Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2022 Dec 1.
Published in final edited form as: Prev Med. 2021 Jul 18;153:106730. doi: 10.1016/j.ypmed.2021.106730

Physical Activity Recommendation by Health Care Providers to Adults with and without Functional Limitations

Jordan Smith a, Kelly R Ylitalo a,*
PMCID: PMC8595525  NIHMSID: NIHMS1728159  PMID: 34284001

Abstract

Adults with functional limitations are more likely to be physically inactive than those without functional limitations, despite evidence that regular physical activity (PA) slows the progression of functional decline. The health care setting provides an opportunity to communicate with patients about positive behavior changes, including increased PA, but there is little information about provider recommendation for PA to adults with functional limitations. This study investigated health care provider recommendation to increase PA among adults with and without functional limitations.

Adults (≥18 years) who participated in the 2016 National Health Interview Survey and reported ≥1 primary care encounter within the previous 12 months were included (unweighted n=23,540; weighted N=170,004,764). Receipt of PA recommendation and physical functioning limitations were self-reported. Statistical analyses were weighted to account for complex survey sampling design.

One-third (35.88%) of adults received a PA recommendation and 19.71% reported functional limitations. Adults who received a PA recommendation were more likely to have a functional limitation than those who did not (28.64% vs. 14.70%; p<0.001), even after adjusting for covariates and current activity level (aOR=1.48; 95% CI:1.33,1.65). PA recommendation for those with functional limitations appeared to increase during middle age and peak for adults aged 65–75 years (57.01%) but declined substantially for adults ≥75 years.

Only one-third of adults in the United States received PA recommendations. Health care providers recommended PA to approximately half of adults with functional limitations. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adults.

Keywords: physical activity, functional limitation, mobility disability, health care provider physical activity recommendation

INTRODUCTION

Insufficient physical activity is a leading risk factor for chronic conditions, including heart disease, obesity, and type 2 diabetes1–2. Regular physical activity improves brain health, prevents cancer, boosts cardiometabolic health, and prevents weight gain3–6. The U.S. Department of Health and Human Services recommends that adults achieve ≥150 minutes of moderate-intensity or ≥75 minutes of vigorous-intensity physical activity, along with muscle strengthening activities, each week7. However, more than 80% of adults fail to meet aerobic and muscle strengthening guidelines and approximately one-third of adults in the United States report no physical activity during a usual week8–9.

In the United States, 16.3% of adults experience physical functioning limitations10 and less than half of adults in the United States with a functional limitation engage in aerobic activity.11, 12 Further, there are significant differences in physical activity for adults with a disability or functional limitations across age groups.12 Physical activity is important for all adults, including those with functional limitations, because physical activity can prevent or delay age-related declines in functioning. Increasing physical activity among those with functional limitations can also lead to related health benefits, including increased strength, improved cardiovascular function, reduced stress and depression, reduced joint swelling, and improved pain management13–14. The majority of physically active adults with functional limitations were adults during their middle age years (aged 45–64 years)11. This demographic pattern differs from physical activity in the larger population, where younger adults report more activity than other age groups14 and men tend to be more active than women15–16.

One method for increasing physical activity among all adults, including those with functional limitations or disability, is through recommendation by a health care provider. The health care setting is a unique opportunity to support healthy behaviors like physical activity because physicians meet with patients face-to-face and can make in-person recommendations to increase preventive health behaviors like screening or engagement in physical activity17. In fact, Healthy People 2030, the U.S. Preventive Services Task Force, and the National Council for Behavioral Health recommend that physicians should include physical activity education and counseling during regular office visits8,18. This is particularly relevant for adults with arthritis and/or obesity19–20.

Previous surveillance work has shown that approximately 44% of adults with disabilities receive a recommendation to increase physical activity from their health care provider21. Functional limitations are a known intermediary between risk factors, such as chronic disease or impairment, and disability.22 It is unclear if recommendations for physical activity to persons with functional limitations differ by sex, age, or other sociodemographic characteristics. Using a representative sample of U.S. adults, the purpose of this paper is to determine the prevalence of adults who received a recommendation from a health care provider to increase physical activity, and determine if recommendations differed by functional limitation status, age, or other sociodemographic characteristics.

METHODS

Data

The National Health Interview Survey (NHIS) is a cross-sectional survey that has monitored the health of Americans annually since 195723. Data for the NHIS is collected through confidential interviews conducted in households across the United States22. NHIS measures physical and mental health status, chronic health conditions, measures of functioning and disability, health care access, insurance coverage, pain management, and demographic information25. In 2016, the final household response rate was 67.1%24. The analytic sample for the present study included 23,540 adults aged ≥18 years who participated in the 2016 NHIS and reported ≥1 primary care encounter within the previous 12 months24.

