Physician advice and support for physical activity: Results from a national survey

doi:10.1016/S0749-3797(01)00350-6

American Journal of Preventive Medicine

Volume 21, Issue 3, October 2001, Pages 189-196

https://doi.org/10.1016/S0749-3797(01)00350-6 Get rights and content

Abstract

Background: It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey.

Methods: A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues.

Results: Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor.

Conclusions: Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.

Section snippets

Sampling

Data were collected via telephone survey, using a modified version of the sampling plan of the Behavioral Risk Factor Surveillance System (BRFSS). The primary objective of the overall survey was to obtain representative data among varied populations across the United States on patterns and determinants of PA. There were no financial or other incentives to respondents, and the survey methods have been described in detail elsewhere.22, 23, 24 The cross-sectional risk factor survey used a

Results

Approximately two thirds of the respondents were female, and the survey was successful in gathering data from adults representing a large range of ages, over 25% of whom were African American (Table 1). About three quarters had a regular doctor and many were from lower-income households. Three quarters of respondents reported household annual incomes <$50,000, with almost 40% having incomes <$20,000. More than half had one or more chronic illnesses, and there was an even distribution on number

Discussion

Only 28% of a random sample of adults reported receiving advice from their physicians to engage in regular exercise. An even smaller proportion, 11% (or approximately 40% of those who received advice), reported assistance from their physicians in planning an exercise routine or follow-up support regarding their exercise patterns. Taken together, these findings replicate others,36 indicating substantial lack of attention to PA in spite of growing evidence for its importance. These rates of

Acknowledgements

This study was funded through the Centers for Disease Control and Prevention, contract U48/CCU710806 (Prevention Research Centers Program), including support from the Community Prevention Study of the National Institutes of Health’s Women’s Health Initiative. Human subjects approval was obtained from the Saint Louis University Institutional Review Board. We are grateful for the assistance of Patsy Henderson, Nancy Noedel, and Mary Cregger of Battelle for assistance in data collection; Frank

References (45)

W.C Taylor et al.
Physical activity interventions in low-income, ethnic minority, and populations with disability
Am J Prev Med
(1998)
D.G Simons-Morton et al.
Effects of interventions in health care settings on physical activity or cardiorespiratory fitness
Am J Prev Med
(1998)
H Nawaz et al.
Physician-patient interactions regarding diet, exercise, and smoking
Prev Med
(2000)
E.M Gentry et al.
The behavioral risk factor surveysII. Design, methods and estimates from combined state data
Am J Prev Med
(1985)
J.F Sallis et al.
The development of scales to measure social support for diet and exercise behaviors
Prev Med
(1987)
R.C Brownson et al.
Promoting physical activity in rural communitieswalking trail access, use, and effects
Am J Prev Med
(2000)
C Friedman et al.
Physician advice to reduce chronic disease risk factors
Am J Prev Med
(1994)
M.W Kreuter et al.
Physician advice for diet and physical activity
Prev Med
(1997)
M Fiore et al.
Smoking status as the new vital signeffect on assessment and intervention in patients who smoke
Mayo Clin Proc
(1995)
E.H Wagner et al.
Quality improvement in chronic illness carea collaborative approach
Jt Comm J Qual Improv
(2001)

Physical activity and health

A report of the Surgeon General Executive Summary. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, The President’s Council on Physical Fitness and Sports

(1996)

Physical activity and cardiovascular health

JAMA

(1996)

S.S Harris et al.

Physical activity counseling for healthy adults as a primary preventive intervention in the clinical settingreport for the U.S. Preventive Services Task Force

JAMA

(1989)

R.R Pate et al.

Physical activity and public healtha recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine

JAMA

(1995)

B.E Ainsworth et al.

Physical inactivity

N.M Clark et al.

Self-management of chronic disease by older adultsa review and questions for research

J Aging Health

(1991)

J.M McGinnis et al.

Actual causes of death in the United States

JAMA

(1993)

C.J Crespo et al.

Prevalence of physical inactivity and its relation to social class in U.S. adultsresults from the Third National Health and Nutrition Examination Survey

Med Sci Sports Exerc

(1999)

D.O Clark

Physical activity and its correlates among urban primary care patients aged 55 years or older

J Gerontol

(1999)

J.F Sallis et al.

Physical activity and behavioral medicine

(1999)

A.L Stewart et al.

