The role of physician counseling in improving adherence to physical activity among the general population
Keywords:
Physical activity, Exercise, Behavioral medicine, Health promotion, Internal medicineAbstract
The regular practice of physical activity at appropriate levels ensures various benefi ts for the individual over the short, medium and long terms. It is therefore important in health promotion. On the other hand, sedentary behavior has reached alarming levels among the general population, which qualifi es it as a serious health problem of endemic proportions. The present review describes public health problems consequent to sedentary behavior and the importance of physician counseling for change their patients’ behavior and making them more physically active on a regular basis. Models and behavioral theories are presented to facilitate physicians’ understanding of how to approach patients during clinical practice. We also describe programs conducted in many countries based on physician counseling for reducing sedentary behavior, and we present many tools used to quantify and qualify patients’ attitudes towards becoming more physically active. Through understanding the barriers faced by patients, we suggest methodologies that will enable physicians to use physical activity promotion appropriately. We hope that this will provide support for physicians in conducting physical activity counseling, as a means for improving the health of the population.
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References
Physical activity and cardiovascular health. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. JAMA. 1996;276(3):241-6.
Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402-7.
Lee IM, Sesso HD, Oguma Y, Paffenbarger RS Jr. Relative intensity of physical activity and risk of coronary hearth disease. Circulation. 2003;107(8):1110-6.
Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34(10):2475-81.
Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493-503.
Hu G, Barengo, NC, Tuomilehto J, Lakka TA, Nissinen A, Jousilahti P. Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland. Hypertension. 2004;43(1):25-30.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW. Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previ- ously sedentary adults. Diabetes Care. 2003;26(3):557-62.
Berman DM, Rogus EM, Busby-Whitehead MJ, Katzel LI, Goldberg AP. Predictors of adipose tissue lipoprotein lipase in middle-age and older men: relationship to leptin and obesity, but not cardiovascular fitness. Metabolism. 1999;48(2):183-9.
Carroll S, Dudfield M. What is the relationship between ex- ercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med. 2004;34(6):371-418.
Donnelly JE, Hill JO, Jacobsen DJ, et al. Effects of 16-month randomized controlled exercise trial on body weight and com- position in young, overweight men and women: the Midwest Exercise Trial. Arch Intern Med. 2003;163(11):1343-50.
Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight in overweight, sedentary women: a randomized trial. JAMA. 2003;290(10):1323-30.
Lee IM, Sesso HD, Paffenbarger RS Jr. Physical activity and risk of lung cancer. Int J Epidemiol. 1999;28(4):620-5.
Mao Y, Pan S, Wen SW, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Physical activity and the risk of lung cancer in Canada. Am J Epidemiol. 2003;158(6):564-75.
McTiernan A, Kooperberg C, White E, et al. Recreation physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA. 2003;290(10):1331-6.
Hou L, Ji B, Blair A, Dai Q, Gao YT, Chow WH. Commuting physical activity and risk of colon cancer in Shanghai, China. Am J Epidemiol. 2004;160(9):860-7.
Slattery ML. Physical activity and colorectal cancer. Sports Med. 2004;34(4):239-52.
Greist JH. Exercise intervention with depressed outpatients. In: Morgan WP, Goldston SE, editors. Exercise and mental health. Washington: Hemisphere; 1987. p. 117-21.
Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol. 2002;156(4):328-34.
Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-65.
U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: U.S. Depart- ment of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996. Available from URL: http://www.cdc.gov/nccdphp/sgr/sgr.htm. Accessed in 2007 (Feb 21).
Ainsworth BE, Macera CA. Physical inactivity. In: Brownson RC, Remington PL, Davis JR, editors. Chronic disease epide- miology and control. Washington: American Public Health Association; 1998. p. 191-213.
Clark DO. Physical activity and its correlates among urban primary care patients aged 55 years or older. J Gerontol B Psychol Sci Soc Sci. 1999;54(1):S41-8.
Rego RA, Berardo FA, Rodrigues SS, et al. Fatores de risco para doenças crônicas näo-transmissíveis: inquérito domiciliar no município de São Paulo, SP (Brasil). Metodologia e resultados preliminares. [Risk factors for chronic non-communicable diseases: a domiciliary survey in the municipality of São Paulo, SP (Brazil). Methodology and preliminary results]. Rev Saude Publica. 1990;24(4):277-85.