Measures

Physical functioning was assessed using nine questions that asked about perceived difficulty in performing tasks, including walking a quarter of a mile; climbing 10 steps without resting; standing on feet for 2 hours; sitting for two hours; stooping, bending, or kneeling; reaching over head; using fingers to grasp small objects; lifting 10-pound objects; and pushing or pulling heavy objects. Response options included: no difficulty, some difficulty, a lot of difficulty, cannot do at all/unable to do, or missing (refused, not ascertained, or don’t know). Adults with functional limitations were defined as adults who reported some or more difficulty on ≥1 task.26 A mobility disability is a specific type of functional limitation with difficulty walking or climbing.27 Adults with a mobility disability were defined as adults who reported some or more difficulty on walking a quarter of a mile or climbing 10 steps without resting.

In the scope of an office visit, physicians may encourage physical activity by advice, prescriptions, referrals, or counseling. For the purposes of this paper, a physical activity recommendation encompasses all of these mechanisms, as is consistent with other work.28 Receipt of a physical activity recommendation was assessed with one question: ‘In the past 12 months, have you been told by a doctor or health professional to increase physical activity or exercise?’23 The analytic sample for this study included 23,540 adults aged ≥18 years who participated in the 2016 NHIS and reported ≥1 primary care encounter within the previous 12 months.

Other variables included sociodemographics, health conditions, and health behaviors. Sociodemographic variables included age (18–35, 35–45, 45–55, 55–65, 65–75, 75+), race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, other), and education (less than high school, HS graduate/GED, some college, bachelor’s degree). BMI was calculated using self-reported height and weight (weight (kg) / height (m)2). BMI was then categorized into underweight (BMI <18.5), normal (18.5≤BMI<25), overweight (25≤BMI<30), and obese (BMI≥30). Health conditions were dichotomized as yes/no based on whether a health professional ever told the participant they had the condition. Conditions included hypertension, high cholesterol, coronary heart disease, chronic obstructive pulmonary disease (COPD), asthma, cancer, diabetes, and arthritis. Any chronic disease was defined as the presence of ≥1 chronic disease. Smoking status was determined using two questions: “Have you smoked at least 100 cigarettes in your entire life?” and “Do you now smoke cigarettes every day, some days or not at all?” and categorized as never, former, or current. Physical activity was measured using the following questions: “How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?”, “About how long do you do these vigorous leisure-time physical activities each time?”, “How often do you do LIGHT OR MODERATE leisure-time physical activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?”, and “About how long do you do these light or moderate leisure-time physical activities each time?” Using cutpoints from the Physical Activity Guidelines for Americans (7), total exercise minutes per week were used to classify participants as inactive (0 minutes per week), insufficiently active (1–149 minutes per week) or sufficiently activity (≥150 minutes per week).

Statistical Analysis

Data management and analyses were performed using SAS v9.4 (SAS Institute Inc., Cary, NC, USA). We determined the unweighted sample size and frequency of all variables of interest. The SURVEYFREQ procedure was used to calculate the weighted prevalence of all variables to account for the complex survey sampling design of NHIS. For all adults, we compared those who did and did not receive a physical activity recommendation using chi-square tests. Then, we assessed the prevalence of physical activity recommendation by age group and functional limitation status. Unadjusted and adjusted logistic regression with survey sampling weights was conducted using the SURVEYLOGISTIC procedure to generate odds ratios (OR) and corresponding 95% confidence intervals (CI). Unadjusted models assessed the relationship between each variable of interest and physical activity recommendation. The adjusted model assessed the relationship between functional limitation and physical activity recommendation, adjusting for age, sex, race/ethnicity, education, any chronic disease, BMI, smoking status, and physical activity behavior.

RESULTS

In 2016, one-third (35.88%) of adults received a physical activity recommendation, 19.70% reported ≥1 functional limitation, and 10.01% reported a mobility disability. Nearly one-quarter (24.06%) of participants were between the ages of 18 and 35 while only 10% of participants were over the age of 75. The majority (54.39%) of adults were female, over two-thirds (67.77%) were non-Hispanic White, over half (64.22%) reported at least some college education, one-third (37.56%) reported hypertension, and 29.08% reported arthritis. Approximately half of participating adults reported being sufficiently physically active (Table 1).

Table 1.

Weighted Characteristics of Adults by Receipt of Physical Activity Recommendation

