Physical Activity Adherence and Prescription in the Catalan population

The behaviour of individuals, communities and populations is one of the major determinants of their health outcomes. This thesis presents the findings from three research projects related to the need of health care systems to focus in health behaviour change related to physical activity (PA) to manage the current burden of chronic diseases. This set of studies set out to investigate the adherence to the current PA recommendations in Catalan population, which appears to support low levels of inactivity in Catalan adults that add an avoidable burden to the nation’s Public Health system. This was undertaken because existing work in Spain – consistent with that in many other countries - has been based on isolated studies, conducted under different policies and through different economic circumstances. Three studies were conducted with the collective aim of exploring adherence to PA in the Catalan population and in Catalan physicians and to assess the outcomes of a primary care-based programme to promote health change related to PA in Catalonia. Collectively this work focuses on different and important facets of the challenge that underpins the promotion of behaviour change in adults The main findings of the studies were (i) high adherence to health-enhancing PA level based on walking activity by Catalan population but high prevalence of sedentary leisure time, (ii) poor lifestyle behaviours related to physical inactivity and overweight among Catalan physicians and (iii) the effectiveness of a PA referral scheme, promoted by the national program “Plan of Physical Activity, Sport and Health” (PAFES) on PA adherence, and associated improvements in quality of life of primary care patients with chronic conditions. The PAFES program has powerful repercussions for changing health behaviour related to PA in Catalan adults and Catalan physicians. The increases in resources and service delivery improvements generated by PAFES was intended to positively impact on both primary health care providers and Catalan population, to overcome many of the established barriers seen regarding physicians’ barriers to PA counselling, resulting from two main factors; lack of protocols and having little relevant training. Furthermore, PA referral scheme has seen to be an effective and easily practicable method for increased PA and quality of life in routine primary care patients with chronic conditions. In addition, PARS promote increased PA in a wide part of the population who otherwise are hard to reach or have a low motivation for lifestyle changes. In conclusion, adherence to PA in Catalan general population and in Catalan physicians’ population has been positively influenced by implementing the national Plan on Physical Activity, Sport and Health (PAFES) through primary care settings. The PAFES program provides a comprehensive strategy that can be deployed with relative ease for directly addressing the widespread clinical challenges that modern inactive lifestyles create for public health. This effectiveness is wide ranging and can be seen in changed health-related behaviours, which in turn reduce risk, morbidity and mortality.