Brief Counseling and Exercise Referral Schemes for Hypertensive Patients in Mexico
In recent years, reports have suggested that Mexico has one of the highest levels of overweight and obese individuals in the world. Other studies have shown that as many as 56% of Mexicans are physically inactive. Despite these troubling statistics, only 13% of physicians in the Mexican primary healthcare centers (PHCC) report providing physical activity (PA) counseling. To address these concerns, a team of researchers, led by Dr. Katia Gallegos-Carrillo from the Mexican Institute of Social Security, conducted a study to investigate strategies to integrate physical activity promotion into the Mexican PHCC system. The goal of the study was to examine different strategies for increasing the proportion of hypertensive adults meeting the national aerobic guidelines of 150 minutes of moderate intensity PA per week.
Dr. Gallegos-Carrillo and her team implemented this study in partnership with four PHCCs, each employing an average of 27 primary care physicians, in Cuernavaca, Mexico. Physically inactive, hypertensive adult patients attending any of the four PHCCs were eligible to participate in the study. Two of the PHCCs engaged patients in a brief counseling intervention, while the other two implemented an exercise referral scheme. Patients at PHCCs providing the brief PA counseling received written and verbal information on the benefits of, as well as advice on safely increasing their PA levels. A primary care nurse provided this counseling in an adjacent room in the clinic over an average of 15 minutes. Patients at PHCCs in the exercise referral condition received referrals to group exercise programs at the local Mexican Social Security Institute. These programs were offered 3 days per week for an hour each day over a 16 week period in a group-based format led by trained exercise instructors. The PA levels of all study participants were objectively assessed using accelerometers prior to the beginning the study, and then again at weeks 16 (the end of the intervention) and 24 (the 6-month follow up period).
Across the four PHCCs, a total of 232 eligible patients were enrolled in the study. A significant increase in the proportion of individuals meeting the national aerobic guidelines was observed in both the brief counseling and exercise referral conditions. The proportion of patients meeting aerobic guidelines increased by 53.9% and 51.9% in the brief counseling and exercise referral groups, respectively. While neither intervention proved to be more effective than the other in increasing the proportion of patients meeting national PA guidelines, an increase of 98 minutes per day in sedentary time was observed in patients in the brief counseling group, compared to only a 4-minute increase in the exercise referral group. A final finding of the study showed that in the exercise referral condition, program adherence was highly correlated with individuals meeting the national PA guidelines.
Findings from this study are particularly encouraging for a number of reasons. First, this work shows that pragmatic strategies for offering both brief PA counseling and implementing an exercise referral scheme in primary care centers is feasible. Both interventions, using existing resources, were able to successfully show changes in Mexican adult PA levels, amounting to increases of 40-50 minutes per week of PA. Overall, these results provide great promise for efforts to integrate PA promotion into the Mexican national prevention strategy (PREVENIMSS) and impact a larger segment of Mexican residents with hypertension or at-risk for other chronic diseases.
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