Lewis BS, Lynch WD. The effect of physician advice on exercise behavior. Prev Med. 1993;22(1):110-21.
Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional por amostra de domicílios. Acesso e utilização de serviços de saúde. Available from: http://www.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad98/saude/default.shtm. Accessed in 2007 (Feb 21).
US Department of Health and Human Services. Healthy People 2010: Understanding and improving health. Washington, DC: US Government Printing Office; 2000. Available from URL: http://www.healthypeople.gov/Document/tableofcontents.htm#under. Accessed in 2007 (Mar 16).
Guide to clinical preventive services. 2nd ed. Available from URL: http://odphp.osophs.dhhs.gov/pubs/guidecps/. Accessed in 2007 (Mar 16).
Damush TM, Stewart AL, Mills KM, King AC, Ritter PL. Prevalence and correlates of physician recommendations to exercise among older adults. J Gerontol A Biol Sci Med Sci. 1999;54(8):M423-7.
Wee CC, McCarthy EP, Davis RB, Phillips RS. Physician coun- seling about exercise. JAMA. 1999;282(16):1583-8.
Nawaz H, Adams ML, Katz DL. Physician-patient interac- tions regarding diet, exercise, and smoking. Prev Med. 2000;31(6):652-7.
Kreuter MW, Scharff DP, Brennan LK, Lukwago SN. Physician recommendations for diet and physical activity: which patients get advised to change? Prev Med. 1997;26(6):825-33.
Wechsler H, Levine S, Idelson RK, Rohman M, Taylor JO. The physician’s role in health promotion--a survey of primary-care practitioners. N Engl J Med. 1983;308(2):97-100.
Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic car- diovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circula- tion. 2003;107(24):3109-16.
American College of Sports Medicine. Guidelines for exercise testing and prescription. 4th ed. Philadelphia: Lea & Febiger; 1991.
Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA Guide- lines for Exercise Testing. A report of the American College of Cardiology/American Hearth Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997;30(1):260-311.
American College of Sports Medicine Position Stand and American Heart Association. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med Sci Sports Exerc. 1998;30(6):1009-18.
Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sport Sci. 1992;17(4):338-45.
American College of Sports Medicine position stand. The rec- ommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22(2):265-74.
DeBusk RF, Stenestrand U, Sheehan M, Haskell WL. Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol. 1990;65(15):1010-3.
Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW 3rd, Blair SN. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA. 1999;281(4):327-34.
Jakicic JM, Wing RR, Butler BA, Robertson RJ. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int J Obes Relat Metab Disord. 1995;19(12):893-901.
Murphy MH, Hardman AE. Training effects of short and long bouts of brisk walking in sedentary women. Med Sci Sports Exerc. 1998;30(1):152-7.
Schnohr P, Scharling H, Jensen JS. Changes in leisure- time physical activity and risk of death: an observa- tional study of 7,000 men and women. Am J Epidemiol. 2003;158(7):639-44.
Blair SN, LaMonte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr. 2004;79(5)913S-920S.
Sallis J, Owen N. Physical activity and behavioral medicine. Thousand Oaks: Sage Publications; 1999.
Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.
Prochaska JO, DiClemente CC. Stages and processes of self- change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390-5.
Sallis JF, Hovell MF, Hofstetter CR, Barrington E. Explanation of vigorous physical activity during two years using social learn- ing variables. Soc Sci Med. 1992;34(1):25-32.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215.
Marcus BH, Simkin LR. The transtheoretical model: ap- plications to exercise behavior. Med Sci Sports Exerc. 1994;26(11):1400-4.
Prochaska J, Redding C, Evers K. The transtheoretical model and stages of change. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research and practice. San Francisco: Jossey-Bass Publishers; 1997. p. 60-84.
Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63(1):60-6.
Marcus B, Sallis J. Determinants of physical activity behavior and implications for interventions. In: Leon AS, editor. Physical activity and cardiovascular health: A National Consensus. Champaing: Human Kinetics Publishers; 1997. p. 192-201.
Chinn DJ, White M, Harland J, Drinkwater C, Raybould S. Barriers to physical activity and socioeconomic position: implications for health promotion. J Epidemiol Community Health. 1999;53(3):191-2.