Total Physical activity recommendation No physical activity recommendation P
Unweighted n=23,540 Weighted n=170,004,764
n % % (SE) % %
Sociodemographics
Age group
 18–35 4627 19.66 24.06 (0.45) 14.64 29.36
 35–45 3035 12.89 15.10 (0.37) 14.66 15.34
 45–55 3738 15.88 17.88 (0.36) 20.92 16.19 <0.001
 55–65 4560 19.37 18.83 (0.36) 22.71 16.64
 65–75 4294 18.24 14.11 (0.30) 17.10 12.42
 75+ 3286 13.96 10.02 (0.24) 9.98 10.04
Sex
 Male 10107 42.94 45.61 (0.43) 44.80 46.09 0.17
 Female 13433 57.06 54.39 (0.43) 55.20 53.91
Race/Ethnicity
 Hispanic 2362 10.03 13.82 (0.66) 14.60 13.39
 Non-Hispanic White 17143 72.82 67.77 (0.84) 65.00 69.32 <0.001
 Non-Hispanic Black 2550 10.83 11.80 (0.52) 13.05 11.08
 Other 1485 6.31 6.62 (0.33) 7.36 6.21
Education
 Less than HS 2703 11.52 11.47 (0.34) 12.25 11.03
 HS graduate/GED 5692 24.26 24.25 (0.46) 24.12 24.32 0.0169
 Some college 7503 31.97 31.90 (0.46) 31.96 30.60
 Bachelor’s degree 7568 32.25 33.19 (0.63) 31.67 34.05
Health conditions
Hypertension 9858 41.94 37.56 (0.48) 52.46 29.22 <0.001
High cholesterol 8460 36.04 32.83 (0.43) 47.61 24.55 <0.001
Coronary heart disease 1591 6.78 5.56 (0.19) 8.63 3.85 <0.001
COPD 1218 5.18 3.92 (0.16) 5.64 2.97 <0.001
Asthma 3491 14.84 14.98 (0.32) 17.85 13.37 <0.001
Cancer 3127 13.30 11.36 (0.27) 13.02 10.43 <0.001
Diabetes 3093 13.59 12.19 (0.29) 21.03 7.40 <0.001
Arthritis 7860 33.43 29.08 (0.46) 39.26 23.40 <0.001
Body Mass Index
 BMI <18.5 388 1.69 1.75 (0.12) 0.88 2.23
 18.5≤BMI<25 7242 31.61 31.56 (0.45) 16.76 39.79 <0.001
 25≤BMI<30 7983 34.84 35.01 (0.44) 32.69 36.28
 BMI≥30 7299 31.86 31.68 (0.48) 49.67 21.69
Functional Limitation Status
 ≥1 Limitation 5431 23.08 19.71 (0.38) 28.64 14.70 <0.001
 0 Limitations 18096 76.92 80.29 (0.38) 71.36 85.30
Mobility Disability 2914 12.38 10.01 (0.27) 13.96 7.79 <0.001
Health behaviors
Smoking status
 Never 13653 58.05 61.09 (0.54) 58.40 62.59
 Former 6392 27.18 24.85 (0.42) 27.35 23.45 <0.001
 Current 3473 14.77 14.06 (0.37) 14.25 13.96
Physical Activity
 Inactive 6540 28.17 27.15 (0.62) 29.30 25.92
 Insufficiently active 4915 21.17 21.24 (0.40) 27.53 17.70 <0.001
 Sufficiently active 11760 50.66 51.61 (0.59) 43.17 56.38
Open in a new tab

Data Source: NCHS, National Health Interview Survey, 2016.

Notes: Physical activity was self-reported. Total exercise minutes per week were used to classify participants as inactive (0 minutes per week), insufficiently active (1–149 minutes per week) or sufficiently activity (≥150 minutes per week).

Table 1 compares adults who received a physical activity recommendation and those who did not receive a physical activity recommendation. Adults with a physical activity recommendation were more likely to be between the ages of 45 and 75 compared to adults without a recommendation (p<0.001). Compared to adults who did not receive a recommendation, adults who received a physical activity recommendation were more likely to have chronic health conditions, including hypertension (52.46% vs. 29.22%; p<0.001), high cholesterol (47.61% vs. 24.55%; p<0.001), arthritis (39.26% vs. 23.40%; p<0.001), and diabetes (21.03% vs. 7.40%; p<0.001. Adults with a physical activity recommendation were more likely to be obese than adults without a recommendation (49.67% vs. 21.69%; p<0.001). Adults with a physical activity recommendation were also more likely to be insufficiently active compared to adults without a recommendation (27.53% vs. 17.70%; p<0.001). However, there was no statistically significant association between sex and physical activity recommendation (Table 1).

Overall, adults with ≥1 functional limitation were more likely to receive a PA recommendation than those without limitations, even after adjusting for covariates and current activity level (aOR=1.48; 95% CI: 1.33,1.65). The prevalence of adults who received a recommendation to increase physical activity differed based on age and the presence of functional limitations. At every age, individuals with at least one functional limitation were more likely to receive a physical activity recommendation compared to those without a functional limitation. Physical activity recommendations for those with functional limitations appeared to increase during middle age and peaked for adults aged 65–75 years (57.01%) but declined substantially for adults ≥75 years (Figure 1). Patterns were similar for adults with mobility disability.

Figure 1.

Figure 1.

Open in a new tab

Prevalence of adults who received a recommendation to increase physical activity by age and functional limitation status NHIS 2016.

