it means for Researchers
The establishment of a commitment to regular physical activity in sedentary individuals program gets a significant but moderate according to this meta-analysis included 29 randomized controlled trials. The level of evidence is limited because of the difficulty in recruiting motivated and problems in measuring physical activity by insufficiently precise questionnaire. The authors recommend in future clinical trials of cost-effectiveness analyzes and take account of socio-economic levels and ethnic backgrounds of the participants. Studies are also needed to determine what type of intervention motivates more long-term participants, at home or in health care institutions, by phone or face to face, in groups or individually.
What it means for Policymakers
In England, 63% of men and 75% of women do not follow international recommendations for weekly physical activity. Physical inactivity significantly increases the risk of developing chronic diseases whose costs of care are exploding. This meta-analysis shows that programs supervised by trained professionals with a duration of six months can increase of 90 minutes per week of physical activity, and that this benefit lasts for at least one year.
Nield L, Summerbell CD, Hooper L, Whittaker V, Moore H (2008). Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane Database of Systematic Reviews, 3, CD005102.
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Same non-pharmacological intervention
To reference this Blog en Sante © article.
Ninot G (2015). Engage to regular exercise. Blog en Sante, A43.
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