Skip to main content
Top
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the “Pas-a-Pas” community intervention trial

Authors: Victoria Arija, Felipe Villalobos, Roser Pedret, Angels Vinuesa, Mercé Timón, Teresa Basora, Dolors Aguas, Josep Basora, Pas-a-Pas research group

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

Background

Physical activity is a major, modifiable, risk factor for cardiovascular disease (CVD) that contributes to the prevention and management of CVD.
The aim of this study was to assess the short- and medium-term effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults.

Methods

Multicentered, randomized, controlled community intervention involving 364 patients in four primary care centers. The participants were randomly assigned to a Control Group (CG = 104) or Intervention Group (IG = 260); mean age 65.19 years; 76.8% women. The intervention consisted of 120 min/week walking (396 METs/min/week) and sociocultural gathering once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose) and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. Incidence of adverse cardiovascular events and continued adherence to the physical activity were assessed 2 years after intervention.

Results

At the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity (774.81 METs/min/week), a significant change during the intervention period in systolic blood pressure (−6.63 mmHg), total cholesterol (−10.12 mg/dL) and LDL-cholesterol (−9.05 mg/dL) even after adjustment for potential confounders. At 2 years after the intervention, in the IG, compared with the CG, tthe incidence of adverse cardiovascular events was significantly lower (2.5% vs. 10.5%) and the adherence to regular physical activity was higher (72.8% vs 27.2%) in IG compared to CG.

Conclusions

This community-based physical activity program improved cardiovascular health in the short- as well as medium-term, and promoted regular physical activity in the medium-term in older Spanish adults.

