title: Brief Counseling and Exercise Referral Scheme: A Pragmatic Trial in Mexico.
abstract: BACKGROUND
  The effectiveness of clinical-community linkages for promotion of physical activity (PA) has not been explored in low- and middle-income countries. This study assessed the effectiveness of a primary care-based, 16-week intervention rooted in behavioral theory approaches to increase compliance with aerobic PA recommendations.
  
  
  METHODS
  Pragmatic cluster randomized trial.
  
  
  METHODS
  Patients had diagnosed (<5 years) hypertension, were aged 35-70 years, self-reported as physically inactive, had a stated intention to engage in PA, and attended Primary Healthcare Centers in the Social Security health system in Cuernavaca, Mexico. Of 23 Primary Healthcare Centers, four were selected based on proximity (5 km radius) to a center.
  
  
  METHODS
  Each center was randomized to a brief PA counseling (BC, n=2) or an exercise referral (ER, n=2) intervention. The study was conducted between 2011 and 2012.
  
  
  METHODS
  Change in objectively measured PA levels (ActiGraph GT3X accelerometers) at baseline, 16, and 24 weeks. Intention-to-treat analyses were used to assess the effectiveness of the intervention overall and according to ER intervention attendance. Longitudinal multilevel mixed-effects analyses considering the interaction (time by intervention) were conducted. Each model was also adjusted by baseline value of the outcome measure, demographic and health variables, social support, PA self-efficacy, and barriers.
  
  
  RESULTS
  Minutes/week of objectively measured moderate to vigorous PA increased by 40 and 53 minutes in the ER and BC groups, respectively (p=0.59). Participants attending >50% of ER program sessions increased their moderate to vigorous PA by 104 minutes/week and compliance with aerobic PA recommendations by 23.8%, versus the BC group (both p<0.05).
  
  
  CONCLUSIONS
  Both BC and ER led to modest improvements in PA levels, with no significant differences between groups. Adequate adherence with the ER program sessions led to significant improvements in compliance with aerobic PA recommendations versus BC. These results can help guide development and implementation of programs integrating standardized PA assessment, counseling, and referrals via clinical-community linkages in Mexico and other low- and middle-income countries in the region.
authors.affiliation: Epidemiology and Health Services Research Unit, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México; Exercise is Medicine Global Research and Collaboration Center, Atlanta, Georgia; Department of Preventive Medicine, University of Southern California, Los Angeles, California. Electronic address: katia.gallegos@espm.insp.mx.
authors.forename: Katia
authors.initials: K
authors.lastname: Gallegos-Carrillo
authors.affiliation: Research Department, Instituto Nacional de Geriatría, Ciudad de Mexico, Mexico.
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Peña
authors.affiliation: Epidemiology and Health Services Research Unit, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México; Research Center in Population Health, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salmerón
authors.affiliation: Research Center in Health Systems, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
authors.forename: Nelly
authors.initials: N
authors.lastname: Salgado-de-Snyder
authors.affiliation: Exercise is Medicine Global Research and Collaboration Center, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Felipe
authors.initials: F
authors.lastname: Lobelo
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D003376:Counseling / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D020377:Self Efficacy; D057566:Self Report; D012944:Social Support; D016896:Treatment Outcome