Data Source: NCHS, National Health Interview Survey, 2016

Figure 2 shows the distribution of functional limitations in the total population. Functional limitations and mobility disabilities are relatively common in the United States – over 16% of adults reported a functional limitation and approximately 8% reported a mobility disability. The most common limitations were walking, standing, and stooping (Figure 2). Figure 3 shows the distribution of physical activity recommendation among those with functional limitations. At least 40% of adults with a functional limitation received a recommendation to increase physical activity. For example, among adults with a walking limitation, 47.58% received a recommendation to increase physical activity and 52.32% did not.

Figure 2.

Figure 2.

Open in a new tab

Distribution of Functional Limitations among Total Population

Data Source: NCHS, National Health Interview Survey, 2016

Figure 3.

Figure 3.

Open in a new tab

Receipt of Physical Activity Recommendation Among Adults with a Functional Limitation

Data Source: NCHS, National Health Interview Survey, 2016

In multivariate models, sex, race, education level, presence of chronic disease, body mass index, physical activity level, and the presence of a limitation were significantly associated with receiving a physical activity recommendation (Table 2). Obesity appeared to have the strongest association with receiving a physical activity recommendation. In the total sample, individuals who were obese had more than four times the odds of receiving a physical activity recommendation (aOR = 4.57; 95% CI: 4.11, 5.08) compared to individuals who were not obese (Table 2). The presence of a chronic disease was also strongly associated with receiving a physical activity recommendation. In the total sample, individuals who were diagnosed with a chronic disease had 2.57 times the odds of receiving a physical activity recommendation (OR = 2.34; 95% CI: 2.10, 2.61) compared to those who did not have a chronic disease (Table 2).

Table 2.

Bivariate and Multivariate Associations Between Characteristics of Adults and Receipt of Physical Activity Recommendation, NHIS 2016.

Bivariable Models Multivariate Model
OR 95% CI OR 95% CI
Age group, years
 18–35 Ref --- Ref ---
 35–45 1.92 1.67, 2.20 1.46 1.26, 1.70
 45–55 2.59 2.26, 2.97 1.64 1.40, 1.91
 55–65 2.74 2.44, 3.07 1.61 1.41, 1.85
 65–75 2.76 2.42, 3.15 1.56 1.34, 1.82
 75+ 1.99 1.75, 2.28 1.29 1.09, 1.52
Sex
 Male Ref --- Ref ---
 Female 1.05 0.98, 1.14 1.10 1.01, 1.20
Race/Ethnicity
 Hispanic 1.16 1.04, 1.30 1.45 1.25, 1.68
 Non-Hispanic White Ref --- Ref ---
 Non-Hispanic Black 1.26 1.12, 1.41 1.20 1.04, 1.37
 Other 1.26 1.09, 1.47 1.95 1.64, 2.31
Education
 Less than HS 1.19 1.05, 1.36 0.76 0.66, 0.89
 HS graduate/GED 1.07 0.97, 1.18 0.79 0.71, 0.89
 Some college 1.12 1.02, 1.23 0.93 0.84, 1.03
 Bachelor’s degree Ref --- Ref ---
Any chronic disease
 No Ref --- Ref ---
 Yes 3.34 3.05, 3.65 2.34 2.10, 2,61
Body Mass Index
 BMI <18.5 0.94 0.64, 1.37 1.00 0.67, 1.49
 18.5≤BMI<25 Ref --- Ref ---
 25≤BMI<30 2.14 1.93, 2.37 1.96 1.77, 2.18
 BMI≥30 5.44 4.93, 5.99 4.57 4.11, 5.08
Smoking status
 Never Ref --- Ref ---
 Former 0.25 1.15, 1.35 −0.01 0.90, 1.08
 Current 1.09 0.99, 1.21 0.99 0.88, 1,12
Physical Activity
 Inactive 1.48 1.35, 1.61 1.08 0.97, 1.20
 Insufficiently active 2.03 1.85, 2.23 1.70 1.53, 1.90
 Sufficiently active Ref --- Ref ---
Any limitation
 No Ref --- Ref ---
 Yes 2.33 2.14, 2.53 1.48 1.33, 1.65
Model c statistic 0.739
Open in a new tab

Data Source: NCHS, National Health Interview Survey, 2016.

Notes: Physical activity was self-reported. Total exercise minutes per week were used to classify participants as inactive (0 minutes per week), insufficiently active (1–149 minutes per week) or sufficiently activity (≥150 minutes per week).

DISCUSSION

The purpose of this investigation was to determine the prevalence of adults who received a recommendation to increase physical activity from a health care provider, by age and functional limitation status. Overall, a third of adults who visited a health care provider during the previous 12 months received a recommendation to increase physical activity. Middle aged adults were more likely than either younger or older adults to receive a physical activity recommendation, such that the pattern by age represented an inverted u-shaped curve. This age pattern was observed for adults both with and without functional limitations or mobility disability as well. Notably, adults with ≥1 functional limitation were much more likely to receive a recommendation to increase physical activity than those without functional limitations, which suggests that health care providers may be targeting adults who may benefit most from increasing physical activity. This could be expanded further by the increasing health care provider awareness, training, and focus on the Exercise Is Medicine initiative.29

Physical activity engagement can prevent, delay, or even improve functional limitations in older adults.30 In a nationally representative study in Spain, the prevalence of functional limitations increased for both men and women as physical activity levels decreased.31 Higher levels of physical activity in middle aged and older adulthood greatly decreased the risk of developing functional limitations for both men and women.32 In our sample, we observed that adults ≥75 years were less likely to receive a physical activity recommendation from a health care provider. International guidelines suggest that all adults, if able, should be engaged in 150 minutes of moderate-intensity physical activity each week throughout the life course, regardless of age.9,33–34 Our findings suggest that health care providers may be missing an opportunity to recommend physical activity engagement among older adults.

