Nicole Freene

Community group exercise versus physiotherapist-led home-based physical activity program: barriers, enablers and preferences in middle-aged adults

Abstract Background/Purpose: Barriers and enablers of physical activity have been investigated, but it remains unclear what middle-aged adults’ physical activity preferences are. Two physical activity interventions were compared to determine barriers, enablers and preferences for physical activity format in sedentary, community-dwelling 50- to 65-year-olds. Methods: Using mixed methods, 37 Physical Activity at Home (PAAH) participants took part in focus groups at the end of the intervention period and completed the Active Australia Survey (AAS). Participants were divided into three sub-groups: (1) group exercise attendees (GA, n = 14); (2) group exercise non-attendees (GNA, n = 9); and (3) physiotherapist-led home-based physical activity program attendees (HB, n = 14). Focus groups were audio-taped, transcribed, coded and analysed using an inductive thematic approach. Thirty-seven exit telephone calls with GNA were included in the analysis. Results: Cost, self-efficacy, work and carer commitments were major themes identified for GA and GNA. HB participants reported fewer barriers and a number of enablers, including flexibility of the program and physiotherapist instruction. HB and GNA were younger than GA (p< 0.05), more likely to be in paid employment and GNA participants were insufficiently active (p ≤ 0.01). All participants preferred some home-based physical activity, although a variety of formats was indicated. Conclusion: The barriers, enablers and preferences indicate that the physiotherapist-led home-based physical activity program with initial face-to-face contact and telephone support may increase the adoption and maintenance of physical activity in middle-aged adults, particularly for those not interested in, or unable to attend, group exercise.

Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis

Objective: Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels. Data sources: Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities. Main Results: From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities. Conclusions: Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.

Validating two self-report physical activity measures in middle-aged adults completing a group exercise or home-based physical activity program.

OBJECTIVES To compare self-reported physical activity recorded in physical activity diaries or the Active Australia Survey with objectively measured physical activity using accelerometry in sedentary middle-aged adults completing two physical activity interventions. DESIGN Cross-sectional study. METHODS Sedentary 50-65 year olds were recruited to a non-randomized 6-month community group exercise program (G) or a physiotherapist-led home-based physical activity program (HB). Over 7-days, 76 participants (HB 39, G 37) wore an ActiGraph GT1M accelerometer (5s epochs), completed the Active Australia Survey (AAS) and a daily physical activity diary. Data were analysed using descriptive statistics and Spearman rank-order correlations. RESULTS The two interventions had similar demographic and physical activity characteristics except that home-based participants were younger (p < 0.01), more likely to be employed full time (p ≤ 0.001) and reported less moderate-to-vigorous physical activity in the physical activity diaries compared to group exercise participants (HB 29 ± 21 min d(-1) vs. G 57 ± 35 min d(-1), p ≤ 0.001). Home-based participants had fair-to-good agreement between the physical activity diaries and AAS or ActiGraph data (r = 0.39-0.68, p < 0.05). Group exercise physical activity diary data did not correlate significantly with either the AAS or ActiGraph data. In contrast, group exercise AAS data had good correlations with ActiGraph data (r = 0.49-0.64, p ≤ 0.001). CONCLUSIONS Physical activity diaries should be interpreted cautiously unless intervention participants have an adequate understanding of physical activity intensity. The AAS is the preferred self-report measure in middle-aged adults independent of intervention.

Physiotherapists use a small number of behaviour change techniques when promoting physical activity: A systematic review comparing experimental and observational studies

