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. 2002 Jan;48:72–80.

Does counseling help patients get active? Systematic review of the literature.

Robert J Petrella 1, Chastity N Lattanzio 1
PMCID: PMC2213933  PMID: 11852615

Abstract

OBJECTIVE: To determine the effect of counseling patients to become more physically active. DATA SOURCES: PubMed was searched for articles during the past 30 years on physicians promoting physical activity. Identified studies were cross-referenced, and experts were consulted for additional articles. STUDY SELECTION: Thirteen articles described primary care counseling on exercise. Six studies were randomized controlled trials (RCTs); seven were quasi-experimental designs. Three of the four RCTs and three of the five quasi-experimental studies were short term (4 weeks to 2 months); the remaining three trials lasted longer than 6 months. Most studies used strategies to address stage of change. SYNTHESIS: Outcome measures included adoption of physical activity, stage of change, and change in physical activity level. Most studies found positive relationships between counseling and these outcomes. No reliable evaluation instruments were found, nor was the long-term effect of interventions established. CONCLUSION: Interventions that included written materials for patients, considered behaviour change strategies, and provided training and materials for physicians were effective at increasing levels of physical activity. New strategies that involve measuring and prescribing specific amounts of exercise might also improve fitness levels and hence improve outcomes of chronic disease. Shortcomings of these studies include lack of long-term data, lack of sustaining activities for family physicians, and scant cost-efficacy analysis.

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Selected References

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

  1. 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]
  2. Blair S. N., Applegate W. B., Dunn A. L., Ettinger W. H., Haskell W. L., King A. C., Morgan T. M., Shih J. A., Simons-Morton D. G. Activity Counseling Trial (ACT): rationale, design, and methods. Activity Counseling Trial Research Group. Med Sci Sports Exerc. 1998 Jul;30(7):1097–1106. doi: 10.1097/00005768-199807000-00012. [DOI] [PubMed] [Google Scholar]
  3. Bull F. C., Jamrozik K. Advice on exercise from a family physician can help sedentary patients to become active. Am J Prev Med. 1998 Aug;15(2):85–94. doi: 10.1016/s0749-3797(98)00040-3. [DOI] [PubMed] [Google Scholar]
  4. Burton L. C., Paglia M. J., German P. S., Shapiro S., Damiano A. M. The effect among older persons of a general preventive visit on three health behaviors: smoking, excessive alcohol drinking, and sedentary lifestyle. The Medicare Preventive Services Research Team. Prev Med. 1995 Sep;24(5):492–497. doi: 10.1006/pmed.1995.1078. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Dampier D., Adams R. Key to prolonging health and independence. Physical activity for older Canadians. Can Fam Physician. 1999 Apr;45:996-8, 1003-4. [PMC free article] [PubMed] [Google Scholar]
  7. Dvorak R. V., Tchernof A., Starling R. D., Ades P. A., DiPietro L., Poehlman E. T. Respiratory fitness, free living physical activity, and cardiovascular disease risk in older individuals: a doubly labeled water study. J Clin Endocrinol Metab. 2000 Mar;85(3):957–963. doi: 10.1210/jcem.85.3.6432. [DOI] [PubMed] [Google Scholar]
  8. King A. C., Sallis J. F., Dunn A. L., Simons-Morton D. G., Albright C. A., Cohen S., Rejeski W. J., Marcus B. H., Coday M. C. Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings. Activity Counseling Trial Research Group. Med Sci Sports Exerc. 1998 Jul;30(7):1086–1096. doi: 10.1097/00005768-199807000-00011. [DOI] [PubMed] [Google Scholar]
  9. Lewis B. S., Lynch W. D. The effect of physician advice on exercise behavior. Prev Med. 1993 Jan;22(1):110–121. doi: 10.1006/pmed.1993.1008. [DOI] [PubMed] [Google Scholar]
  10. Logsdon D. N., Lazaro C. M., Meier R. V. The feasibility of behavioral risk reduction in primary medical care. Am J Prev Med. 1989 Sep-Oct;5(5):249–256. [PubMed] [Google Scholar]
  11. Long B. J., Calfas K. J., Wooten W., Sallis J. F., Patrick K., Goldstein M., Marcus B. H., Schwenk T. L., Chenoweth J., Carter R. A multisite field test of the acceptability of physical activity counseling in primary care: project PACE. Am J Prev Med. 1996 Mar-Apr;12(2):73–81. [PubMed] [Google Scholar]
  12. 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]
  13. Norris S. L., Grothaus L. C., Buchner D. M., Pratt M. Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO. Prev Med. 2000 Jun;30(6):513–523. doi: 10.1006/pmed.2000.0673. [DOI] [PubMed] [Google Scholar]
  14. Pate R. R., Pratt M., Blair S. N., Haskell W. L., Macera C. A., Bouchard C., Buchner D., Ettinger W., Heath G. W., King A. C. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995 Feb 1;273(5):402–407. doi: 10.1001/jama.273.5.402. [DOI] [PubMed] [Google Scholar]
  15. Petrella R. J., Wight D. An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP). Arch Fam Med. 2000 Apr;9(4):339–344. doi: 10.1001/archfami.9.4.339. [DOI] [PubMed] [Google Scholar]
  16. Pinto B. M., Goldstein M. G., DePue J. D., Milan F. B. Acceptability and feasibility of physician-based activity counseling. The PAL project. Am J Prev Med. 1998 Aug;15(2):95–102. doi: 10.1016/s0749-3797(98)00043-9. [DOI] [PubMed] [Google Scholar]
  17. Prochaska J. O., DiClemente C. C. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983 Jun;51(3):390–395. doi: 10.1037//0022-006x.51.3.390. [DOI] [PubMed] [Google Scholar]
  18. Simons-Morton D. G. Dose-response relationship of physical activity and cardiovascular disease risk. J Am Geriatr Soc. 1998 Feb;46(2):238–240. doi: 10.1111/j.1532-5415.1998.tb02546.x. [DOI] [PubMed] [Google Scholar]
  19. Stevens W., Hillsdon M., Thorogood M., McArdle D. Cost-effectiveness of a primary care based physical activity intervention in 45-74 year old men and women: a randomised controlled trial. Br J Sports Med. 1998 Sep;32(3):236–241. doi: 10.1136/bjsm.32.3.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Swinburn B. A., Walter L. G., Arroll B., Tilyard M. W., Russell D. G. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners. Am J Public Health. 1998 Feb;88(2):288–291. doi: 10.2105/ajph.88.2.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Williams P. T. Coronary heart disease risk factors of vigorously active sexagenarians and septuagenarians. J Am Geriatr Soc. 1998 Feb;46(2):134–142. doi: 10.1111/j.1532-5415.1998.tb02529.x. [DOI] [PubMed] [Google Scholar]
  22. Williams P. T. Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners. The National Runners' Health Study. Arch Intern Med. 1997 Jan 27;157(2):191–198. [PMC free article] [PubMed] [Google Scholar]

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