What is the time cost of exercise? Cost of time spent on exercise in a primary health care intervention to increase physical activity

Lars Hagberg; Stefan Lundqvist; Lars Lindholm

doi:10.1186/s12962-020-00209-9

What is the time cost of exercise? Cost of time spent on exercise in a primary health care intervention to increase physical activity

Cost Eff Resour Alloc. 2020 Mar 18:18:14. doi: 10.1186/s12962-020-00209-9. eCollection 2020.

Authors

Lars Hagberg¹, Stefan Lundqvist^{2

3}, Lars Lindholm⁴

Affiliations

¹ 1Centre for Health Care Science, Faculty of Medicine and Health, Örebro University, P.O.Box 1324, 701 13 Örebro, Sweden.
² 2Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Centrum för Fysisk Aktivitet Göteborg, Svangatan 2B, Region Västra Götaland, 416 68 Göteborg, Sweden.
⁴ 4Unit of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden.

Abstract

Background: In health care interventions aimed at increased physical activity, the individual's time spent on exercise is a substantial input. Time costs should therefore be considered in cost-effectiveness analyses. The aim of this study was to estimate the cost of time spent on exercise among 333 primary health care patients with metabolic risk factors receiving physical activity on prescription.

Methods: Based on a theoretical framework, a yardstick was constructed with experience of work (representing claim of salary as compensation) as the lower anchor-point, and experience of leisure activity forgone due to extended exercise time (no claim) as the higher anchor-point. Using this yardstick experience of exercise can be valued. Another yardstick was constructed with experience of cleaning at home in combination with willingness to pay for cleaning as the lowest anchor-point.

Results: The estimated costs of exercise time were between 14 and 37% of net wages, with physical activity level being the most important factor in determining the cost. Among sedentary individuals, the time cost was 21-51% of net wages while among individuals performing regular exercise it was 2-10%. When estimating the cost of time spent on exercise in a cost-effectiveness analysis, experience of exercise, work, leisure activity forgone, and cleaning at home (or other household work that may be relevant to purchase) should be measured. The individual's willingness to pay for cleaning at home and their net salary should also be measured.

Conclusions: When using a single valuation of cost of time spent on exercise in health care interventions, for employed participants 15-30% of net salary should be used. Among unemployed individuals, lower cost estimation should be applied. Better precision in cost estimations can be achieved if participants are stratified by physical activity levels.Trial registration The study was conducted as a survey of existing clinical physical activity on prescription work, and was approved by the Regional Ethical Review Board in Gothenburg, Sweden (ref: 678-14).

Keywords: Cost-effectiveness; Exercise; Physical activity; Primary health care; Time cost; Voluntary time.