Implementation of the EIRA 3 Intervention by Targeting Primary Health Care Practitioners: Effectiveness in Increasing Physical Activity
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting
2.2.1. PHC Centers
2.2.2. Participants
2.2.3. Assignment of PHC Centers to Different Interventions
2.2.4. Intervention Group
2.2.5. Usual Care Group
2.3. Outcomes
2.3.1. Primary Outcome
2.3.2. Secondary Outcomes
2.4. Sample Size
2.5. Statistical Analysis
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Basal Characteristics of the Participants | Control (n = 1581) | Intervention (n = 1481) |
---|---|---|
Sex, n/N (%) | ||
Men | 709/1581 (44.8%) | 672/1481 (45.4%) |
Women | 872/1581 (55.2%) | 809/1481 (54.6%) |
Age (years), mean ± SD | 58.3 ± 8.3 | 57.7 ± 7.9 |
(mean 95% CI) | (57.9, 58.7) | (57.3, 58.1) |
Civil status, n/N (%) | ||
Married/Co-habitant | 1.055/1575 (67.0%) | 1024/1461 (70.1%) |
Single/Living apart | 520/1575 (33%) | 437/1461 (29.9%) |
Work status | ||
Active | 713/1575 (45.3%) | 661/1456 (45.4%) |
Inactive | 431/1575 (27.4%) | 424/1456 (29.1%) |
Retired | 431/1575 (27.4%) | 371/1456 (25.5%) |
Level of studies | ||
Higher education, university or similar | 267/1572 (17.0%) | 247/1461 (16.9%) |
High school | 621/1572(39.5%) | 573/1461 (39.2%) |
Primary school, not finished primary school, or without studies | 684/1572 (43.5%) | 641/1461 (43.9%) |
Weight (kg), mean ± SD | 78.77 ± 17.41 | 82.3 ± 17.81 |
(mean 95% CI) | (77.91, 79.63) | (81.38, 83.21) |
BMI (kg/m2), mean ± SD | 29.3 ± 5.6 | 30.6 ± 5.9 |
(mean 95% CI) | (29.0, 29.5) | (30.3, 30.9) |
BMI, n/N (%) | ||
Normal | 363/1574 (23.1%) | 228/1454 (15.7%) |
Overweight | 595/1574 (37.8%) | 491/1454 (33.8%) |
Obese | 616/1574 (39.1%) | 735/1454 (50.6%) |
Waist circumference (cm), mean ± SD | 99.9 ± 15.0 | 102.0 ± 14.4 |
(mean 95% CI) | (99.1, 100.6) | (101.2, 102.7) |
Physical activity level (MET mins/week) mean ± SD | 1794.2 ± 3018.0 | 1480.0 ± 2382.0 |
(mean 95% CI) | (1644.2, 19442.2) | (1356.7, 1306.3) |
Physical activity level, n/N (%) | ||
Low | 709/1557 (45.5%) | 729/1437 (50.7%) |
Moderate | 648/1557 (41.6%) | 570/1437 (39.7%) |
High | 200/1557 (12.8%) | 138/1437 (9.6%) |
Follow WHO recommendations (Yes), n/N (%) | 252/1580 (15.9%) | 205/1476 (13.9%) |
Moderate-intensity physical activity (min/day) mean ± SD | 20.1 ± 56.4 | 16.4 ± 51.5 |
(mean 95% CI) | (17.2, 22.9) | (13.7, 19.1) |
High-intensity physical activity (min/day) mean ± SD | 9.2 ± 45.9 | 7.6 ± 36.1 |
(mean 95% CI) | (6.9, 11.6) | (5.7, 9.5) |
Time spent sitting (min/day) mean ± SD | 328.7 ± 188.7 | 321.2 ± 176.9 |
(mean 95% CI) | (319.2, 338.1) | (311.9, 330.4) |
Stages of change: physical activity, n/N (%) | ||
