A multidimensional primary care intervention reduces sedentary behaviour and promotes behavioural readiness for physical activity in hypertension and diabetes patients
M Ramos De Carvalho, M S Marcolino, D Motta-Santos, R M F de Moura, S F da Fonseca, T B C Soares, A C S Lopes, J Batchelor, A L P Ribeiro, C C R Cimini, C R A de OliveiraAbstract
Background
Hypertension and diabetes mellitus (DM) disproportionately affect underserved populations, where low physical activity and high sedentary behaviour increase cardiovascular risk. Effective, scalable primary care strategies remain limited.
Purpose
To evaluate the effects of a multidimensional intervention combining telehealth tools and in-person activities on physical activity, sedentary behaviour, and stages of change among individuals with hypertension or DM in an underserved Brazilian region.
Methods
This is a subanalysis of a cluster randomized controlled trial. Physical activity (leisure-time, transportation, household) and sedentary behaviours were assessed using validated questions from the Brazilian Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). An algorithm recommended by the Brazilian Ministry of Health was used to assess participants’ stages of change for increasing physical activity: precontemplation; contemplation; preparation; action; maintenance. Outcomes were self-reported via telephone at baseline and 12 months. Intervention group (IG) professionals received structured training and biweekly teletutoring, conducted group physical activity sessions, and provided behavioural counselling. Control group (CG) received usual care. Logistic regression models adjusted for municipality, sex, age, residence area, and baseline values of each outcome were used to estimate intervention effects.
Results
875 (16.2% of the study sample) participants completed the phone interview (53.8% IG, 73.0% women, 39.2% 65 and older, 49.3% rural setting). Adequate physical activity ranged from 27.6% (transportation) to 63.8% (sufficiently active) at baseline, and from 13.6% (transportation) to 62.5% (sufficiently active) at follow-up completion. Sedentary behaviours ranged from 5.7% (3+ hours of non-TV screens a day) to 19.2% (3+ hours of TV a day) at baseline, and from 3.2% (3+ hours of non-TV screens) to 15.0% (3+ hours of TV) at follow-up. Maintenance was the most frequent stage of change at baseline (44.6%), and 59.1% of the sample progressed through stages or remained in maintenance at follow-up. The IG had 165% higher odds of improving their habit of spending 3+ hours on other screens, and 61% higher odds of progressing through stages of change. No intervention effect was identified on physical activity.
Conclusion
In a vulnerable population, a multidimensional primary care intervention for hypertension and DM management improved behavioural readiness for physical activity and reduced sedentary behaviour. Behavioural progression may precede measurable activity change, and longer follow-up is warranted to identify measurable increases in physical activity.