Trials registration

Clinicaltrials.​gov ID NCT02767739. Trial registered on May 5th, 2016. Retrospectively registered
Literature
1.
go back to reference Organizacion Mundial de la Salud. Informe sobre la situación mundial de las enfermedades no transmisibles. WHO. 2014;1–18. Organizacion Mundial de la Salud. Informe sobre la situación mundial de las enfermedades no transmisibles. WHO. 2014;1–18.
2.
go back to reference Claas SA, Arnett DK. The role of healthy lifestyle in the primordial prevention of cardiovascular disease. Curr Cardiol Rep. 2016;18:56.CrossRefPubMed Claas SA, Arnett DK. The role of healthy lifestyle in the primordial prevention of cardiovascular disease. Curr Cardiol Rep. 2016;18:56.CrossRefPubMed
3.
go back to reference Truthmann J, Busch MA, Scheidt-Nave C, Mensink GBM, Gößwald A, Endres M, et al. Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke. BMC Public Health. 2015;15:701.CrossRefPubMedPubMedCentral Truthmann J, Busch MA, Scheidt-Nave C, Mensink GBM, Gößwald A, Endres M, et al. Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke. BMC Public Health. 2015;15:701.CrossRefPubMedPubMedCentral
4.
go back to reference Schuler G, Adams V, Goto Y. Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. Eur Heart J. 2013;34:1790–9.CrossRefPubMed Schuler G, Adams V, Goto Y. Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. Eur Heart J. 2013;34:1790–9.CrossRefPubMed
5.
go back to reference Dalleck LC, Van Guilder GP, Quinn EM, Bredle DL. Primary prevention of metabolic syndrome in the community using an evidence-based exercise program. Prev. Med. (Baltim). 2013;57:392–5.CrossRef Dalleck LC, Van Guilder GP, Quinn EM, Bredle DL. Primary prevention of metabolic syndrome in the community using an evidence-based exercise program. Prev. Med. (Baltim). 2013;57:392–5.CrossRef
6.
go back to reference Stensvold D, Nauman J, Nilsen TIL, Wisløff U, Slørdahl SA, Vatten L. Even low level of physical activity is associated with reduced mortality among people with metabolic syndrome, a population based study (the HUNT 2 study, Norway). BMC Med. BioMed Central. 2011;9:109. Stensvold D, Nauman J, Nilsen TIL, Wisløff U, Slørdahl SA, Vatten L. Even low level of physical activity is associated with reduced mortality among people with metabolic syndrome, a population based study (the HUNT 2 study, Norway). BMC Med. BioMed Central. 2011;9:109.
7.
go back to reference Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008 * Comité Español Interdisciplinario para la Prevención Cardiovascular. Rev. Clin. Española. 2009;26:157–80. Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008 * Comité Español Interdisciplinario para la Prevención Cardiovascular. Rev. Clin. Española. 2009;26:157–80.
8.
go back to reference Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315–81.CrossRefPubMed Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315–81.CrossRefPubMed
9.
go back to reference Dumith SC, Hallal PC, Reis RS, Kohl HW. Worldwide prevalence of physical inactivity and its association with human development index in 76 countries. Prev Med (Baltim). 2011;53:24–8.CrossRef Dumith SC, Hallal PC, Reis RS, Kohl HW. Worldwide prevalence of physical inactivity and its association with human development index in 76 countries. Prev Med (Baltim). 2011;53:24–8.CrossRef
10.
go back to reference Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380:294–305.CrossRefPubMed Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380:294–305.CrossRefPubMed
11.
go back to reference Hamer M, Stamatakis E. Low-dose physical activity attenuates cardiovascular disease mortality in men and women with clustered metabolic risk factors. Circ Cardiovasc Qual Outcomes. 2012;5:494–9.CrossRefPubMed Hamer M, Stamatakis E. Low-dose physical activity attenuates cardiovascular disease mortality in men and women with clustered metabolic risk factors. Circ Cardiovasc Qual Outcomes. 2012;5:494–9.CrossRefPubMed
12.
go back to reference Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M-C, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378:1244–53.CrossRefPubMed Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M-C, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378:1244–53.CrossRefPubMed
13.
go back to reference Salinas CJ, Bello SM, Flores CA, Carbullanca LL, Torres GM. Actividad física integral con adultos y adultos mayores en Chile: Resultados de un programa piloto. Rev. Chil. Nutr. Sociedad Chilena de Nutrición, Bromatología y Toxicología. 2005;32:215–24. Salinas CJ, Bello SM, Flores CA, Carbullanca LL, Torres GM. Actividad física integral con adultos y adultos mayores en Chile: Resultados de un programa piloto. Rev. Chil. Nutr. Sociedad Chilena de Nutrición, Bromatología y Toxicología. 2005;32:215–24.
14.
go back to reference Murphy MH, Murtagh EM, Boreham CA, Hare LG, Nevill AM. The effect of a worksite based walking programme on cardiovascular risk in previously sedentary civil servants. BMC Public Health. 2006;6:136.CrossRefPubMedPubMedCentral Murphy MH, Murtagh EM, Boreham CA, Hare LG, Nevill AM. The effect of a worksite based walking programme on cardiovascular risk in previously sedentary civil servants. BMC Public Health. 2006;6:136.CrossRefPubMedPubMedCentral
