| Summary: | 碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 100 === Background and Objective:
Despite the health benefits of physical activity is evident, most adults do not take the recommended amount of exercise. Exercise referral schemes (ERS) have been introduced to encourage exercise participation in sedentary adults, particularly those with chronic illness. . A systematic review demonstrated ERS resulted in a modest but statistically significant increase in the numbers of participants doing moderate exercise with a combined risk ratio of 1.20 (95%CI: 1.06-1.35). The small effect was most likely due to poor participation and compliance rates, with personal and exercise scheme-related barriers identified for the inadequate adherence. A novel “National Exercise Referral Scheme” (NERS) in Taiwan, initiated by the Sports Affairs Council, Executive Yuan, was commenced to encourage regular exercise participation in sedentary adults with chronic illness. This study aimed to investigated the effectiveness and cost-effectiveness of NERS in Taiwan, and explore the predictors for attaining positive outcomes.
Methods:
This is a multi-center, one-group pretest-posttest study design. Subjects were recruited from the participants of NERS in Taiwan. People possessing the following chronic conditions would be qualified to enroll the NERS, including: metabolic syndrome, stress urinary incontinence, frail elders, tendency toward melancholy, medically stable stroke, medically stable osteoarthritis, medically stable cardiovascular disease or anyone requiring encouragement to being physically active. Exclusion criteria are those who were contraindicated for regular exercise participation advised by their primary physicians. The participants received a supervised class-based exercise program for , 30-45 minutes per session, at least 2 times per week. Outcome measures include 2 main categories: 1) Physical fitness (body composition, muscle strength, muscle flexibility and cardiovascular fitness); and 2) Questionnaires (self-report physical activity, quality of life, exercise motivation, exercise self-efficacy, social support and self-perceived exercise benefit). Measurements were conducted at baseline and 12 weeks. Paired t-test, Wilcoxon signed-ranks test and Cohen’s effect size were performed to examine the intervention effects of NERS. Stepwise logistic regression analyses were used to explore the predictors for attaining positive outcomes. Incremental cost utility ratio (ICUR) was performed for the cost-utility analysis. The significance level s was set at 0.05.
Results:
The study recruited 413 people who enrolled the NERS from 11 community exercise centers, with 70.6% female and mean age 48.9 years. Main referral categories were metabolic syndrome, knee osteoarthritis, osteoporosis and tendency toward melancholy. After 12 weeks, the attrition rate was 2%, and the exercise adherence rate for those participants retained in the NERS was 96%. Positive results were found in physical activity level (988.3 →2243.3 Kcal/week, medium effect size, P<0.001), health-related quality of life (0.69→0.79, medium effect size, P<0.001), exercise motivation (33.3 →37.0, trivial effect size, P<0.001), exercise self-efficacy (7.58 →8.00, small effect size, P=0.025), as well as all physical fitness measures (P<0.001). The ICUR was NT 355,937-1,203,538/QALY for short term, and NT68,408-121,806/QALY for long term. Taking into account the parameters obtained from literatures and the current study, the societal cost saved will be estimated to be NT$ two hundred ninety million provided that the clients with metabolic syndrome become physically active.
Conclusions: We concluded that NERS not only produced positive health effects but also economic effects, especially for the clients with metabolic syndrome, knee osteoarthritis, osteoporosis and tendency toward melancholy. The program would be worthwhile for wider implementation.
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