Skip to main content
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 1998 Sep;32(3):242–247. doi: 10.1136/bjsm.32.3.242

Barriers to physical activity promotion by general practitioners and practice nurses

J McKenna, P J Naylor, N McDowell
PMCID: PMC1756103  PMID: 9773175

Abstract

OBJECTIVE: To examine the promotion of physical activity by general practitioners (GPs) and practice nurses (PNs). METHODS: A questionnaire that examined the types of barriers and the levels of their influence as well as stage of change for activity promotion and for personal behaviour was mailed to 846 subjects. RESULTS: The return rate exceeded 70% in each group with a high proportion (69%) of GPs and PNs reporting that they regularly promote physical activity with their patients. GPs were less likely to regularly promote physical activity with their patients if they indicated lack of time as a barrier (odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.58 to 0.93) or lack of incentives (OR = 0.74, 95% CI 0.59 to 0.94), and more likely to promote exercise if they themselves were regular exercisers (OR = 3.19, 95% CI 1.96 to 5.18). However, for PNs longer consultation times (by 1.5 to 2 minutes) had a higher likelihood of producing regular promotion of activity (OR = 1.61, 95% CI 1.02 to 1.62). For PNs personal physical activity stage was the strongest significant predictor of promotion level, but with a stronger effect (OR = 4.77, 95% CI 1.48 to 15.35) than in the GPs. CONCLUSION: The main finding is that GPs in the action or maintenance stage of changing their own physical activity are three times more likely to regularly promote the same behaviour in their patients than those in the other stages; for PNs the same difference quadruples the likelihood of them promoting physical activity. Professional readiness to change is influenced by known system barriers in GPs, and not in PNs, but is more strongly predicted by personal physical activity behaviour in both groups. 




Full Text

The Full Text of this article is available as a PDF (118.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrams D. B., Biener L. Motivational characteristics of smokers at the workplace: a public health challenge. Prev Med. 1992 Nov;21(6):679–687. doi: 10.1016/0091-7435(92)90075-s. [DOI] [PubMed] [Google Scholar]
  2. Armstrong D., Reyburn H., Jones R. A study of general practitioners' reasons for changing their prescribing behaviour. BMJ. 1996 Apr 13;312(7036):949–952. doi: 10.1136/bmj.312.7036.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ashenden R., Silagy C., Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract. 1997 Apr;14(2):160–176. doi: 10.1093/fampra/14.2.160. [DOI] [PubMed] [Google Scholar]
  4. Belcher D. W., Berg A. O., Inui T. S. Practical approaches to providing better preventive care: are physicians a problem or a solution? Am J Prev Med. 1988;4(4 Suppl):27–52. [PubMed] [Google Scholar]
  5. Booth M. L., Macaskill P., Owen N., Oldenburg B., Marcus B. H., Bauman A. Population prevalence and correlates of stages of change in physical activity. Health Educ Q. 1993 Fall;20(3):431–440. doi: 10.1177/109019819302000312. [DOI] [PubMed] [Google Scholar]
  6. Calfas K. J., Long B. J., Sallis J. F., Wooten W. J., Pratt M., Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med. 1996 May-Jun;25(3):225–233. doi: 10.1006/pmed.1996.0050. [DOI] [PubMed] [Google Scholar]
  7. Calnan M., Cant S., Williams S., Killoran A. Involvement of the primary health care team in coronary heart disease prevention. Br J Gen Pract. 1994 May;44(382):224–228. [PMC free article] [PubMed] [Google Scholar]
  8. Calnan M., Williams S. Coronary heart disease prevention: the role of the general practitioner. Fam Pract. 1993 Jun;10(2):137–151. doi: 10.1093/fampra/10.2.137. [DOI] [PubMed] [Google Scholar]
  9. Carney P. A., Dietrich A. J., Keller A., Landgraf J., O'Connor G. T. Tools, teamwork, and tenacity: an office system for cancer prevention. J Fam Pract. 1992 Oct;35(4):388–394. [PubMed] [Google Scholar]
  10. DiClemente C. C., Hughes S. O. Stages of change profiles in outpatient alcoholism treatment. J Subst Abuse. 1990;2(2):217–235. doi: 10.1016/s0899-3289(05)80057-4. [DOI] [PubMed] [Google Scholar]
  11. Fletcher G. F., Blair S. N., Blumenthal J., Caspersen C., Chaitman B., Epstein S., Falls H., Froelicher E. S., Froelicher V. F., Pina I. L. Statement on exercise. Benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart association. Circulation. 1992 Jul;86(1):340–344. doi: 10.1161/01.cir.86.1.340. [DOI] [PubMed] [Google Scholar]
  12. Frank E., Kunovich-Frieze T. Physicians' prevention counseling behaviors: current status and future directions. Prev Med. 1995 Nov;24(6):543–545. doi: 10.1006/pmed.1995.1086. [DOI] [PubMed] [Google Scholar]
  13. Harsha D. M., Saywell R. M., Jr, Thygerson S., Panozzo J. Physician factors affecting patient willingness to comply with exercise recommendations. Clin J Sport Med. 1996 Apr;6(2):112–118. doi: 10.1097/00042752-199604000-00009. [DOI] [PubMed] [Google Scholar]
  14. Kushner R. F. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med. 1995 Nov;24(6):546–552. doi: 10.1006/pmed.1995.1087. [DOI] [PubMed] [Google Scholar]
  15. Little P., Margetts B. The importance of diet and physical activity in the treatment of conditions managed in general practice. Br J Gen Pract. 1996 Mar;46(404):187–192. [PMC free article] [PubMed] [Google Scholar]
  16. Marcus B. H., Goldstein M. G., Jette A., Simkin-Silverman L., Pinto B. M., Milan F., Washburn R., Smith K., Rakowski W., Dubé C. E. Training physicians to conduct physical activity counseling. Prev Med. 1997 May-Jun;26(3):382–388. doi: 10.1006/pmed.1997.0158. [DOI] [PubMed] [Google Scholar]
  17. Marcus B. H., Pinto B. M., Simkin L. R., Audrain J. E., Taylor E. R. Application of theoretical models to exercise behavior among employed women. Am J Health Promot. 1994 Sep-Oct;9(1):49–55. doi: 10.4278/0890-1171-9.1.49. [DOI] [PubMed] [Google Scholar]
  18. Marcus B. H., Rakowski W., Rossi J. S. Assessing motivational readiness and decision making for exercise. Health Psychol. 1992;11(4):257–261. doi: 10.1037//0278-6133.11.4.257. [DOI] [PubMed] [Google Scholar]
  19. Pommerenke F. A., Dietrich A. Improving and maintaining preventive services. Part 1: Applying the patient path model. J Fam Pract. 1992 Jan;34(1):86–91. [PubMed] [Google Scholar]
  20. Rollnick S., Kinnersley P., Stott N. Methods of helping patients with behaviour change. BMJ. 1993 Jul 17;307(6897):188–190. doi: 10.1136/bmj.307.6897.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Stross J. K., Hiss R. G., Watts C. M., Davis W. K., Macdonald R. Continuing education in pulmonary disease for primary-care physicians. Am Rev Respir Dis. 1983 Jun;127(6):739–746. doi: 10.1164/arrd.1983.127.6.739. [DOI] [PubMed] [Google Scholar]
  22. Wells K. B., Ware J. E., Jr, Lewis C. E. Physicians' attitudes in counseling patients about smoking. Med Care. 1984 Apr;22(4):360–365. doi: 10.1097/00005650-198404000-00007. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES