Key result
Multidimensional primary care intervention yields ~2.6-fold higher odds of cutting screen time vs usual care.
Why the study?
Hypertension and DM disproportionately affect underserved populations, where low physical activity and high sedentary behaviour increase cardiovascular risk, yet effective and scalable primary care strategies remain limited.
Does a multidimensional primary care intervention combining telehealth and in-person activities improve physical activity, sedentary behaviour, and behavioural stages of change in underserved individuals with hypertension or diabetes mellitus?
RCT (n=875)
Cluster randomized
Yes
Does a multidimensional primary care intervention combining telehealth and in-person activities improve physical activity, sedentary behaviour, and behavioural stages of change in underserved individuals with hypertension or diabetes mellitus?
A multidimensional primary care intervention combining telehealth training and group activities reduced non-TV screen sedentary behaviour and improved behavioural readiness for physical activity in underserved patients with hypertension and diabetes, although it did not measurably increase physical activity levels at 12 months.
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.
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Carvalho et al. (2026) conducted an RCT in Hypertension or diabetes mellitus (n=875). Multidimensional primary care intervention combining telehealth tools (professional training, biweekly teletutoring) and in-person activities (group physical activity, behavioural counselling) vs. Usual care was evaluated on Physical activity, sedentary behaviour (3+ hours on non-TV screens), and stages of change for increasing physical activity (165% higher odds (non-TV screen habit improvement); 61% higher odds (stage of change progression)). A multidimensional primary care intervention yielded 165% higher odds of reducing non-TV screen time and 61% higher odds of progressing in readiness for physical activity vs usual care.
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