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Electronic Letters to:
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eLetters: Electronic letters published:
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Tailored physical Activity Intervention in General Practice
- Ali Y Alam (11 December 2005)
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Ali Y Alam, Epidemiologist Johns Hopkins University
Send letter to journal:
aalam{at}jhsph.edu Ali Y Alam
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I read with interest the article: “Effect of Tailored Physical Activity Intervention Delivered in General Practice settings: Results of a Randomized Controlled Trial.” In the American Journal of Public Health, October 2005, issue. There was no significant difference in the physical activity outcome between the intervention group and the control group in this study. As pointed by the authors this could be attributed to the higher baseline levels of physical activity in the control group in comparison to Intervention group. Minutes per week of exercise and meeting ACSM/CDC guidelines were the two main outcome measures of physical activity. These two variables were significantly mismatched at the baseline. The controls were spending significantly more median minutes per week in physical activity as compared to the intervention group (330 min vs 240 min). Similarly significantly higher percentage of patients in the control group were meeting the ACSM/CDC guidelines at baseline (49.2% vs 38.2%, p=0.04). So the control group was significantly better off in comparison to the intervention group to the start with resulting in failure of the study to find a significant increase in physical activity time by the intervention group. Significant improvement in the physical activity time in both the groups in comparison to their baseline values, is an indication that physician’s advice are given due regard by the patients and that health promotion activities along with behavioral change interventions centered around the GP’s could be rewarding in other areas of immense public health significance as well, such as Smoking cessation programmes, reduction of obesity and Nutrition intervention programmes such as low fat low refined sugar diet. This study could have been better targeted by doing a baseline survey and excluding patients with baseline physical activity levels higher then a specified value and targeting only those patients whose physical activity level was below the specified value. Interestingly, an inverse intervention effect over time was observed for waist circumference in the intervention group ( with intervention group gaining in waist circumference), due to interaction with BMI at baseline. Waist hip ratio has been found to be a good index of central obesity1 and high Total Cholesterol/HDL-c ratio2 in some cross-sectional studies. It would have been a good idea to include this parameter in longitudinal studies as well. Although this study was not designed to see the effect of improved physical activity on control of hypertension, hyperglycemia, hypercholesterolemia, glycosylated hemoglobin levels, it would have been a good idea to relate improvement in physical activity to some outcomes of interest such as better control of hypertension, hyperglycemia or hypercholesterolemia. Relating improvement in physical activity to such outcomes might motivate patients to sustain the level of physical activity even beyond the period of the study. References: 1.Jabbar A, Irfanullah A, Akhter J, Mirza Y. Dyslipidemia and its relation with body mass index versus waist hip ratio.J Pak Med Assoc Dec 1997;47(12):308-10 2. Noreen Sultan, Muhammad Nawaz, Ambreen Sultan, Muhammad Fayaz. Waist Hip Ratio as an index for identifying women with raised TC/HDL ratios J Ayub Med Coll Abottabad Mar 2004;16(1):38-41. |
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