Physician-based physical activity counseling for middle-aged and older adults: A randomized trial

Sedentary behavior among older adults increases risk for chronic diseases. Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients. The Physically Active for Life (PAL) project was a randomized, controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels. The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory. Twenty-four community-based primary care medical practices were recruited into the study; 12 were randomized to the Intervention condition and 12 to the Control condition. Physicians in the Intervention practices received training in the delivery of brief physical activity counseling. Subjects in the Intervention practices (n=181) received brief activity counseling matched to their stage of motivational readiness for physical activity, a patient manual, a follow-up appointment with their physician to discuss activity counseling, and newsletter mailings. Subjects in the Control practices (n=174) received standard care. Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly (PASE) were administered to subjects in both conditions at baseline, 6 weeks following their initial appointment, and at 8 months. Results showed that at the 6-week follow-up, subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition. This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores. Results suggest that more intensive, sustained interventions may be necessary to promote the adoption of physical activity among sedentary, middle-aged, and older adults in primary care medical practices.

[1]  K. Patrick,et al.  A controlled trial of physician counseling to promote the adoption of physical activity. , 1996, Preventive medicine.

[2]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[3]  B H Marcus,et al.  Evaluation of Motivationally Tailored vs. Standard Self-Help Physical Activity Interventions at the Workplace , 1998, American journal of health promotion : AJHP.

[4]  R. Niaura,et al.  Self-efficacy and the stages of exercise behavior change. , 1992, Research quarterly for exercise and sport.

[5]  A. Jette,et al.  Training physicians to conduct physical activity counseling. , 1997, Preventive medicine.

[6]  S. Oparil,et al.  Physical activity and cardiovascular health , 1996 .

[7]  R. Wolfinger,et al.  Generalized linear mixed models a pseudo-likelihood approach , 1993 .

[8]  J. Hollis,et al.  Nurse-Assisted Counseling for Smokers in Primary Care , 1993, Annals of Internal Medicine.

[9]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[10]  W. Lynch,et al.  The effect of physician advice on exercise behavior. , 1993, Preventive medicine.

[11]  A. Bandura Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[12]  A. Jette,et al.  The Physical Activity Scale for the Elderly (PASE): development and evaluation. , 1993, Journal of clinical epidemiology.

[13]  B. Pinto,et al.  Acceptability and feasibility of physician-based activity counseling. The PAL project. , 1998, American journal of preventive medicine.

[14]  David Haber,et al.  Guide to clinical preventive services: a challenge to physician resourcefulness , 1993 .

[15]  B H Marcus,et al.  Using the Stages of Change Model to Increase the Adoption of Physical Activity among Community Participants , 1992, American journal of health promotion : AJHP.

[16]  C. Caspersen,et al.  Physical activity epidemiology as applied to elderly populations. , 1994, Bailliere's clinical rheumatology.

[17]  V. Froelicher,et al.  The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Position stand of the American College of Sports Medicine. , 1990, Schweizerische Zeitschrift fur Sportmedizin.

[18]  E. Simonsick,et al.  Risk due to inactivity in physically capable older adults. , 1993, American journal of public health.

[19]  D. Abrams,et al.  The stages and processes of exercise adoption and maintenance in a worksite sample. , 1992 .

[20]  R. Paffenbarger,et al.  Physical activity, all-cause mortality, and longevity of college alumni. , 1986, The New England journal of medicine.

[21]  B H Marcus,et al.  Assessing motivational readiness and decision making for exercise. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[22]  Husten Cg,et al.  How to help your patients stop smoking. , 1990 .

[23]  E. Larson,et al.  Benefits of exercise for older adults. A review of existing evidence and current recommendations for the general population. , 1992, Clinics in geriatric medicine.

[24]  Parsons Vl,et al.  Current estimates from the National Health Interview Survey. United States, 1985. , 1986, Vital and health statistics. Series 10, Data from the National Health Survey.

[25]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.

[26]  M. Goldstein,et al.  Patient Education in the Medical Encounter: How to Facilitate Learning, Behavior Change, and Coping , 1995 .

[27]  J. Sallis,et al.  Physical activity assessment methodology in the Five-City Project. , 1985, American journal of epidemiology.

[28]  P. F. Adams,et al.  Current estimates from the National Health Interview Survey, 1994. , 1995, Vital and health statistics. Series 10, Data from the National Health Survey.

[29]  B H Marcus,et al.  The stages of exercise behavior. , 1993, The Journal of sports medicine and physical fitness.

[30]  R. Meier,et al.  The feasibility of behavioral risk reduction in primary medical care. , 1989, American journal of preventive medicine.

[31]  B. Marcus,et al.  Activity counseling by primary care physicians. , 1998, Preventive medicine.