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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Getting patients to exercise more: a systematic review of underserved populations - brief counseling and a written plan increase exercise rates in the underserved

JK Carroll, K Fiscella, RM Epstein, P Jean-Pierre, C Figueroa-Moseley, GC Williams, KM Mustian, and GR Morrow.

Review published: 2008.

CRD summary

This review found limited information on effectiveness of counselling for increasing physical activity in underserved populations, although the authors concluded that some studies showed promising results. Counselling was not the sole intervention in most included studies, so the conclusions may be overstated. Only studies performed in USA were included, so the findings may not be generalisable.

Authors' objectives

To assess the effectiveness of physician-initiated counselling interventions for promoting physical activity in underserved (ethnic minority or vulnerable) populations


The authors searched PubMed, CINAHL, PsycINFO, The Cochrane Library and HealthSTAR for studies published between 1966 and 2005. Search terms were reported. They also searched reference lists of retrieved articles and contacted experts in the field to obtain relevant data.

Study selection

Studies were eligible for the review if they were conducted in primary care in the USA and recruited participants from an underserved population (defined as individuals from minority ethnic backgrounds or vulnerable populations such as people with low educational attainment, low income, lack of insurance or those living in rural communities). Interventions had to include a specific component of counselling by primary care physicians. Studies had to have an appropriate control or comparison group, use a randomised or quasi-experimental design and report change in physical activity as an outcome.

The included studies used a wide variety of physical activity interventions and methods of delivering them. Participants were adolescents or adults. The percentage of females ranged from 37% to 100%. The proportion of participants who belonged to racial or ethnic minorities ranged from 15% to 100%. The proportion who were unemployed ranged from 11% to 65% (where reported) and the proportion with no college education or degree ranged from 11% to 65% (where reported). The intensity of counselling ranged from one to three minutes of contact on one occasion up to repeated sessions of more than five minutes. Most interventions included other components alongside counselling. All studies included a self-report measure of physical activity and some also used objective measures.

It appeared that one reviewer selected studies for the review.

Assessment of study quality

The authors did not state that they assessed study quality. However, studies were assigned a level of evidence rating using the Strength of Recommendation Taxonomy (SORT) system.

Data extraction

The authors did not state how data were extracted for the review.

Methods of synthesis

Studies were synthesised narratively. Differences between studies were discussed in the text and were evident from tables.

Results of the review

Eight studies (n=1,801 participants, range 44 to 874) were included in the review: seven randomised controlled trials at the patient level and one non-randomised trial with treatment assignment at the primary care professional level. All were multicentre trials.

Six studies reported some improvement in short-term physical activity outcomes in the intervention group, although there was considerable variation in how outcomes were measured. Three studies used both objective and self-report measures of physical activity and found no substantial difference between objectively and subjectively measured outcomes. Three studies reported difficulties with attrition among minority participants. The studies with the highest retention rates attempted to address specific barriers to participation or used a lead-in period.

Authors' conclusions

Information on exercise counselling interventions for underserved populations in primary care was limited, although some studies showed promising results.

CRD commentary

The review question and inclusion criteria were clear. The search covered a range of relevant sources. It was unclear whether language restrictions were applied during the search and risk of publication bias was not assessed. The search was limited to studies performed in USA, so studies performed in similar populations and settings in other countries would have been excluded. Included studies were evaluated using a level of evidence scheme, but validity (risk of bias) was not formally assessed and so the reliability of the included studies was unclear. Methods used for study selection and data extraction were not fully reported, which made the risk of errors and bias affecting these processes uncertain. Relevant characteristics of included studies were reported in an online table. Use of a narrative synthesis was appropriate in view of the variety of populations and interventions in the included studies. The use of other interventions alongside counselling made the precise effect of the counselling interventions on physical activity uncertain and hence the authors' conclusions may be overstated. The limitation to studies performed in USA means that the findings may not be applicable to other countries.

Implications of the review for practice and research

Practice: The authors stated that physical activity can be increased, at least in the short-term, by brief, focused/goal-oriented counselling that is related to the patient's specific health needs, is delivered over multiple contacts and includes a written plan. Additional recommendations for practice were presented in the paper.

Research: The authors stated that future research should assess: the effects of practice-based systems in promoting physical activity; the dose-response relationship between counselling and physical activity outcomes; and the effects of the physician-patient relationship and continuity of care on physical activity outcomes. They also suggested that research should assess the effects of community-based referrals for physical activity programmes.


Grant 1R25CA102618 from the National Cancer Institute

Bibliographic details

Carroll JK, Fiscella K, Epstein RM, Jean-Pierre P, Figueroa-Moseley C, Williams GC, Mustian KM, Morrow GR. Getting patients to exercise more: a systematic review of underserved populations - brief counseling and a written plan increase exercise rates in the underserved. Journal of Family Practice 2008; 57(3): 170-176. [PMC free article: PMC2974565] [PubMed: 18321453]

Indexing Status

Subject indexing assigned by NLM


Adult; Child; Exercise; Health Behavior; Humans; Medically Underserved Area; Outcome and Process Assessment (Health Care); Patient Compliance; Patient Education as Topic /methods; Primary Health Care /methods; Research Design; United States



Database entry date


Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 18321453


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