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The feasibility and effectiveness of clinical-community linkages and exercise-referral schemes for the promotion of physical activity (PA) has not been explored in low-to-middle income countries (LMICs). We evaluated the effectiveness of a primary-cared based, 16-week intervention rooted in behavioral theory approaches to increase compliance with aerobic PA recommendations.
Methods
Participants were patients with diagnosis (< 5 years) of mild hypertension, 35-70 years of age, self-reported as physically inactive, with a stated intention to engage in PA, and assigned to exercise-referral (ER) or brief counseling (BC) groups, using a clustered randomized design at four primary health care centers in Cuernavaca, Mexico. The primary outcome was change in PA levels measured via accelerometers at baseline, 16 and 24 weeks. Intention-to-treat analyses were used to estimate the effects of the intervention. Longitudinal multi-level analyses were conducted to account for the three assessment time-points adjusted for potential confounding or modifier variables
Results
Minutes/week of objectively-assessed moderate-to-vigorous physical activity (MVPA) increased by, 37 and 47 minutes in the ER and BC groups, respectively (p=0.54 between groups). Participants attending > 50% of planned ER program sessions significantly increased their MVPA by 85 minutes/week and their compliance with aerobic PA recommendations by 15.5% (p<0.001).
Conclusions
Both BC and ER led to modest improvements in PA levels, with no significant differences between groups. However, adequate adherence with the planed ER program led to significant improvements in the compliance with aerobic PA recommendations compared to BC. These results provide important contextual evidence to help guide the development and implementation of PA promotion programs using clinical-community linkages in LMICs.