Physical activity on prescription : studies on physical activity level, adherence and cardiovascular risk factors

Physical activity is one of the most important public health determinants, and the health care sector is highlighted as a central setting in the promotion of physical activity in the population as well as at an individual level. One method that has attracted attention over recent years, is physical activity prescribed by doctors or other health care professionals, even though there is insufficient evidence to determine that any method of promoting physical activity in the health care setting is superior to another. It is therefore important to investigate whether physical activity on prescription leads to a more physically active lifestyle and to possible health benefits in clinical settings.

This thesis investigated the effectiveness of individualized physical activity on prescription making use of two studies with different design and conducted within two different clinical settings. The study populations included patients in general primary health care centres (n=481, 75% female, mean age 50 years [12 81]) and elderly insufficiently physically active individuals with overweight and abdominal obesity recruited from a population based ongoing prospective cohort study (n=101, 57% female, 67-68 years).

The main finding was that individualized prescriptions of physical activity increases physical activity level for at least six months. Physical activity on prescription can be suitable as conventional treatment in an ordinary primary health care setting to promote a more physically active lifestyle. Self-reported physical activity level, stages of change and quality of life increased significantly, and the adherence to physical activity on prescription was 65%, which is as good as adherence to other treatments of chronic diseases. In elderly people with overweight physical activity on prescription is an effective method to increase physical activity level, as significantly higher improvements were seen in the intervention group (two to three times higher) than in the control group regardless of assessment method. Individualized physical activity on prescription also improves body composition and reduces cardiometabolic risk factors in older insufficient physical active overweight individuals.

This thesis shows that individualized physical activity on prescription (PAP) is effective in clinical settings; • PAP can be carried out as a part of routine care and is effective in promoting physical activity; • Adherence to PAP in primary health care settings is as good as adherence to other treatments of chronic diseases; • Self-reported quality of life, both regarding physical and mental aspects increased 6 months after receiving PAP; • PAP increased physical activity level three times more than in a control group; and • PAP reduced several cardiometabolic risk factors in elderly women and men with low physical activity level, overweight and abdominal obesity.

Therefore, physical activity on prescription has a potential to become an important method for promoting physical activity in a public health perspective, thus improving health and quality of life, and decreasing disease burden both for individuals as well as for the health care system.

List of scientific papers

I. Kallings LV, Leijon M, Hellenius ML, Ståhle A (2008). "Physical activity on prescription in primary health care: a follow-up of physical activity level and quality of life." Scand J Med Sci Sports 18(2): 154-61.
https://pubmed.ncbi.nlm.nih.gov/17555539

II. Kallings LV, Leijon ME, Kowalski J, Hellenius ML, Ståhle A (2008). "Self-reported adherence - a method for evaluating prescribed physical activity in primary health care patients." J Phys Act Health. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/19842463

III. Kallings LV, Ståhle A, Hemmingsson E, Höglund C, Kowalski J, Hellenius ML (2008). "Individualized physical activity on prescription increases physical activity level in overweight individuals results from a randomized controlled trial." [Submitted]

IV. Kallings LV, Sierra Johnson J, Fisher RM, de Faire U, Ståhle A, Hemmingsson E, Hellenius ML. (2008). "Beneficial effects of individualized physical activity on prescription on body composition and cardiometabolic risk factors - results from a RCT." Eur J Cardiovasc Prev Rehabil. [Submitted]