Abstract
Background
While the benefits of physical activity are generally recognized, over half of adult Canadians are not active enough to receive those benefits. Physicians may influence patient activity through counselling; however, research is inconsistent regarding their effectiveness in doing so. Increasing patients’ use of self-regulatory skills in managing their activity and additional telephone support are suggested as two means of improving physician counselling. When assessing the effectiveness of physician counselling, it may be important to measure both outcome and treatment adherence. We compared physician-directed activity counselling (modified PACE protocol) with a modified PACE protocol augmented with telephone-based counselling for patient support for both outcome and treatment adherence.
Methods
Physicians counselled 90 patients using a modified PACE protocol that included self-regulatory skills. Physical activity was assessed by questionnaire at baseline (prior to counselling) and one month later. Participants were divided into two groups: counselling (modified PACE counselling) and enhanced counselling (modified PACE counselling plus telephone support).
Results
The main outcome (mean energy expenditure) and secondary outcomes of treatment adherence (frequency, frequency of moderate activity, and duration) significantly increased over time (p<0.05). No significant interactions between group and time were found.
Interpretation
Our results support the effectiveness of physician counselling for activity that included the use of self-regulation skills. The effectiveness of telephone support over and above that of physician counselling was not supported. Our results demonstrate that assessing treatment adherence provides a means of discerning whether the counselling intervention was delivered as intended.
Keywords: Directive counselling, exercise, physicians
Résumé
Contexte
Bien que les avantages de l’activité physique soient généralement reconnus, plus de la moitié des Canadiens adultes n’en tirent pas parti, car ils ne sont pas suffisamment actifs. Les médecins peuvent influencer le niveau d’activité de leurs patients par des conseils, mais les chercheurs ne s’entendent pas sur l’efficacité de ce counseling. Deux moyens sont suggérés pour améliorer les conseils des médecins: accroître l’utilisation des techniques d’autorégulation du conditionnement physique par les patients et leur offrir un soutien téléphonique supplémentaire. Lorsqu’on évalue l’efficacité du counselling des médecins, il peut être important de mesurer à la fois les résultats et l’assiduité au traitement. Nous avons donc comparé les conseils sur l’activité physique donnés par les médecins (selon un protocole PACE1 modifié) et les mêmes conseils agrémentés d’un soutien téléphonique aux patients, en mesurant à la fois les résultats obtenus et l’assiduité au traitement.
Méthode
Des médecins ont conseillé 90 patients à l’aide d’un protocole PACE modifié incluant des techniques d’autorégulation. Les niveaux d’activité physique ont été évalués au moyen d’un questionnaire de départ (avant le counselling) et un mois plus tard. Les participants ont été divisés en deux groupes, selon qu’ils avaient reçu le counselling PACE modifié ou le counselling amélioré (protocole PACE modifié et soutien téléphonique).
Résultats
Le résultat principal (la force moyenne dépensée) et les résultats secondaires, liés à l’assiduité au traitement (fréquence, fréquence des activités physiques d’intensité modérée, durée), ont considérablement augmenté au fil du temps (p<0,05). Aucune interaction significative n’a été observée entre les données selon le groupe et les données selon la date d’administration du questionnaire.
Interprétation
Les résultats confirment l’efficacité des conseils des médecins en matière d’activité physique lorsqu’ils incluent des techniques d’autorégulation. L’efficacité du soutien téléphonique en plus des conseils des médecins n’est pas confirmée. Ces résultats montrent que l’évaluation de l’assiduité au traitement est un moyen de déterminer si l’intervention de counselling a été offerte comme il le fallait.
Motsclés: counselling directif, conditionnement, médecins
Footnotes
Acknowledgements: This work was funded by the Heart and Stroke Foundation of Canada. We would like to acknowledge the support we received from the Canadian Fitness Lifestyle and Research Institute to conduct this study
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