PEPAF: Evaluation of Family Physician's Effectiveness for Physical Activity Promotion
Condition: Exercise; Physical Fitness; Quality of Life
Study type: Interventional
Phase: Phase 3

Summary: 
      The potential health gains from active lifestyles are very well-known and it is recommended
      that all adults dedicate at least 30 minutes to activities of at least moderate intensity at
      least five days a week. What is still not known is how to help sedentary people follow this
      recommendation, by means of brief interventions feasible in routine general practice. This
      multi-center study was designed to evaluate the effectiveness of a physical activity
      promotion program (called PEPAF) implemented in 56 general practices of the Spanish public
      primary health care system. The study will test the capacity of the program to increase the
      physical activity level, physical fitness and health related quality of life of sedentary
      people.
    

Detailed description: 
      Despite sedentary behavior being one of the strongest risk factors for chronic diseases and
      mortality, most of the population remains sedentary and evidence is inconclusive that
      counseling adults in the primary care setting to increase physical activity is effective.

      The OBJECTIVE of this randomized clinical trial was to evaluate the effectiveness of an
      innovative programme to promote physical activity (called PEPAF) implemented by family
      doctors into daily routine practice. Doctors randomly allocated to the PEPAF group identified
      sedentary people who visited them for any reason, diagnosed their stage of change and
      prescribed a written plan of physical activity with those patients ready to change. Those not
      prepared to change were briefly counseled and given printed materials to motivate them.
      Patients with cardiovascular disease or other problems meaning that exercise could cause
      adverse effects were excluded.

      Participating people will be followed for 24 months to measure the increase in the level of
      physical activity from baseline measurement to 6, 12 and 24 months, using 7-day physical
      activity recall. Health-related quality of life and cardiorespiratory fitness (submaximal
      cycle ergometer test) will also be measured.

      People assigned to the PEPAF group will be COMPARED to patients of family doctors randomly
      assigned to the control group in which any systematic intervention on physical activity
      promotion has been postponed until year 2006, except for those patients whose health problems
      were directly related to a sedentary lifestyle. The average changes observed in the two
      groups will be compared, on the basis of intention to treat through analysis of covariance.
      The investigators will use mixed-effect models to take into account intra-patient,
      intra-doctor and intra-center correlation.
    

Intervention name(s): Experimental Programme for Physical Activity Promotion; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): General practitioner's (GP) physical activity (PA) assessment and advise using a web-based software that prompted open questions to elicit believes about benefits of PA, graphical information about risks of inactivity and examples of type sentences to provide medical advise.
Educational materials summarizing benefits, risks and motivation.
Prescription: 15 minutes educational session in which GP negotiated a goal, addressed possible barriers and anticipated solutions using web-based tools for lack of time, community resources, and health problems. Finally, they designed a 3-month PA activity plan that derived in a standardized printed prescription of frequency, duration, intensity and progression of a selected PA or exercise that included a self-monitoring log.; Control general practitioners assessed physical activity and performed recruitment in a similar way but offered usual care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: Primary Health Care; Physicians, Family; Family Practice; Health Promotion; Randomized Controlled Trials; Multicenter Studies; Physical Fitness; Quality of Life