Prevention of functional limitations or mobility disability during middle age is important. Longitudinal data from the Study of Women’s Health Across the Nation suggest the onset of functional limitations occurs during the middle age, beginning earlier than previously accepted.35–36 Early identification of functional limitations not only improves symptom management but can also support amelioration and/or reversal of limitations.35 In fact, physical functioning may be most dynamic during the middle age, which suggests this time period is critical for intervention.37 Ameliorating functional limitations can reduce health care costs and improve quality of life. Healthcare costs associated with disability accounted for 26.7% of all healthcare expenditures in the United States in 2018.38 In a prospective cohort study of 843 adults, functionally dependent persons spent $5,000 more per year on healthcare compared to those who were independent.39

Adults with chronic conditions were significantly more likely to receive a physical activity recommendation from a health care provider than adults without chronic conditions. Our findings are consistent with other work40 demonstrating that physician recommendations for physical activity are higher for persons with cardiovascular disease, arthritis, diabetes, hypertension, and alcohol misuse.41–44 Similar to survey data from the National Health and Nutrition Examination Survey45, each of the health conditions tested in our sample showed a significantly higher likelihood of receiving a physical activity recommendation from a health care provider. Our results are consistent with previous findings. Adults with diabetes, arthritis, high cholesterol, or hypertension were more likely to receive a physical activity recommendation from a health care provider than adults without health conditions. We also observed that patients who received a recommendation to increase physical activity were more likely to be obese than patients who did not receive a recommendation. Other work has suggested that physicians are highly concerned with elevated BMI in patients but have limited interest in assuming an active role in reducing BMI.46 Only a quarter of adults with obesity received a recommendation for physical activity from a health care provider in 2014. One goal of Healthy People 2030 is to increase the percent of obese adults who receive a physical activity recommendation to 32.6%.19 In a study examining the relationship between behavior and physician advice, about one-third of overweight and obese patients received a recommendation from a physician to increase physical activity.47 Another study found that less than 22% of primary care physicians tracked concerning weight or weight-related behaviors and less than half counseled patients on diet and exercise practices.48 In our study, more than 80% of patients who received a recommendation to increase physical activity were overweight or obese, which suggests that health care providers are taking an active role in health behavior counseling.

Successful health behavior intervention includes the 5 A’s: Ask, Assess, Advise, Assist, and Arrange. The 5 A’s were developed as a behavioral intervention for smoking cessation but have been adapted to many different settings.49 The Agency for Healthcare Research and Quality recommends the 5 A’s to promote physical activity as well, particularly for adults with functional limitations.50 Health care providers should first ask patients about their current physical activity levels. The health care provider uses the patient response to assess which behaviors may need to change. Then, the health care provider can advise the patient about ways to improve physical activity and assist the patient in identifying facilitators and barriers to activity and setting goals. Lastly, health care providers can arrange for follow up in order to determine if the physical activity advice is being followed. Previous work suggests that health care providers focus on asking and advising during a clinical encounter, yet patients respond better to assessing and arranging.51 By also incorporating assess and arrange into a clinical encounter, the health care provider will likely determine the root of the behavior and allow the patient to have a say in the solving the problem.51 The 5 A’s give health care providers a clear structure or template for including physical activity recommendation into a normal office visit.

Limitations

As this is a cross-sectional study, we examined correlates of physical activity recommendation and our work is subject to temporal ambiguity. Inclusion criteria included a visit to a healthcare provider in the previous 12 months. As a consequence of the unknown margin of time between the survey and the healthcare visit, it is not possible to determine whether self-reported physical activity behavior occurred before or after the health care encounter. Another limitation of this study is the ambiguity of the health care providers’ knowledge of the functional limitations. Functional limitations may not be visually apparent and thus may require prior knowledge. Because of this, we are unable to conclude whether health care providers are targeting adults with functional limitations or if they are recommending physical activity for other reasons. We are also unable to measure potential variability of the patient-provider interactions. Our work may be subject to selection bias because our sample was limited to those who had a health care encounter within the last year, which may limit the inclusion of some adults. Barriers to seeking healthcare include high cost, lack of insurance, time constraints, distrust of the medical system, and low perceived need of healthcare52, so interpretations should consider inclusion and exclusion criteria. Lastly, functional limitations were self-reported and not performance-based. Nevertheless, self-reported difficulty in completing tasks is a validated measure and is consistent with other work in this area.53 Despite its limitations, the utilization of the NHIS ensured a large, nationally representative sample of U.S. adults and provides important information about ways to leverage health care encounters for health behavior change.

