小柯机器人

英国拉夫堡大学Victoria E Kettle团队研究了初级保健机构卫生专业人员提供或提示的体力活动干预的有效性。相关论文于2022年2月23日发表在《英国医学杂志》上。

为了检查初级保健专业人员提供或提示的体力活动干预措施对增加成年患者中等至剧烈强度体力活动（MVPA）的有效性，研究组在Medline、Embase和科学引文索引等大型数据库，ClinicalTrials.gov等试验注册中心检索从建库到2020年9月的灰色文献（OpenGrey）来源。筛选出由初级保健专业人员与普通保健对照组或另一个不涉及体力活动的对照组进行有氧体力活动干预的随机对照试验，进行系统回顾和荟萃分析。

由两名独立的评价者筛选检索结果，从符合条件的试验中提取数据，并使用Cochrane偏倚风险工具（版本2）来评估偏倚风险。使用随机效应模型进行的反方差荟萃分析评估从基线检查到最终随访期间各组MVPA（分钟/周）差异的主要结局。还分析了在随访中符合MVPA指南的几率。

研究组共确定了14566份独特报告，荟萃分析包括46项随机对照试验和一系列随访（3-60个月），涉及16198名参与者。初级保健专业人员提供或提示的体力活动干预使MVPA每周增加了14分钟，差异具有统计学意义。异质性显著（I²=91%）。对使用设备测量体力活动的试验进行的限制性分析表明，MVPA组间无显著差异。

使用自我报告测量的试验表明，干预组参与者每周获得的MVPA比对照组多24分钟，组间差异显著。此外，与对照组相比，干预措施使患者符合MVPA指南的几率增加了33%。46项研究中有14项存在高偏倚风险，但排除这些研究的敏感性分析并未改变结局。

研究结果表明，由初级保健专业人员提供或推动的体力活动干预措施似乎能有效提高自我报告的MVPA的参与率。在日常实施中应考虑此类干预措施，以提高体力活动水平，改善人群的健康状况。

附：英文原文

Title: Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials

Author: Victoria E Kettle, Claire D Madigan, April Coombe, Henrietta Graham, Jonah J C Thomas, Anna E Chalkley, Amanda J Daley

Issue&Volume: 2022/02/23

Abstract:

Objective To examine the effectiveness of physical activity interventions delivered or prompted by primary care health professionals for increasing moderate to vigorous intensity physical activity (MVPA) in adult patients.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Databases (Medline and Medline in progress, Embase, PsycINFO, CINAHL, SPORTDiscus, Sports Medicine and Education Index, ASSIA, PEDro, Bibliomap, Science Citation Index, Conference Proceedings Citation Index), trial registries (Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, TRoPHI), and grey literature (OpenGrey) sources were searched (from inception to September 2020).

Eligibility criteria for selecting studies Randomised controlled trials of aerobic based physical activity interventions delivered or prompted by health professionals in primary care with a usual care control group or another control group that did not involve physical activity.

Study selection and analysis Two independent reviewers screened the search results, extracted data from eligible trials and assessed the risk of bias using the Cochrane risk of bias tool (version 2). Inverse variance meta-analyses using random effects models examined the primary outcome of difference between the groups in MVPA (min/week) from baseline to final follow-up. The odds of meeting the guidelines for MVPA at follow-up were also analysed.

Results 14566 unique reports were identified and 46 randomised controlled trials with a range of follow-ups (3-60 months) were included in the meta-analysis (n=16198 participants). Physical activity interventions delivered or prompted by health professionals in primary care increased MVPA by 14 min/week (95% confidence interval 4.2 to 24.6, P=0.006). Heterogeneity was substantial (I2=91%, P<0.001). Limiting analyses to trials that used a device to measure physical activity showed no significant group difference in MVPA (mean difference 4.1 min/week, 95% confidence interval 1.7 to 9.9, P=0.17; I2=56%, P=0.008). Trials that used self-report measures showed that intervention participants achieved 24 min/week more MVPA than controls (95% confidence interval 6.3 to 41.8, P=0.008; I2=72%, P<0.001). Additionally, interventions increased the odds of patients meeting guidelines for MVPA by 33% (95% confidence interval 1.17 to 1.50, P<0.001; I2=25%, P=0.11) versus controls. 14 of 46 studies were at high risk of bias but sensitivity analyses excluding these studies did not alter the results.

Conclusions Physical activity interventions delivered or prompted by health professionals in primary care appear effective at increasing participation in self-reported MVPA. Such interventions should be considered for routine implementation to increase levels of physical activity and improve health outcomes in the population.

DOI: 10.1136/bmj-2021-068465

Source: https://www.bmj.com/content/376/bmj-2021-068465

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