Prevention through physical activity in primary health care; the BeweegKuur and beyond

In 2007, the Dutch Minister of Health decided that a combined lifestyle intervention BeweegKuur (BK) with focus on increase of physical activity (PA) should be available for adults at risk of chronic diseases. The BK should be covered by basic health insurance and carried out in primary care. General practitioner, physical therapist, and dietician are involved. The main professional is the lifestyle coach (LSC), who guides the participant during one year, stimulates multidisciplinary collaboration, and leads a local network around the BK including also representatives from sport and local authorities. NISB was asked to optimize and concurrently implement the BK nationwide. The number of locations rose from 8 in 2008 to 160 in 2011. Many process and other evaluations surrounded the BK and led to multiple changes in contents and implementation. In 2014, we see results at multiple levels. Participants significantly improve parameters of health, mobility, PA, and are significantly more intrinsically motivated to be physically active, based on motivational interviewing. Flexibility in use of the protocol is needed for meeting local working practices and needs of participants. The LSC is highly valued by other professionals and participants. Improved collaboration between health professionals was a major result. Health care workers perceived better accessibility of sport facilities for people with chronic diseases when local networks also included sport professionals. In 2011, the new Minister decided that the BK should not be covered by health insurance. Policy focus is now on health and PA in the neighborhood, supported by networks for which BK networks are set as an example. A new type of professional is born, part of his tasks also based on the LSC. A political landslide, giving municipalities much larger responsibilities for health and health-related facilities for citizens, stimulates the basis for prevention through increased PA. While the BK is not covered by basic health insurance, health insurance companies are investing more in financing prevention activities. Pilots are set up to evaluate effects of structural embedding and financing of the LSC in primary care. Contracts are signed between local authorities and health insurances to cover costs of the BK for people in lower SES categories. In the presentation we will discuss milestones and major results of the BK and the timeline of prevention through PA related to primary care in the Netherlands