Evaluation of CHAMPS, a physical activity promotion program for older adults

Ann Behav Med

(1997)

Current estimates from the National Health Interview Survey. Series 10, No. 200

(1996)

Cited by (227)

Oncology health professionals' perspectives of determinants of exercise by cancer patients: A socio-ecological approach
2022, European Journal of Oncology Nursing
Scientific evidence has shown that practicing exercise reduced the risk of overall and cancer-specific mortality for cancer patients. Numerous studies have shown limited support has been provided by cancer and general health professionals. This present study identifies determinants of suggesting of exercise from the oncology health professionals' perspective by using a socio-ecological approach.
Health professionals from two oncology services in France were contacted, which resulted in 36 semi-structured interviews questioning elements of support for exercise, from individual to political determinants.
intrapersonal-level findings revealed that exercise is considered complementary to treatment, not recommended at all times of the disease duration and not to all patients. For interpersonal determinants, health professionals discuss exercise based on their own sport practice and their exercise knowledge. Health professionals interchangeably use exercise, sport, or exercise. Examination of institutional determinants showed that the oncology services did not use tools to evaluate or follow up on exercise. Only one of the services had an exercise referral scheme. Examination of community determinants showed that health professionals identified a diversity of exercise providers, without the ability to differentiate exercise program quality. Public policy findings have shown that despite an exercise prescription law, health professionals do not prescribe exercise, do not know how to prescribe it, and consider that the exercise useless because of no refund system for patients.
The results provide a systemic understanding of the determinants helping cancer patients and health professionals improve adherence to exercise.
A systematic scoping review: Resources targeting the training and education of health and recreation practitioners to support physical activity among people with physical disabilities
2019, Disability and Health Journal
Health and recreation practitioners play an important role in promoting and supporting leisure time physical activity (LTPA) among persons with physical disabilities (PWPD), yet many practitioners lack training and education to provide the basic knowledge, skills, and resources necessary.¹ Little is known about existing LTPA information and training resources for health and recreation practitioners and there has been no known systematic effort to identify existing resources.
The purpose of the current study was to engage systematic scoping methodologies to identify resources that target the training and education of health and recreation practitioners to promote and support LTPA among PWPD. To further analyze the identified resources, an assessment of quality was conducted.
Systematic scoping review methodologies were employed, which included searches of academic and grey literature, online materials (i.e., Google search) and expert consultation. Results: Several (N = 46) resources were identified from academic, government and non-government, and professional organizations. Most resources were targeted to a specific PWPD population. The resources were of high technical quality. Conclusion: The paper serves as a listing of existing resources for practitioners working with PWPD in LTPA settings. The review provides a catalyst for action in further research and practice regarding the analysis, design, development, implementation and evaluation of optimally effective resources targeting practitioners to promote and support LTPA among PWPD.
Several (N = 46) resources were identified from academic, government and non-government, and professional organizations. Most resources were targeted to a specific PWPD population. The resources were of high technical quality.
The paper serves as a listing of existing resources for practitioners working with PWPD in LTPA settings. The review provides a catalyst for action in further research and practice regarding the analysis, design, development, implementation and evaluation of optimally effective resources targeting practitioners to promote and support LTPA among PWPD.
Prevalence and Correlates of Receiving Medical Advice to Increase Physical Activity in U.S. Adults: National Health and Nutrition Examination Survey 2013–2016
2019, American Journal of Preventive Medicine
Citation Excerpt :
Low HDL cholesterol was defined as serum HDL cholesterol <40 mg/dL. Self-reported health behaviors, which were based on previous research,11,12 included: smoking status (never smoked, former smoker, current smoker) and adherence to the national PA aerobic guidelines of the equivalent of ≥150 minutes of moderate-intensity activity in the previous week (met PA guidelines or did not meet PA guidelines).21 Demographic characteristics (selected a priori and based on factors described in the literature that may influence patient and provider communication22–24) included: age group (20–39, 40–59, ≥60 years), sex (male or female), race/Hispanic origin (Hispanic, non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and other, which included all non-Hispanic individuals who reported more than one race group), educational level (less than high school, high school, some college, college or more), poverty status based on family income-to-poverty ratio (FIPR, calculated by dividing family income by the U.S. poverty threshold specific for family size and where categories were selected based on Supplemental Nutrition Assistance Program income eligibility limits; <130% FIPR, 130%–349% FIPR, or ≥350% FIPR),25 and health insurance status (whether participant was or was not covered by health insurance or some other kind of healthcare plan).
National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care–utilizing adults and differences in associations by age group.
Analyses included 8,410 health care–utilizing adults aged ≥20 years from the 2013–2016 National Health and Nutrition Examination Surveys (analyzed in 2018). Logistic regression was used to examine associations between receipt of medical advice to increase physical activity in the past year and measured health conditions, reported health behaviors, and demographic characteristics. Models were stratified by age group (20–39, 40–59, and ≥60 years).
Physical activity medical advice was received by 42.9% (95% CI=40.8, 44.9) of adults overall. By age group, 32.7% of younger adults, 46.7% of middle-aged adults, and 48.9% of older adults received advice. Among all adults and across all age groups, receipt of advice was higher among adults with chronic health conditions: obesity (63.0%, 95% CI=60.3, 65.7), hypertension (56.5%, 95%=CI 53.8, 59.2), diabetes (69.8%, 95% CI=66.5, 72.8), hypercholesterolemia (55.6%, 95% CI=52.3, 59.0), and low high-density lipoprotein cholesterol (53.8%, 95% CI=50.1, 57.4). Among all adults, those with obesity, hypertension, and diabetes had significantly greater odds of receipt of advice after adjustment. Stronger associations between diabetes and hypercholesterolemia and receiving physical activity advice were observed among younger adults.
Receipt of physical activity medical advice was highest among adults with specific chronic health conditions, and this pattern was stronger among younger adults with diabetes and hypercholesterolemia. However, most health care–utilizing adults did not receive physical activity medical advice.
Overweight and Obesity
2019, Encyclopedia of Biomedical Gerontology: Volume 1-3
This article discusses the literature on overweight and obesity with a specific focus on older adults. Overweight and obesity refers to an excess of body fat relative to lean body mass. Globally data suggests that overweight and obesity are on the rise and this is likely driving the corresponding increase in metabolic syndrome. Strong evidence exists from meta-analyses that overweight and obesity is associated with increased risk of several physical and mental health conditions, but in older adults some evidence now exists that it may offer protection against some of these conditions, including mortality, particularly in clinical samples. A growing concern in older adults is that of sarcopenic obesity, highlighting a need to reduce both muscle loss and weight gain. Weight loss and conditioning advice may be best delivered to older adults by health care professionals.
Overweight and obesity
2019, Encyclopedia of Biomedical Gerontology
This article discusses the literature on overweight and obesity with a specific focus on older adults. Overweight and obesity refers to an excess of body fat relative to lean body mass. Globally data suggests that overweight and obesity are on the rise and this is likely driving the corresponding increase in metabolic syndrome. Strong evidence exists from meta-analyses that overweight and obesity is associated with increased risk of several physical and mental health conditions, but in older adults some evidence now exists that it may offer protection against some of these conditions, including mortality, particularly in clinical samples. A growing concern in older adults is that of sarcopenic obesity, highlighting a need to reduce both muscle loss and weight gain. Weight loss and conditioning advice may be best delivered to older adults by health care professionals.
Knowledge and practice of the physical activity prescription by generalists and specialist physicians of the city of Kinshasa: a cross-sectional study
2023, BMC Sports Science, Medicine and Rehabilitation