Precontemplation | 643/1548 (41.5%) | 152/1270 (12.0%) |
Contemplation | 389/1548 (25.1%) | 229/1270 (18.0%) |
Preparation | 204/1548 (13.2%) | 516/1270 (40.6%) |
Action | 137/1548 (8.9%) | 266/1270 (20.9%) |
Maintenance/Termination | 175/1548 (11.3%) | 107/1270 (8.4%) |
Diet, n/N (%) | ||
Inadequate | 1261/1576 (80.0%) | 1240/1480 (83.8%) |
Adequate | 315/1576 (20.0%) | 240/1480 (16.2%) |
Social support DUKE-UNC-11 mean ± SD | 45.5 ± 8.4 | 45.4 ± 8.9 |
(mean 95% CI) | (45.0, 45.9) | (44.9, 45.9) |
Health status EQ5D5L mean ± SD | 67.6 ± 20.0 | 65.0 ± 21.0 |
(mean 95% CI) | (66.6, 68.6) | (63.9, 66.1) |
Depression (Yes) n/N (%) | 211/1196 (17.6%) | 219/1140 (19.2%) |
Tobacco use, n/N (%) | ||
Non-smoker | 444/1581 (28.1%) | 432/1481 (29.2%) |
Ex-smoker | 440/1581 (27.8%) | 408/1481 (27.5%) |
Smoker | 697/1581 (44.1%) | 641/1481 (43.3%) |
Diabetes (Yes), n/N (%) | 323/1579 (20.5%) | 277/1469 (18.9%) |
Systolic blood pressure (mmHg) mean ± SD | 130.8 ± 17.5 | 132.85 ± 16.5 |
(mean 95% CI) | (129.8, 131.8) | (131.8, 133.9) |
Diastolic blood pressure (mmHg) mean ± SD | 79.88 ± 10.31 | 82.27 ± 10.08 |
(mean 95% CI) | (79.3, 80.5) | (81.6, 82.9) |
Hypertension (Yes), n/N (%) | 610/1577 (38.7%) | 587/1459 (40.2%) |
LDL mean ± SD | 108.3 ± 33.9 | 108.0 ± 39.3 |
(mean 95% CI) | (104.3, 112.3) | (103.2, 112.8) |
HDL mean ± SD | 45.9 ± 12.2 | 46.7 ± 12.8 |
(mean 95% CI) | (44.5, 47.4) | (45.14, 48.28) |
TG mean ± SD | 131.4 ± 81.7 | 135.1 ± 80.1 |
(mean 95% CI) | (126.2, 136.7) | (129.6, 140.5) |
Blood sugar mean ± SD | 102.1 ± 29.6 | 104.3 ± 31.8 |
(mean 95% CI) | (100.2, 103.9) | (102.2, 106.5) |
Glycated hemoglobin mean ± SD | 7.19 ± 1.37 | 7.12 ± 1.36 |
(mean 95% CI) | (7.03, 7.35) | (6.95, 7.29) |
Use of statin (Yes), n/N (%) | 420/1569 (26.8%) | 449/1462 (30.7%) |
Cardiovascular disease (Yes), n/N (%) | 87/1568 (5.5%) | 87/1452 (6%) |
REGICOR Cardiovascular risk mean ± SD | 5.4 ± 0.1 | 5.6 ± 0.1 |
(mean 95% CI) | (5.2, 5.6) | (5.4, 5.7) |
Baseline | At 12 Months | Per-Protocol | Intention to Treat | |||||
---|---|---|---|---|---|---|---|---|
Control (n = 1581) | Intervention (n = 1481) | Control (n = 1285) | Intervention (n = 1107) | Mean Difference (95% CI) | p-Value | Mean Difference (95% CI) | p-Value | |
MET mins/week mean ± SD | 1794.2 ± 3018.0 | 1480.0 ± 2382.0 | 1508.1 ± 2135.3 | 1507.1 ± 1996.0 | 52.37 | 0.534 | 284.09 | 0.335 |
(mean 95% CI) | (1644.2–19442.2) | (1356.7–1306.3) | (1387.7, 1628.4) | (1385.0, 1629.2) | (−112.61, 217.34) | (−298.24, 866.42) | ||
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |||||
Physical activity (IPAQ7) | 0.800 | 0.822 | ||||||
