How to make exercise counseling more effective: Lessons from rural America

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Original Research

How to make exercise counseling more effective: Lessons from rural America

J Fam Pract. 2008 June;57(6):394-402

By

Karrisa A. Weidinger, MPH

Presenting counseling as a detailed prescription and periodically following up make a big difference

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References

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Practice recommendations

To help overweight patients and those with a sedentary lifestyle to adopt and stick with an exercise regimen, develop a detailed and realistic plan with their help, and follow up with them periodically to see how they’re doing.

Abstract

Purpose: Exercise counseling by primary care physicians has been shown to improve physical activity in patients. However, the prevalence and effectiveness of physician counseling is unknown in rural populations that are at increased risk for chronic diseases.

Methods: Using a population-based telephone survey at baseline and again at 1-year follow-up, we assessed physical activity behavior among 1141 adults (75% female, 95% white) living within 12 rural communities of Missouri, Tennessee, and Arkansas. We tested the association between physician counseling and patients meeting current physical activity recommendations using logistic regression analysis controlling for demographic variables.

Results: Participants who saw a doctor for regular care were 54% more likely to be physically active (adjusted odds ratio [aOR]=1.54; 95% confidence interval [CI], 1.04-2.28). Overweight adults (body mass index [BMI]=25-29.9 kg/m²) who had been advised by their physician to exercise more were nearly 5 times more likely to meet physical activity recommendations if their doctor helped develop an exercise plan (aOR=4.99; 95% CI, 1.69-14.73).

Overweight individuals who received additional follow-up with the exercise plan from their doctor had a 5½-fold increase in likelihood of meeting physical activity recommendations (P<.05).

In the overall sample, patients were significantly more likely to initiate (P=.01) and maintain (P=.002) physical activity when the physician prescribed and followed up on an exercise plan.

Conclusion: This longitudinal study provides evidence that exercise counseling is most effective when the physician presents the counseling as a plan or prescription and when he or she follows up with the patient on it.

Simply telling sedentary patients that they need to exercise may not help them much. If the goal is to inspire action, a more effective approach would be to help them devise a plan for exercise and then inquire periodically about how it’s going. That premise was the basis for our study.

There’s good reason to get your patients moving

FAST TRACK

Five of the top 10 health concerns are chronic conditions that can be ameliorated with adequate physical activity

Physical inactivity is an independent risk factor for the most prevalent chronic diseases, including obesity, cardiovascular disease, and type 2 diabetes. Physical activity at moderate or vigorous intensities reduces stress and depressive symptoms, controls high blood pressure and cholesterol levels, improves sleep, reduces or reverses weight gain, and prevents or controls chronic diseases.¹ Based on these benefits, all physicians are encouraged to counsel sedentary patients to increase activity levels.²

National disease prevention objectives of Healthy People 2010 call for physicians to counsel at-risk patients on health behaviors such as physical activity and diet.³ Knowledge of patients’ families, environments, and communities makes primary care physicians uniquely suited to give effective advice,⁴ and physician counseling is known to positively influence patients’ health-related behavior.^5-12

To date, findings on counseling effectiveness have been mixed. Unfortunately, previous controlled trials of primary care physicians counseling adult patients on physical activity have varied in quality and yielded mixed results.¹³ Therefore, in its Guide to Clinical Preventive Services, the US Preventive Services Task Force did not recommend for or against behavioral counseling in primary care settings to promote physical activity.¹⁴ The guidelines state that existing studies do not provide a clear picture of which counseling components are effective.¹³

A population-based study by Glasgow and colleagues suggests that follow-up support by the physician may be needed to change physical activity behavior. Generalizations were limited, though, by the cross-sectional study design and post hoc analysis.¹⁵

More research is also needed to determine which strategies help patients stay physically active, a necessary component to sustaining the health benefits of exercise.¹⁶ Unfortunately, few primary care physicians counsel overweight or inactive patients on the benefits of diet and physical activity, let alone assist them with long-term follow-through.^7,8,11,16-18

Why we chose to study a rural population

Rural Americans are among the groups at highest risk for chronic diseases. On average they are older, less educated, and poorer than their urban counterparts.^19,20 And rural residents walk 13% less than suburbanites.²¹ According to the Rural Healthy People 2010 survey, 5 of the top 10 health concerns are chronic conditions that can be prevented or ameliorated with adequate physical activity.²²

FAST TRACK

Individuals who had a doctor for regular care were 54% more likely to be physically active than those who didn’t have a doctor

Studies have shown that healthy adults believe their health care providers are a credible source of information, and that they are motivated to comply with physician advice.²³ Nondisabled adults believe their physicians want them to be physically active.¹⁹ However, to our knowledge, no study has examined the effects of physician counseling on physical activity behavior for patients at increased risk for chronic diseases in rural areas.