OBJECTIVES Physiotherapists promote physical activity as part of their practice. This study reviewed the behaviour change techniques physiotherapists use when promoting physical activity in experimental and observational studies. DESIGN Systematic review of experimental and observational studies. METHODS Twelve databases were searched using terms related to physiotherapy and physical activity. We included experimental studies evaluating the efficacy of physiotherapist-led physical activity interventions delivered to adults in clinic-based private practice and outpatient settings to individuals with, or at risk of, non-communicable diseases. Observational studies reporting the techniques physiotherapists use when promoting physical activity were also included. The behaviour change techniques used in all studies were identified using the Behaviour Change Technique Taxonomy. The behaviour change techniques appearing in efficacious and inefficacious experimental interventions were compared using a narrative approach. RESULTS Twelve studies (nine experimental and three observational) were retained from the initial search yield of 4141. Risk of bias ranged from low to high. Physiotherapists used seven behaviour change techniques in the observational studies, compared to 30 behaviour change techniques in the experimental studies. Social support (unspecified) was the most frequently identified behaviour change technique across both settings. Efficacious experimental interventions used more behaviour change techniques (n=29) and functioned in more ways (n=6) than did inefficacious experimental interventions (behaviour change techniques=10 and functions=1). CONCLUSIONS Physiotherapists use a small number of behaviour change techniques. Less behaviour change techniques were identified in observational studies compared to experimental studies, suggesting physiotherapists use less BCTs clinically than experimentally.

Are we missing opportunities? Physiotherapy and physical activity promotion: a cross-sectional survey

BackgroundPhysical activity (PA) promotion in healthcare is an important strategy for increasing PA levels. Physiotherapists are well-positioned to promote PA, however no studies have investigated PA promotion by physiotherapists Australia-wide.MethodsAn online survey of practicing Australian physiotherapists was conducted to investigate knowledge of the Australian Physical Activity and Sedentary Behaviour (PASB) guidelines and factors associated with increased promotion frequency. Participants were asked to state the PASB guidelines and a 4-component scoring system was used to measure knowledge. Multivariate logistic regression analysis was conducted to assess factors associated with frequency of promotion.Results257 Australian physiotherapists completed the survey. Only 10% were able to accurately state the PASB guidelines and 54% reported promoting PA to 10 or more patients per month. Males were nearly three times more likely than females to promote PA to 10 or more patients per month (OR 2.68, 95% CI 1.25–5.74). Those who lacked counselling skills and felt PA promotion wouldn’t change their patients’ behaviour were much less likely to promote PA.ConclusionAustralian physiotherapists have poor knowledge of the Australian PASB guidelines and infrequently promote PA. Education and training in PA counselling and behaviour change strategies is indicated to enhance PA promotion by Australian physiotherapists.

A wake-up call for physical activity promotion in Australia: results from a survey of Australian nursing and allied health professionals

Objective Nursing and allied health professionals (AHPs) are in an ideal position to promote physical activity (PA) as part of their health care provision. The aim of this study was to investigate current promotion and knowledge of PA among people in these disciplines. Methods A cross-sectional online survey of practicing Australian physiotherapists, nurses, exercise physiologists, occupational therapists, dietitians and pharmacists was conducted in 2016. Results A total of 433 nurses and AHPs completed the survey. All disciplines agreed that providing PA advice was part of their role, although nurses were less likely to agree. All disciplines felt they had the skills to promote PA but nurses were more likely to report a lack of time as a barrier. Physiotherapists and exercise physiologists were more confident giving PA advice to patients. Most health professionals (68%) were aware of the PA guidelines, although only 16% were accurately able to describe all relevant components. In logistic regression modelling, women and those working in public hospitals were less likely to encourage PA. Awareness of the PA guidelines doubled the odds of encouraging PA in patients (odds ratio 2.01, 95% confidence interval 1.18-3.43). Conclusions Australian nurses and AHPs perceive that PA promotion is part of their role, however few have specific knowledge of the PA guidelines. To increase PA promotion by nurses and AHPs awareness of the PA guidelines appears to be essential. What is known about the topic? Nurses and AHPs are in an ideal position to promote PA, although there is limited evidence of their PA promotion and knowledge. What does the paper add? Australian nurses and AHPs are confident and think it is feasible to promote PA to patients in several healthcare settings but many lack sufficient PA knowledge, limiting their PA promotion. What are the implications for practitioners? Increasing PA knowledge of nurses and AHPs could generate increased levels of PA in the Australian population and improve national health and wellbeing.