Low | 709/1557 (45.5%) | 729/1437 (50.7%) | 505/1220 (41.4%) | 473/1082 (43.7%) | Ref | Ref | ||
Moderate-High | 848/1557 (55.5%) | 708/1437 (49.3%) | 715/1220 (58.6%) | 609/1082 (56.3%) | 0.98 (0.82, 1.16) | 1.02 (0.85, 1.23) | ||
Follow WHO recommendations | 0.020 | |||||||
No | 1328/1580 (84.1%) | 1271/1476 (86,1%) | 1059/1231 (86.0%) | 906/1086 (83.4%) | ref | ref | ||
Yes | 252/1580 (15.9%) | 205/1476 (13.9%) | 172/1231 (14.0%) | 180/1086 (16.6%) | 1.33 (1.05, 1.70) | 0.019 | 1.29 (1.04, 1.60) | |
Mean Difference (95% CI) | p-Value | Mean Difference (95% CI) | p-Value | |||||
BMI (kg/m2) mean ± SD | 29.3 ± 5.6 | 30.6 ± 5.9 | 28.97 ± 5.50 | 30.29 ± 5.65 | −0.11 | 0.134 | 0.03 | 0.961 |
(mean 95% CI) | (29.0–29.5) | (30.3–30.9) | (28.66, 29.28) | (29.94, 30.63) | (−0.25, 0.03) | (−1.22, 1.28) | ||
Weight (kg) mean ± SD | 78.77 ± 17.41 | 82.3 ± 17.81 | 78.25 ± 17.31 | 81.36 ± 17.34 | −0.30 | 0.097 | −0.04 | 0.982 |
(mean 95% CI) | (77.91–79.63) | (81.38–83.21) | (77.28, 79.22) | (80.31, 82.41) | (−0.66, 0.05) | (−3.30, 3.22) | ||
Waist circumference (cm) mean ± SD | 99.9 ± 15.0 | 102.0 ± 14.4 | 98.67 ± 14.80 | 101.43 ± 14.20 | 0.60 | 0.043 | 1.10 | 0.454 |
(mean 95% CI) | (99.1–100.6) | (101.2–102.7) | (97.82, 99.52) | (100.55, 102.31) | (0.02, 1.18) | (−1.81, 4.00) | ||
Systolic BP (mmHg) mean ± SD | 130.8 ± 17.5 | 132.85 ± 16.5 | 131.81 ± 17.14 | 131.00 ± 16.42 | −1.96 | 0.001 | −1.13 | 0.497 |
(mean 95% CI) | (129.8–131.8) | (131.8–133.9) | (130.84, 132.78) | (130.00, 132.01) | (−3.13, −0.79) | (−4.41, 2.16) | ||
Diastolic BP (mmHg) mean ± SD | 79.88 ± 10.31 | 82.27 ± 10.08 | 80.07 ± 10.26 | 81.07 ± 9.94 | −0.13 | 0.737 | 0.30 | 0.779 |
(mean 95% CI) | (79.3–80.5) | (81.6–82.9) | (79.49, 80.65) | (80.46, 81.68) | (−0.89, 0.63) | (−1.80, 2.41) | ||
LDL(mg/dL) mean ± SD | 108.3 ± 33.9 | 108.0 ± 39.3 | 105.75 ± 32.51 | 104.63 ± 32.09 | −1.92 | 0.165 | −2.49 | 0.530 |
(mean 95% CI) | (104.3–112.3) | (103.2–112.8) | (100.98–110.51) | (99.80–109.46) | (−4.63, 0.79) | (−10.38, 5.39) | ||
HDL(mg/dL) mean ± SD | 45.9 ± 12.2 | 46.7 ± 12.8 | 47.76 ± 12.85 | 47.28 ± 13.23 | −0.08 | 0.828 | −0.28 | 0.843 |
(mean 95% CI) | (44.5–47.4) | (45.14–48.28) | (45.87, 49.64) | (45.29, 49.27) | (−0.85, 0.68) | (−3.08, 2.52) | ||
TG (mg/dL) mean ± SD | 131.4 ± 81.7 | 135.1 ± 80.1 | 130.9 ± 81.7 | 138.5 ± 81.6 | 5.41 | 0.051 | 7.99 | 0.487 |
(mean 95% CI) | (126.2–136.7) | (129.6–140.5) | (126.5, 135.3) | (132.9, 144.0) | (−0.02, 10.84) | (−14.76, 30.73) | ||
Blood sugar (mg/dL) mean ± SD | 102.1 ± 29.6 | 104.3 ± 31.8 | 135.94 ± 46.84 | 135.36 ± 38.75 | −0.72 | 0.491 | 0.88 | 0.763 |
(mean 95% CI) | (100.2–103.9) | (102.2–106.5) | (129.07–142.81) | (129.52–141.19) | (−2.78, 1.34) | (−4.91, 6.68) | ||