CONCLUSION

Increasing physical activity among those with functional limitations is an important public health objective. Research has shown that increasing physical activity among people with functional limitations has the potential to decrease disability status26. Our research shows that physical activity recommendations are underutilized in the primary care setting. Health care providers recommended physical activity to just over half of adults with functional limitations, which suggests a major opportunity to increase recommendations during clinical encounters. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adult populations with functional limitations.

Highlights.

  • Health care providers recommend physical activity to about one-third of all adults

  • Health care providers recommend physical activity to almost half of adults with functional limitations

  • The health care setting can be leveraged for behavior changes like increasing physical activity

Acknowledgements

K.R.Y. is supported by the National Institute on Aging of the National Institutes of Health under Award Number K01AG058754. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

  • 1.Booth FW, Roberts CK, Laye MJ. Lack of Exercise Is a Major Cause of Chronic Diseases. Comprehensive Physiology. 2012. Doi: 10.1002/cphy.c110025 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Centers for Disease Control and Prevention. Lack of Physical Activity. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/physical-activity.htm. Published September 25, 2019. Accessed October 2020.
  • 3.Di Liegro CM, Schiera G, Proia P, Di Liegro I. Physical Activity and Brain Health. Genes (Basel). 2019;10(9):720. 10.3390/genes10090720 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Lee I-M. Physical Activity and Cancer Prevention – Data from Epidemiologic Studies. Medicine & Science in Sports & Exercise. 2003;35(11):1823–1827. Doi: 10.1249/01.mss.0000093620.27893.23 [DOI] [PubMed] [Google Scholar]
  • 5.Camhi SM, Sisson SB, Johnson WD, Katzmarzyk PT, Tudor-Locke C. Accelerometer-determined moderate intensity lifestyle activity and cardiometabolic health. Preventive Medicine. 2011;52(5):358–360. Doi: 10.1016/j.ypmed.2011.01.030 [DOI] [PubMed] [Google Scholar]
  • 6.Fogelholm M, Kukkonen-Harjula K. Does physical activity prevent weight gain - a systematic review. Obesity Reviews. 2000;1(2):95–111. Doi: 10.1046/j.1467-789x.2000.00016.x [DOI] [PubMed] [Google Scholar]
  • 7.U.S. Department of Health and Human Services. Current Guidelines. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Published 2018. Accessed 2020. [Google Scholar]
  • 8.U.S. Department of Health and Human Services. Physical Activity. Physical Activity | Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity. Published December 2010. Accessed 2020. [Google Scholar]
  • 9.U.S. Department of Health and Human Services. Scientific Report. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines/scientific-report. Published 2018. Accessed 2020. [Google Scholar]
  • 10.Centers for Disease Control and Prevention. About NCHS – NCHS Fact Sheets – National Health Interview Survey. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/about/factsheets/factsheet_nhis.htm. Published August 16, 2019. Accessed October 25, 2020. [Google Scholar]
  • 11.Hollis NTD, Zhang QC, Cyrus AC, Courtney-Long E, Watson K, Carroll D. Physical activity types among US adults with mobility disability, Behavioral Risk Factor Surveillance System, 2017. Disability and Health Journal. 2020;13(3). Doi: 10.1016/j.dhjo.2020.100888 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Kamil-Rosenberg S, Greaney ML, Hochman T, Garber CE. How Do Physical Activity and Health Vary Among Younger, Middle-Aged, and Older Adults With and Without Disability? Journal of Aging and Physical Activity. 2019;27(2):234–241. Doi: 10.1123/japa.2017-0215 [DOI] [PubMed] [Google Scholar]
  • 13.U.S. Department of Health and Human Services. Stay Active with a Disability: Quick tips. Office of Disease Prevention and Health Promotion. https://health.gov/myhealthfinder/topics/health-conditions/obesity/stay-active-disability-quick-tips. Published 2020. Accessed 2020. [Google Scholar]
  • 14.Centers for Disease Control and Prevention. Physical Activity and Health: A Report of the Surgeon General. Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/sgr/disab.htm. Published 1999. Accessed October 2020. [Google Scholar]
  • 15.Ham SA, Ainsworth BE. Disparities in Data on Healthy People 2010. Physical Activity Objectives Collected by Accelerometry and Self-Report. American Journal of Public Health. 2010;100(S1). Doi: 10.2105/ajph.2009.180075 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Basterfield L, Adamson AJ, Frary JK, Parkinson KN, Pearce MS, Reilly JJ. Longitudinal Study of Physical Activity and Sedentary Behavior in Children. Pediatrics. 2010;127(1). Doi: 10.1542/peds.2010-1935 [DOI] [PubMed] [Google Scholar]