View all citing articles on Scopus

View full text

Physician advice and support for physical activity: Results from a national survey

Abstract

Section snippets

Sampling

Results

Discussion

Acknowledgements

Am J Prev Med

Am J Prev Med

Prev Med

Am J Prev Med

Prev Med

Am J Prev Med

Am J Prev Med

Prev Med

Mayo Clin Proc

Jt Comm J Qual Improv

Physical activity and health

A report of the Surgeon General Executive Summary. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, The President’s Council on Physical Fitness and Sports

Physical activity and cardiovascular health

JAMA

Physical activity counseling for healthy adults as a primary preventive intervention in the clinical settingreport for the U.S. Preventive Services Task Force

JAMA

Physical activity and public healtha recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine

JAMA

Physical inactivity

Self-management of chronic disease by older adultsa review and questions for research

J Aging Health

Actual causes of death in the United States

JAMA

Prevalence of physical inactivity and its relation to social class in U.S. adultsresults from the Third National Health and Nutrition Examination Survey

Med Sci Sports Exerc

Physical activity and its correlates among urban primary care patients aged 55 years or older

J Gerontol

Physical activity and behavioral medicine

Evaluation of CHAMPS, a physical activity promotion program for older adults

Ann Behav Med

Current estimates from the National Health Interview Survey. Series 10, No. 200