Glycated hemoglobin (%) mean ± SD | 7.19 ± 1.37 | 7.12 ± 1.36 | 6.97 ± 1.15 | 6.81 ± 1.05 | −0.10 | 0.273 | −0.08 | 0.719 |
(mean 95% CI) | (7.03–7.35) | (6.95–7.29) | (6.80–7.14) | (6.65–6.97) | (−0.28, 0.08) | (−0.51, 0.35) | ||
REGICOR mean ± SD | 5.4 ± 0.1 | 5.6 ± 0.1 | 5.33 ± 3.36 | 5.34 ± 3.60 | −0.26 | 0.030 | −0.15 | 0.464 |
(mean 95% CI) | (5.2–5.6) | (5.4–5.7) | (5.10, 5.55) | (5.08, 5.59) | (−0.50, −0.03) | (−0.56, 0.26) | ||
Moderate-intensity physical activity (IPAQ7) | 0.038 | 0.100 | ||||||
(min/day) mean ± SD | 20.1 ± 56.4 | 16.4 ± 51.5 | 16.15 ± 48.73 | 18.54 ± 52.23 | 0.25 | 0.21 | ||
(mean 95% CI) | (17.2–22.9) | (13.7–19.1) | (13.41, 18.88) | (15.40, 21.68) | (0.01, 0.49) | (−0.04, 0.45) | ||
High-intensity physical activity (IPAQ7) | 0.491 | 0.402 | ||||||
(min/day) mean ± SD | 9.2 ± 45.9 | 7.6 ± 36.1 | 6.60 ± 36.61 | 7.08 ± 35.13 | 0.16 | 0.15 | ||
(mean 95% CI) | (6.9–11.6) | (5.7–9.5) | (4.55, 8.66) | (4.97, 9.19) | (−0.29, 0.60) | (−0.20, 0.49) | ||
Mins/day spent sitting (IPAQ7) | 0.764 | 0.920 | ||||||
mean ± SD | 328.7 ± 188.7 | 321.2 ± 176.9 | 314.66 ± 160.94 | 309.48 ± 165.54 | 0.01 | −0.003 | ||
(mean 95% CI) | (319.2–338.1) | (311.9–330.4) | (305.62, 323.69) | (299.54, 319.43) | (−0.03, 0.04) | (−0.07, 0.06) |
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Contreras-Martos, S.; Leiva, A.; Sanchez, Á.; Motrico, E.; Bellón, J.; Aldecoa Landesa, S.; Magallón-Botaya, R.; Casajuana-Closas, M.; Zabaleta-del-Olmo, E.; Bolíbar, B.; et al. Implementation of the EIRA 3 Intervention by Targeting Primary Health Care Practitioners: Effectiveness in Increasing Physical Activity. Int. J. Environ. Res. Public Health 2021, 18, 10537. https://doi.org/10.3390/ijerph181910537
Contreras-Martos S, Leiva A, Sanchez Á, Motrico E, Bellón J, Aldecoa Landesa S, Magallón-Botaya R, Casajuana-Closas M, Zabaleta-del-Olmo E, Bolíbar B, et al. Implementation of the EIRA 3 Intervention by Targeting Primary Health Care Practitioners: Effectiveness in Increasing Physical Activity. International Journal of Environmental Research and Public Health. 2021; 18(19):10537. https://doi.org/10.3390/ijerph181910537
Chicago/Turabian StyleContreras-Martos, Sara, Alfonso Leiva, Álvaro Sanchez, Emma Motrico, Juan Bellón, Susana Aldecoa Landesa, Rosa Magallón-Botaya, Marc Casajuana-Closas, Edurne Zabaleta-del-Olmo, Bonaventura Bolíbar, and et al. 2021. "Implementation of the EIRA 3 Intervention by Targeting Primary Health Care Practitioners: Effectiveness in Increasing Physical Activity" International Journal of Environmental Research and Public Health 18, no. 19: 10537. https://doi.org/10.3390/ijerph181910537