15.
go back to reference Duru OK, Sarkisian CA, Leng M, Mangione CM. Sisters in motion: a randomized controlled trial of a faith-based physical activity intervention. J Am Geriatr Soc. 2010;58:1863–9.CrossRefPubMedPubMedCentral Duru OK, Sarkisian CA, Leng M, Mangione CM. Sisters in motion: a randomized controlled trial of a faith-based physical activity intervention. J Am Geriatr Soc. 2010;58:1863–9.CrossRefPubMedPubMedCentral
16.
go back to reference Halbert J, Silagy C, Finucane P. Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice. Med J Aust. 2000;173:85–7. Halbert J, Silagy C, Finucane P. Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice. Med J Aust. 2000;173:85–7.
17.
go back to reference Kim J, Tanabe K, Yoshizawa Y, Yokoyama N, Suga Y, Kuno S. Lifestyle-based physical activity intervention for one year improves metabolic syndrome in overweight male employees. Tohoku J Exp Med. 2013;229:11–7.CrossRefPubMed Kim J, Tanabe K, Yoshizawa Y, Yokoyama N, Suga Y, Kuno S. Lifestyle-based physical activity intervention for one year improves metabolic syndrome in overweight male employees. Tohoku J Exp Med. 2013;229:11–7.CrossRefPubMed
18.
go back to reference Andersen E, Høstmark AT, Anderssen SA. Effect of a physical activity intervention on the metabolic syndrome in Pakistani immigrant men: a randomized controlled trial. J Immigr Minor Health. 2012;14:738–46.CrossRefPubMedPubMedCentral Andersen E, Høstmark AT, Anderssen SA. Effect of a physical activity intervention on the metabolic syndrome in Pakistani immigrant men: a randomized controlled trial. J Immigr Minor Health. 2012;14:738–46.CrossRefPubMedPubMedCentral
19.
go back to reference Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ. 2003;326:793.CrossRefPubMedPubMedCentral Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ. 2003;326:793.CrossRefPubMedPubMedCentral
20.
go back to reference García-Ortiz L, Grandes G, Sánchez-Pérez Á, Montoya I, Iglesias-Valiente JA. Recio-Rodríguez JI, et al. Efecto en el riesgo cardiovascular de una intervención para la promoción del ejercicio físico en sujetos sedentarios por el médico de familia. Rev. Española Cardiol. 2010;63:1244–1252. García-Ortiz L, Grandes G, Sánchez-Pérez Á, Montoya I, Iglesias-Valiente JA. Recio-Rodríguez JI, et al. Efecto en el riesgo cardiovascular de una intervención para la promoción del ejercicio físico en sujetos sedentarios por el médico de familia. Rev. Española Cardiol. 2010;63:1244–1252.
21.
go back to reference Liira H, Engberg E, Leppävuori J, From S, Kautiainen H, Liira J, et al. Exercise intervention and health checks for middle-aged men with elevated cardiovascular risk: a randomized controlled trial. Scand. J. Prim. Health Care. 2014;32:156–62. Liira H, Engberg E, Leppävuori J, From S, Kautiainen H, Liira J, et al. Exercise intervention and health checks for middle-aged men with elevated cardiovascular risk: a randomized controlled trial. Scand. J. Prim. Health Care. 2014;32:156–62.
22.
go back to reference Lawton BA, Rose SB, Elley CR, Dowell AC, Fenton A, Moyes SA. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial. BMJ. 2008;337:a2509.CrossRefPubMedPubMedCentral Lawton BA, Rose SB, Elley CR, Dowell AC, Fenton A, Moyes SA. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial. BMJ. 2008;337:a2509.CrossRefPubMedPubMedCentral
23.
go back to reference Van Sluijs EMF, Twisk JWR, Calfas KJ, van Poppel MNM, Chin A, Paw MJ, et al. Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial. Am J Public Health. 2005;95:1825–31.CrossRefPubMedPubMedCentral Van Sluijs EMF, Twisk JWR, Calfas KJ, van Poppel MNM, Chin A, Paw MJ, et al. Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial. Am J Public Health. 2005;95:1825–31.CrossRefPubMedPubMedCentral
24.
go back to reference Tiessen AH, Smit AJ, Broer J, Groenier KH, van der Meer K. Randomized controlled trial on cardiovascular risk management by practice nurses supported by self-monitoring in primary care. BMC Fam Pract. 2012;13:90.CrossRefPubMedPubMedCentral Tiessen AH, Smit AJ, Broer J, Groenier KH, van der Meer K. Randomized controlled trial on cardiovascular risk management by practice nurses supported by self-monitoring in primary care. BMC Fam Pract. 2012;13:90.CrossRefPubMedPubMedCentral
25.
go back to reference Kouvonen A, De Vogli R, Stafford M, Shipley MJ, Marmot MG, Cox T, et al. Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II study. Eur J Pub Health. 2012;22:514–8.CrossRef Kouvonen A, De Vogli R, Stafford M, Shipley MJ, Marmot MG, Cox T, et al. Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II study. Eur J Pub Health. 2012;22:514–8.CrossRef
26.
go back to reference Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2008;39:1423–34.CrossRef Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2008;39:1423–34.CrossRef
27.
go back to reference World Health Organization. Global recommendations on physical activity for health. Geneva World Health Organization. 2010;1–60. World Health Organization. Global recommendations on physical activity for health. Geneva World Health Organization. 2010;1–60.
