The feasibility of a simple, low-cost, general practitioner delivered intervention to promote physical activity.
Lead Research Organisation:
UNIVERSITY OF EXETER
Department Name: Sport and Health Sciences
Abstract
The National Institute for Health and Clinical Excellence (NICE), has advised that all General Practitioners (GPs) should whenever possible, identify inactive patients and advise them to increase their physical activity. How best to advise patients to increase their physical activity in a cost effective way is unknown. We propose to assess how feasible it is for GPs to deliver a simple, low cost intervention to increase daily walking in inactive patients. We also intend to assess the feasibility of adding a pedometer (a small device for recording walking) to the brief GP advice.
Technical Summary
The National Institute for Health and Clinical Excellence (NICE), has advised that all General Practitioners (GPs) should whenever possible, identify inactive patients and advise them to increase their physical activity. How best to advise patients to increase their physical activity in a cost effective way is unknown. A randomised, controlled trial testing the effectiveness and cost effectiveness of a simple, low cost, GP delivered walking message to reduce the number of inactive patients is urgently needed. However, there are a number of methodological and practical uncertainties that preclude immediate progress to a full trial.
A feasibility study is proposed in order to address a number of uncertainties that preclude immediate progress to a full trial. A randomised 2x2 trial factorial design will be used to explicitly compare methods of randomisation (practice or patient) and methods of patient recruitment (opportunistic or systematic). Additional uncertainties the feasibility study will explore are GP willingness and ability to follow NICE guidance on screening and advice; patient acceptability of GP screening and advice; expected patient recruitment rates and loss to follow up. In addition the effect size in terms of physical activity and intra-class correlation coefficients will be estimated to inform the sample size and power of the full trial.
Three interventions delivered at the level of general practice will be compared. All consenting patients will be informed that the GP is participating in a study assessing the effect of physical activity information on physical activity. They will all be asked to take away a physical activity information booklet and wear a sealed pedometer to measure routine physical activity.
(i) Arm A (Usual care - Control). Written information about the benefits of physical activity as well as local opportunities for physical activity.
(ii) Arm B (Brief GP advice). In addition to receiving the written physical activity information in Arm A, patients will be advised by the GP to ?walk at least a mile per day (15-20 minutes) at a brisk to fast pace, each day of the week.?
(iii) Arm C (Brief GP advice + pedometer). Following the GP walking advice, patients will be given an unsealed pedometer to self monitor their daily walking and will be given daily targets.
Main outcome measures will be assessed at 12 weeks post intervention.
A feasibility study is proposed in order to address a number of uncertainties that preclude immediate progress to a full trial. A randomised 2x2 trial factorial design will be used to explicitly compare methods of randomisation (practice or patient) and methods of patient recruitment (opportunistic or systematic). Additional uncertainties the feasibility study will explore are GP willingness and ability to follow NICE guidance on screening and advice; patient acceptability of GP screening and advice; expected patient recruitment rates and loss to follow up. In addition the effect size in terms of physical activity and intra-class correlation coefficients will be estimated to inform the sample size and power of the full trial.
Three interventions delivered at the level of general practice will be compared. All consenting patients will be informed that the GP is participating in a study assessing the effect of physical activity information on physical activity. They will all be asked to take away a physical activity information booklet and wear a sealed pedometer to measure routine physical activity.
(i) Arm A (Usual care - Control). Written information about the benefits of physical activity as well as local opportunities for physical activity.
(ii) Arm B (Brief GP advice). In addition to receiving the written physical activity information in Arm A, patients will be advised by the GP to ?walk at least a mile per day (15-20 minutes) at a brisk to fast pace, each day of the week.?
(iii) Arm C (Brief GP advice + pedometer). Following the GP walking advice, patients will be given an unsealed pedometer to self monitor their daily walking and will be given daily targets.
Main outcome measures will be assessed at 12 weeks post intervention.