  • 17.Auyoung M, Linke SE, Pagoto S, et al. Integrating Physical Activity in Primary Care Practice. The American Journal of Medicine. 2016;129(10):1022–1029. Doi: 10.1016/j.amjmed.2016.02.008 [DOI] [PubMed] [Google Scholar]
  • 18.U.S. Preventive Services. Recommendation: Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Risk Factors: Behavioral Counseling: United States Preventive Services Taskforce. U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/healthful-diet-and-physical-activity-for-cardiovascular-disease-prevention-in-adults-without-known-risk-factors-behavioral-counseling. Published July 11, 2017. Accessed 2020. [Google Scholar]
  • 19.U.S. Department of Health and Human Services. Increase the proportion of health care visits by adults with obesity that include counseling on weight loss, nutrition, or physical activity – NWS-05. Increase the proportion of health care visits by adults with obesity that include counseling on weight loss, nutrition, or physical activity – NWS-05 – Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/overweight-and-obesity/increase-proportion-health-care-visits-adults-obesity-include-counseling-weight-loss-nutrition-or-physical-activity-nws-05. Published 2020. Accessed December 14, 2020. [Google Scholar]
  • 20.U.S. Department of Health and Human Services. Increase the proportion of adults with arthritis who get counseling for physical activity – A-04. A. https://health.gov/healthypeople/objectives-and-data/browse-objectives/arthritis/increase-proportion-adults-arthritis-who-get-counseling-physical-activity-04. Published 2020. Accessed December 14, 2020. [Google Scholar]
  • 21.Carroll DD, Courtney-Long EA, Stevens AC, et al. Vital signs: disability and physical activity—United States, 2009–2012. MMWR Morb Mortal Wkly Rep. 2014;63(18):407–413. [PMC free article] [PubMed] [Google Scholar]
  • 22.Lawrence RH, Jette AM. Disentangling the disablement process. J Gerontol B Psychol Sci Soc Sci. 1996;51(4):S173–S182. Doi: 10.1093/geronb/51b.4.s173 [DOI] [PubMed] [Google Scholar]
  • 23.U.S. Census Bureau. National Health Interview Survey (NHIS). The United States Census Bureau. https://www.census.gov/programs-surveys/nhis.html. Published June 18, 2019. Accessed 2020. [Google Scholar]
  • 24.National Center for Health Statistics. National Health Interview Survey, 2016. Public-use data file and documentation. https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm. 2017. [Google Scholar]
  • 25.National Center for Health Statistics. Survey Description, National Health Interview Survey, 2016. Hyattsville, Maryland. 2017. [Google Scholar]
  • 26.Loeb M, Chen L-H. Assessing injury-related movement difficulties: A method for analyzing the association between functional limitations and social participation. Disability and Health Journal. 2011;4(2):102–111. Doi: 10.1016/j.dhjo.2010.05.007 [DOI] [PubMed] [Google Scholar]
  • 27.Gill TM, Allore HG, Hardy SE, Guo Z. The Dynamic Nature of Mobility Disability in Older Persons. Journal of the American Geriatrics Society. 2006;54(2):248–254. Doi: 10.1111/j.1532-5415.2005.00586.x [DOI] [PubMed] [Google Scholar]
  • 28.Brunet J, Wurz A, O’Rielly C, Howell D, Bélanger M, Sussman J. The effectiveness of health care provider physical activity recommendations in cancer survivors: A systematic review and meta-analysis protocol. Systematic Reviews. 2017;6(1). Doi: 10.1186/s13643-017-0453-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Sallis R. Exercise is medicine: a call to action for physicians to assess and prescribe exercise. The Physician and Sportsmedicine. 2015;43(1):22–26. Doi: 10.1080/00913847.2015.1001938 [DOI] [PubMed] [Google Scholar]
  • 30.Pahor M, Guralnik JM, Anton SD, et al. Impact and Lessons From the Lifestyle Interventions and Independence for Elders (LIFE) Clinical Trials of Physical Activity to Prevent Mobility Disability. Journal of the American Geriatrics Society. 2020;68(4):872–881. Doi: 10.1111/jgs.16365 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Latorre-Román PA, Laredo-Aguilera JA, García-Pinillos F, Soto-Hermoso VM, Carmona-Torres JM. Physical activity, weight and functional limitations in elderly Spanish people: the National Health Survey (2009–2014). European Journal of Public Health. 2018;28(4):778–783. Doi: 10.1093/eurpub/ckx219 [DOI] [PubMed] [Google Scholar]
  • 32.Bonsdorff MBV, Rantanen T. Progression of functional limitations in relation to physical activity: a life course approach. European Review of Aging and Physical Activity. 2010;8(1):23–30. Doi: 10.1007/s11556-010-0070-9 [DOI] [Google Scholar]
  • 33.WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. [Google Scholar]