28.
go back to reference Otero M, Domínguez-Gil A. Propuesta de un indicador de la “clase social” basado en la ocupación. Farm Hosp. 2000;24:258–66. Otero M, Domínguez-Gil A. Propuesta de un indicador de la “clase social” basado en la ocupación. Farm Hosp. 2000;24:258–66.
29.
go back to reference Marrugat J, Solanas P, D’Agostino R, Sullivan L, Ordovas J, Cordón F, et al. Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Española Cardiol. 2003;56:253–61.CrossRef Marrugat J, Solanas P, D’Agostino R, Sullivan L, Ordovas J, Cordón F, et al. Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Española Cardiol. 2003;56:253–61.CrossRef
30.
go back to reference Ipaq. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire ( IPAQ ) – Short and Long Forms. Ipaq. 2005;1–15. Ipaq. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire ( IPAQ ) – Short and Long Forms. Ipaq. 2005;1–15.
31.
go back to reference Rodríguez IT, Ballart JF, Pastor GC, Jordà EB, Val VA. Validation of a short questionnaire on frequency of dietary intake: reproducibility and validity. Nutr Hosp. 2008;23:242–52.PubMed Rodríguez IT, Ballart JF, Pastor GC, Jordà EB, Val VA. Validation of a short questionnaire on frequency of dietary intake: reproducibility and validity. Nutr Hosp. 2008;23:242–52.PubMed
32.
go back to reference Arija V, Salas Salvado J, Fernández-Ballart J, Cuco GM-H. Consumo alimentario, hábitos, y estado nutricional de la población de Reus (VIII). Evolución de la ingesta energética y nutricional desde 1983 a 1993. Med. Clin. (Barc). 1996;20:45–50. Arija V, Salas Salvado J, Fernández-Ballart J, Cuco GM-H. Consumo alimentario, hábitos, y estado nutricional de la población de Reus (VIII). Evolución de la ingesta energética y nutricional desde 1983 a 1993. Med. Clin. (Barc). 1996;20:45–50.
33.
go back to reference Rippe JM, Price JM, Hess SA, Kline G, DeMers KA, Damitz S, et al. Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. Obes Res. 1998;6:208–18.CrossRefPubMed Rippe JM, Price JM, Hess SA, Kline G, DeMers KA, Damitz S, et al. Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. Obes Res. 1998;6:208–18.CrossRefPubMed
34.
go back to reference Ramos R, Solanas P, Cordón F, Rohlfs I, Elosua R, Sala J, et al. Comparación de la función de Framingham original y la calibrada del REGICOR en la predicción del riesgo coronario poblacional. Med. Clin. (Barc). 2003;121:521–6.CrossRefPubMed Ramos R, Solanas P, Cordón F, Rohlfs I, Elosua R, Sala J, et al. Comparación de la función de Framingham original y la calibrada del REGICOR en la predicción del riesgo coronario poblacional. Med. Clin. (Barc). 2003;121:521–6.CrossRefPubMed
35.
go back to reference Hegde SM, Solomon SD. Influence of physical activity on hypertension and cardiac structure and function. Curr Hypertens Rep. 2015;17:588.CrossRef Hegde SM, Solomon SD. Influence of physical activity on hypertension and cardiac structure and function. Curr Hypertens Rep. 2015;17:588.CrossRef
36.
go back to reference Besler C, Heinrich K, Rohrer L, Doerries C, Riwanto M, Shih DM, et al. Mechanisms underlying adverse effects of HDL on eNOS-activating pathways in patients with coronary artery disease. J Clin Invest. 2011;121:2692–708.CrossRef Besler C, Heinrich K, Rohrer L, Doerries C, Riwanto M, Shih DM, et al. Mechanisms underlying adverse effects of HDL on eNOS-activating pathways in patients with coronary artery disease. J Clin Invest. 2011;121:2692–708.CrossRef
37.
go back to reference American Diabetes Association. Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39 Suppl 1:S1–112. American Diabetes Association. Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39 Suppl 1:S1–112.
38.
go back to reference Segerström AB, Glans F, Eriksson K-F, Holmbäck AM, Groop L, Thorsson O, et al. Impact of exercise intensity and duration on insulin sensitivity in women with T2D. Eur J Intern Med. 2010;21:404–8.CrossRefPubMed Segerström AB, Glans F, Eriksson K-F, Holmbäck AM, Groop L, Thorsson O, et al. Impact of exercise intensity and duration on insulin sensitivity in women with T2D. Eur J Intern Med. 2010;21:404–8.CrossRefPubMed
39.
go back to reference Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004;117:912–8.CrossRefPubMed Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004;117:912–8.CrossRefPubMed
40.
go back to reference Mora S, Cook N, Buring JE, Ridker PM, Lee I-M. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007;116:2110–8.CrossRefPubMedPubMedCentral Mora S, Cook N, Buring JE, Ridker PM, Lee I-M. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007;116:2110–8.CrossRefPubMedPubMedCentral
Metadata
Title
Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the “Pas-a-Pas” community intervention trial
Authors
Victoria Arija
Felipe Villalobos
Roser Pedret
Angels Vinuesa
Mercé Timón
Teresa Basora
Dolors Aguas
Josep Basora
Pas-a-Pas research group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4485-3

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue