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This publication is provided for historical reference only and the information may be out of date.

Cover of Clinician Counseling to Promote Physical Activity

Clinician Counseling to Promote Physical Activity

Systematic Evidence Reviews, No. 9

, PhD, , PhD, , MD, MSc, , PhD, RN, FAAN, and , MD, MPH.

Oregon Health Sciences University Evidence-based Practice Center, Portland, Oregon

Structured Abstract

Purpose:

To determine whether counseling adults in primary care settings improves and maintains physical activity levels.

Data Sources:

The Cochrane Registry of Controlled Trials, MEDLINE, HealthStar and Best Evidence databases were searched for papers published from 1994 to June 2001.

Study Selection:

We reviewed controlled trials, case-control studies, observational studies, and systematic reviews that reported behavioral outcomes of counseling interventions aimed at increasing physical activity in general primary care populations. For inclusion, a patient's primary care clinician (physician, nurse, nurse practitioner, or physician assistant) had to perform some component (assessment, advising, counseling, referral, etc.) of the intervention, behavioral outcomes (physical activity) were reported, the study was of "good" or "fair" quality using criteria developed by the U.S. Preventive Services Task Force (USPSTF).

Data Extraction:

We abstracted from each study: information on the design and execution; quality information; details of the providers, patients, setting, and counseling intervention; and self-reported physical activity at follow-up.

Data Synthesis:

Nine trials involving 9,227 adults met the inclusion criteria for this report. Most counseling interventions in the studies were relatively brief (3-5 minutes). Two of six fair to good quality trials reported statistically significant improvements in physical activity for intervention patients compared with patients receiving usual care. The remaining three trials compared two or more interventions (contained no usual care comparison). These trials reported an increased effect: when the patient was given advice in combination with a written prescription; for female patients, when the intervention included behavior counseling and extended phone call support; or when the patient (male or female) set a physical activity goal.

Most studies had at least one of the following limitations: provided limited details on the counseling intervention, had follow-up on only 60-79% of subjects, excluded nonresponders from the analysis, studied selected provider populations, reported differences in physical activity levels at baseline between treatment groups, and/or had uncertain or low provider compliance. It was often difficult to assess whether patients had actually received a physical activity behavioral intervention. Most trials only assessed the patients' activity levels short-term (less than six months). These methodological problems made it hard to rigorously assess the efficacy or effectiveness of the interventions. More research is needed to clarify the effect, benefits and/or potential harms of counseling patients in primary care to increase physical activity.

Conclusions:

Evidence that counseling adults in the primary care setting to increase physical activity is inconclusive.

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018, Task Order No. 2, Technical Support of the U.S. Preventive Services Task Force. Prepared by: Oregon Health Sciences University Evidence-based Practice Center, Portland, Oregon.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers -- patients and clinicians, health system leaders, and policymakers -- make more informed decisions and improve the quality of health care services.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

1

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Bookshelf ID: NBK42783PMID: 20722178
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