  • 34.Sugiyama T, Healy GN, Dunstan DW, Salmon J, Owen N. Joint associations of multiple leisure-time sedentary behaviours and physical activity with obesity in Australian adults. International Journal of Behavioral Nutrition and Physical Activity. 2008;5(1):35. doi: 10.1186/1479-5868-5-35 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Karvonen-Gutierrez CA, Strotmeyer ES. The urgent need for disability studies among midlife adults. Women’s Midlife Health. 2020;6(1). doi: 10.1186/s40695-020-00057-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Dugan SA, Gabriel KP, Lange-Maia BS, Karvonen-Gutierrez C. Physical Activity and Physical Function. Obstetrics and Gynecology Clinics of North America. 2018;45(4):723–736. doi: 10.1016/j.ogc.2018.07.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Karvonen-Gutierrez CA, Ylitalo KR. Prevalence and Correlates of Disability in a Late Middle-Aged Population of Women. Journal of Aging and Health. 2013;25(4):701–717. doi: 10.1177/0898264313488165 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Centers for Disease Control and Prevention. Disability and Health Healthcare Cost Data. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/disabilityandhealth/data-highlights.html. Published September 16, 2020. Accessed October 25, 2020. [Google Scholar]
  • 39.Manini TM, Pahor M. Physical activity and maintaining physical function in older adults. British Journal of Sports Medicine. 2008;43(1):28–31. doi: 10.1136/bjsm.2008.053736 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Omura JD, Bellissimo MP, Watson KB, Loustalot F, Fulton JE, Carlson SA. Primary care providers’ physical activity counseling and referral practices and barriers for cardiovascular disease prevention. Preventive Medicine. 2018;108:115–122. doi: 10.1016/j.ypmed.2017.12.030 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Li LC, Sayre EC, Xie H, et al. Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study. Journal of Medical Internet Research. 2018;20(4). doi: 10.2196/jmir.8514 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Bock C, Diehl K, Schneider S, Diehm C, Litaker D. Behavioral Counseling for Cardiovascular Disease Prevention in Primary Care Settings. Medical Care Research and Review. 2012;69(5):495–518. doi: 10.1177/1077558712441084 [DOI] [PubMed] [Google Scholar]
  • 43.Ludman EJ, Curry SJ. Perspectives in Implementing a Primary Care–Based Intervention to Reduce Alcohol Misuse. American Journal of Preventive Medicine. 2015;49(3). doi: 10.1016/j.amepre.2015.05.016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Berra K, Rippe J, Manson JE. Making Physical Activity Counseling a Priority in Clinical Practice: The Time for Action Is Now. JAMA. 2015;314(24):2617–2618. doi: 10.1001/jama.2015.16244 [DOI] [PubMed] [Google Scholar]
  • 45.Zwald ML, Kit BK, Fakhouri TH, Hughes JP, Akinbami LJ. Prevalence and Correlates of Receiving Medical Advice to Increase Physical Activity in U.S. Adults: National Health and Nutrition Examination Survey 2013–2016. American Journal of Preventive Medicine. 2019;56(6):834–843. doi: 10.1016/j.amepre.2019.01.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Kristeller JL, Hoerr RA. Physician Attitudes toward Managing Obesity: Differences among Six Specialty Groups. Preventive Medicine. 1997;26(4):542–549. doi: 10.1006/pmed.1997.0171 [DOI] [PubMed] [Google Scholar]
  • 47.Dorsey R, Songer T. Lifestyle behaviors and physician advice for change among overweight and obese adults with prediabetes and diabetes in the United States. Preventing chronic disease. 2011;8(6). [PMC free article] [PubMed] [Google Scholar]
  • 48.Smith AW, Borowski LA, Liu B, et al. U.S. Primary Care Physicians’ Diet-, Physical Activity–, and Weight-Related Care of Adult Patients. American Journal of Preventive Medicine. 2011;41(1):33–42. doi: 10.1016/j.amepre.2011.03.017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013;59(1):27–31. [PMC free article] [PubMed] [Google Scholar]
  • 50.Agency for Healthcare Research and Quality. Five Major Steps to Intervention (The “5 A’s”). https://www.ahrq.gov/prevention/guidelines/tobacco/5steps.html. Published 2012. Accessed October 10, 2020.
  • 51.Pollak KI, Tulsky JA, Bravender T, et al. Teaching primary care physicians the 5 A’s for discussing weight with overweight and obese adolescents. Patient Education and Counseling. 2016;99(10):1620–1625. doi: 10.1016/j.pec.2016.05.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Taber JM, Leyva B, Persoskie A. Why do People Avoid Medical Care? A Qualitative Study Using National Data. Journal of General Internal Medicine. 2014;30(3):290–297. doi: 10.1007/s11606-014-3089-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Khoudary SRE, Mcclure CK, Vopham T, et al. Longitudinal Assessment of the Menopausal Transition, Endogenous Sex Hormones, and Perception of Physical Functioning: The Study of Women’s Health Across the Nation. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2014;69(8):1011–1017. doi: 10.1093/gerona/glt285 [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES