Physical activity: Prescription in health care and relationship to different health measures

Abstract

Background: Physical inactivity is one of the major modifi able risk factors, contributing to the global burden of disease. Thus, reducing physical inactivity is of importance for global health. Worldwide, different methods designed to improve physical activity (PA) behaviour in patients, have been developed, including physical activity on prescription (PAP) in Sweden. Aim: The overall aim of the present thesis was to analyse the association between self-reported leisure time physical activity level and health measures and to study the effi cacy of the Swedish method of physical activity on prescription in terms of long-term effects and health-related quality of life (HRQL). Another aim was to analyse health economy and cost-effectiveness of two different variations of the Swedish PAP-method, offering different degrees of support. The studies included in this thesis offered the opportunity to explore the usability of a single-item question to measure physical activity in different contexts. Method: Three study populations were included in this thesis. The fi rst study included a random sample of 3,588 adults that answered a questionnaire and collected blood samples. The second study included 3,114 individuals in a working population that received two questionnaires regarding life style, work-related factors and psychosocial health two years apart. In the PAP-study 144 patients and 54 reference patients were included. All received four questionnaires concerning PA and HRQL (SF-36). Costeffectiveness was estimated from SF-6D derived from SF-36. Results: The simple physical activity assessment question showed associations with other cardiovascular risk factors and was associated with stress-related mental illness at follow up. Furthermore, there was signifi cant change in the level of PA following PAP at six and 12 months and HRQL, extending to 24 months. The health economic study supported the more supportive framework in this setting, despite being more costly. Conclusion: The single item question measuring self-reported physical activity level seem to be a valid and feasible tool to assess risk in adults, including working population and patient populations. The effi cacy of the Swedish PAP model is further established by the results of the present thesis, showing both long-term effects and cost effectiveness.