The Gothenburg physical activity on prescription study: experiences from a 5-year intervention in patients with metabolic risk factors

Abstract Introduction Long-term effects of, and adherence to, lifestyle behaviour-change models remain insufficiently understood. This review integrates eight publications from the Gothenburg physical activity on prescription (PAP) intervention study, summarising outcomes over 5 years among physically inactive adults with metabolic risk factors treated in routine primary care. Content The Swedish PAP model combines patient-centred counselling, tailored physical activity (PA) prescriptions, and individually adapted follow-ups. The included substudies comprise observational analyses (6 months), a 2-year randomised trial, a 3-year cost-effectiveness analysis, long-term exercise-capacity evaluations (2 and 4.5 years), a 5-year qualitative study, and a 5-year longitudinal cohort. Summary Across study designs and time frames, PAP consistently produced clinically relevant and sustained increases in PA, with long-term gains of ∼730 MET-min/week and ∼50 % adherence at 5 years. Significant improvements were observed in cardiometabolic risk markers, mental health, and exercise capacity, even among initially inactive or early non-responsive patients. No systematic medication escalation was found, supporting a direct PA-mediated contribution. Mental health benefits persisted, while physical health related quality of life showed small age-related declines. Cost-effectiveness analyses demonstrated comparable value for standard and physiotherapist-supported PAP. Qualitative findings highlighted the importance of tailored prescriptions, autonomy support, and flexible follow-up to sustain long-term behaviour change. Outlook Long-term PAP delivered in routine primary care appears feasible, scalable, cost-effective, and clinically effective for improving PA and mitigating metabolic risk. Future research should refine need-based follow-up models, integrate objective PA measures, optimise dose progression, and develop targeted strategies for vulnerable subgroups to strengthen long-term adherence.