Araújo TL, Andrade DR, Matsudo SMM, et al. Behavior stages and barriers related to physical activity. FIMS World Congress Abstracts Program; 1998. p. 40.
Matsudo S, Matsudo V. Physical activity and ageing in develop- ing countries. In: Bailey S, editor. Women, sport and physical activity: Perpectives — The multidisciplinary series of physical education and sport science. Physical activity and ageing. In- ternational Council of Sport Science and Physical Education; 2000. p. 65-82.
Andrade D, Figueira A, Araujo T, Matsudo V, Matsudo S, Andrade E. Barriers to adhesion among activity young adults. Med Sci Sports Exerc. 1998;30(5 Suppl):S182. [abstract].
Sallis J, Owen N. Ecological models. health behavior and health education. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research and practice. 2nd ed. San Francisco: Jossey Bass Publishers; 1997. p. 403-24.
Tai SS, Gould M, Smith P, Iliffe S. Promoting physical activity in general practice: should prescribed exercise be free J R Soc Med. 1999;92(2):65-7.
Patrick K, Sallis JF, Long B, et al. A new tool for encour- aging physical activity: Project PACE. Phys Sportsmed. 1994;22(11):45-55.
Calfas K, Sallis J, Oldenburg B, Frech M. The impact of health-care providers on physical activity. In: Leon A, edi- tor. Physical activity and cardiovascular health: A National Consensus. Champaing: Human Kinetics Publishers; 1997. p. 245-51.
Pinto BM, Goldstein MG, DePue JD, Milan FB. Acceptability and feasibility of physician-based activity counseling. The PAL project. Am J Prev Med. 1998;15(2):95-102.
Blair SN, Applegate WB, Dunn AL, et al. Activity Coun- seling Trial (ACT): rationale, design, and methods. Activ- ity Counseling Trial Research Group. Med Sci Sports Exerc. 1998;30(7):1097-106.
Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care: the Ac- tivity Counseling Trial: a randomized controlled trial. JAMA. 2001;286(6): 677-87.
Albright CL, Cohen S, Gibbons L, et al. Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial. Am J Prev Med. 2000:18(3):225-34.
Matsudo SM, Matsudo VR. Coalitions and networks: facilitat- ing global physical activity promotion. IUHPE – Promotion & Education. XIII, 2; 2006. Available from URL: http://www. agitasp.org.br/material/arquivos/Matsudo-Promotion-Health- 2006-ENG.pdf. Accessed in 2007 (Mar 16).
McClellan W. The physician and patient education: a review. Patient Educ Couns. 1986;8(2):151-63.
Campbell MJ, Browne D, Waters WE. Can general practitioners influence exercise habits Controlled trial. Br Med J (Clin Res Ed). 1985;290(6474):1044-6.
Logsdon DN, Lazaro CM, Meier RV. The feasibility of behav- ioral risk reduction in primary medical care. Am J Prev Med. 1989;5(5):249-56.
Balde A, Figueras J, Hawking DA, Miller JR. Physician ad- vice to the elderly about physical activity. J Aging Phys Act. 2003;11(1):90-7.
Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med. 1996;25(3):225-33.
Swinburn BA, Walter LG, Arroll B, Tilyard MW, Russell DG. The green prescription study: a randomized controlled trial of a written exercise advice provided by general practitioners. Am J Public Health. 1998;88(2):288-91.
Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician. 2002;48:72-80.
Kreuter MW, Chheda SG, Bull FC. How does physician advice influence patient behavior Evidence for a priming effect. Arch Fam Med. 2000;9(5):426-33.
Campbell MK, DeVellis BM, Stretcher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: the ef- fectiveness of tailored messages in primary care settings. Am J Public Health. 1994;84(5):783-7.
Petty RT, Cacioppo JT, Strathman AJ, Priester JR. To think or not to think: exploring two routes to persuasion. In: Shavitt S, Brock TC, editors. Persuasion: Psychological insights and perspectives. Boston: Allyn and Bacon; 1994. p. 81-116.
Skinner CS, Siegfried JC, Kegler MC, Stretcher VJ. The po- tential of computers in patient education. Patient Educ Couns. 1993;22(1):27-34.
Marshall AL, Smith BJ, Bauman AE, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005;39(5):294-7; discussion 294-7.