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Prof. Dr. Dr. Hermann Faller
Universität Würzburg
Institut für Psychotherapie und Medizinische Psychologie, 
AB Rehabilitationswissenschaften
Klinikstr. 3
97070 Würzburg
Tel. 0931/31-82713
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Evaluation of a planning intervention with telephone-based aftercare for maintaining physical activity in everyday life

Project leader: Prof. Dr. Dr. Hermann Faller

Approval period: 03/2008 – 08/2011
Co-workers: Dr. Veronika Ströbl, Ulrike Landgraf, M.A

Indications: Patients with obesity (E66) in medical rehabilitation

Themes: Physical activity, planning, aftercare, volition, weight reduction

 

Background:

The sustainability of measures of medical rehabilitation is often not optimal. In part, patients do not manage to continue the behavioural changes initiated in rehabilitation in the long term and to integrate them into their everyday lives. Therefore, aftercare measures are called for in order to improve the transfer. Of particular importance for obese patients with comorbidity or associated morbidity is a long-term change in the nutritional and physical activity in order to stabilise a weight reduction achieved in rehabilitation in the long term. For physical activity, interventions on the planning of implementation in everyday life in cardiac and orthopaedic rehabilitation have proved to be successful. In order to support patients with obesity in the integration of physical activity in everyday life and to foster the long-term implementation, a planning intervention was combined with telephone-based aftercare.

 

Aims and research questions:

The aim of the project was to examine the effectiveness and sustainability of a combined planning and aftercare intervention on physical activity in comparison to the inpatient standard treatment program of a rehabilitation clinic in patients with obesity (BMI between 30 and 44). In the framework of the intervention, the patients already planned physical activities during the rehabilitation stay which they would like to implement at home; in six telephone-based aftercare consultations they were supported in the realisation of the plans. The aftercare telephone calls stretched over a period of two weeks to six months after the rehabilitation. In the telephone calls, the experiences in the implementation of the planned activities were discussed with a sports therapist, and where applicable, the patients were supported in overcoming emerging obstacles as well as in modifying the plans. The primary research question concerned the effectiveness of the intervention in terms of weight reduction and physical activity behaviour. Secondary questions concerned the effects of the intervention in terms of the dependent variables motivation and quality of life. Moreover, the differential effectiveness was examined depending on gender, comorbid diseases as well as initial motivation.

 

Study design/ Methods

The research questions were answered through a prospective, controlled and randomised design with follow-ups six and 12 months after the rehabilitation. All dependent variables were measured through questionnaires, and the body weight additionally through doctors’ information. In total, over a period of 13 months (2008/2009), 467 patients took part in the study whose data could be evaluated (intervention group, IG: n=228; control group, CG: n=239). The participants’ age lay between 18 and 64 and was an average of 48 years. 55% of the participants were men. The majority were in employment (88%). At the beginning of rehab, the mean body weight in the sample was 110kg and the mean BMI amounted to 36.

 

Results:

The intervention showed a good feasibility and high acceptance by the participants. On average, for each participant of the IG, five telephone contacts with the sports therapist took place (SD=1). The total duration of all aftercare telephone calls amounted to an average of 44 minutes per participant (SD=20), and the average duration of an individual telephone call was 8 minutes (SD=3). 12 months after the rehabilitation, an effect of the intervention on the physical activity behaviour was found, but not on a weight reduction. Under consideration of the baseline differences, 12 months after the rehabilitation, the IG was physically active for an average of 54 minutes per week longer than the CG and had an activity-related caloric expenditure of 495kcal per week higher than the CG. This corresponded to small effect sizes. Both the IG and the CG were more active six and 12 months after the rehabilitation than at the start of rehab. In both groups, there was a weight reduction at the end of rehab and at both follow-up time points. However, 12 months after the rehabilitation, the groups did not differ in terms of BMI or in the frequency with which a weight reduction of at least 5% was achieved. Nevertheless, in patients with obesity, the increase in movement in itself fosters health and reduces the risk of illness – independently of whether the weight has also reduced. The hypotheses on differences in motivational variables were only confirmed at the end of rehab and not, by contrast, at the 6- and 12-month follow-ups. The intervention had no effects on quality of life, which improved equally in the both groups, and 12 months after rehabilitation, no significant differential effects were present. The intervention showed a good feasibility with a manageable time expenditure and a high acceptance on the part of the participants. It proved to be effective for the sustainable promotion of physical activity. For a further optimisation, an extension of the aftercare period to 12 months can be considered. An adaptation for other indication areas is possible.




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