OBJECTIVES: It is widely recognized that regular exercise improves fitness, with increasing evidence that physical activity (PA; movement resulting in elevated energy expenditure beyond basal levels) can affect health, particularly in chronic disease. While pharmacologic therapy and exercise training have been shown to improve capacity, persistent increase in PA requires behavior change. This review examined studies testing the effectiveness of behavioral interventions to increase PA in adults with chronic disease. METHODS: Embase and PubMed searches of intervention studies published in English, 1995-2011. Inclusion criteria: Adults>45 years; COPD, diabetes, heart failure, obesity; exercise or PA endpoint; behavioral intervention described in sufficient detail to permit interpretation. RESULTS: A total of 932 abstracts screened; 169 articles retrieved; 36 reviewed. Most were randomized trials (n=30, 83%) with 2 intervention arms (n=29, 81%), medium to high quality (n=34, 94%). Subjects were recruited through clinical settings (n=28, 78%), with disease severity a primary eligibility criterion (n=23, 64%); 15 (42%) had sample sizes 40-100. Mean study duration = 9.6 months (range: 1-84). Exercise intervention: 30-50 minutes aerobic activity 3-5 times/week (n=22, 61%); 64% included walking. Instruction was individual (n=25, 69%), initially supervised (n=24, 67%) followed by unsupervised home exercise (n=15, 42%). Behavioral intervention: counseling (n=19, 53%) with personal contact follow-up (n=12, 33%). Control group: exercise without behavioral intervention (n=14, 39%) or usual care (n=15, 42%). Significant effects of the intervention were reported in 15 of 25 (60%) studies testing exercise capacity (6-minute walk, cycle or treadmill), 19 of 26 (73%) testing PA outcomes (pedometer, activity log, questionnaire), 11 of 22 (50%) measuring HRQL, and 8 of 13 (62%) capturing behavioral endpoints. CONCLUSIONS: This review provides insight into the range of designs, interventions, and outcome measures used in studies testing methods to improve PA in chronic disease. Results identify promising interventions, with implications for improving research methods and outcomes.
Leidy, N. K., Kimel, M., Ajagbe, L., Kim, K., Hamilton, A., & Becker, K. (2012). PRM7 Increasing Physical Activity in Patients With Chronic Disease: What is the Literature Telling Us? Value in Health, 15(7), A461. https://doi.org/10.1016/j.jval.2012.08.1471