Implementation and effectiveness of a primary care based physical activity counselling scheme

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Abstract

The aim of the project was to reach inactive people through primary care offices and motivate them to become more active for health purposes. Physical activity questionnaires based on the transtheoretical model (TM) of behaviour change were handed out to every person entering one of five primary care offices. All inactive people were entered into a randomised controlled trial (RCT). Individuals assigned to the feedback group were given feedback from their physician concerning their physical activity level. In addition, the advice plus group received further advice and stage matched leaflets and was offered a 45-min counselling session. Changes in physical activity behaviour were measured 7 weeks as well as 14 months after the intervention. Physicians and patients alike reacted positively to the project. Ninety percent of patients entering the primary care offices were willing to participate. Ninety percent of inactive people agreed to be entered into the RCT. The follow-up rate in this trial was 82% at 14 months. At 7 weeks, 35% of patients in the feedback group were now classified as active and 38% of patients in the advice plus group. At 14 months, 47% of the subjects in both groups were active. Inactive people can be reached effectively through primary care offices. Patients receiving feedback from their physician concerning their physical activity level improved their behaviour to the same extent as patients who were given further advice and written materials, and were offered a counselling session.

Introduction

An increasing wealth of literature underpins the importance of physical activity for our health. A first comprehensive collection of evidence was the Surgeon General’s Report [1]. In addition to the well known protective effect of physical activity against cardiovascular diseases, the risk of suffering chronic diseases such as osteoporosis, depression, colon cancer, and type II diabetes is related to one’s physical activity behaviour [1], [2].

According to recent research, physical activity need only be of moderate intensity for a protective effect [3]. The international recommendation for health enhancing physical activity (HEPA) has therefore been revised and set at half an hour daily activity with moderate intensity, which corresponds to any activity which causes a person to be slightly out of breath [4]. In addition, the previous recommendation of vigorous activity for at least 20 min three times a week still retains its validity and is to be seen as a possible alternative to the new recommendation.

In the national HEPA survey conducted in 1999, 37% of the population living in Switzerland reported not meeting either one of the recommendations stated above. Women and older people were more likely to be inactive. In the German speaking part of Switzerland, where this project took place, 27% of the population were classified as inactive [5]. There is, therefore, a remarkable potential for increase. The importance of promotional activities is underlined by the fact that 50% of inactive people in Switzerland consider themselves active enough for health benefits [5].

In motivation studies, inactive people most often stated the advice of the general practitioner to be the one incentive which would help them become more active [6], [7]. Primary care offices are therefore a promising setting for physical activity promotion. Furthermore, there is a high potential for reaching inactive people, as 80% of the Swiss population consult their physician at least once a year [8]. In addition, a risk assessment can take place in the office.

Four comprehensive reviews published between 1998 and 2003 were found which evaluated the effectiveness of primary care based physical activity intervention trials. The studies reviewed were exclusively from Anglo-Saxon countries. In general, reviewers noted a lack of randomised trials with long-term follow-up and high follow-up rates [9], [10], [11], [12]. Outcomes differed greatly between studies, and positive effects were mainly seen in the short-term [9], [10], [11]. Approaches that were tailored to patient characteristics and which included written materials appeared to be more successful [9], [10]. The transtheoretical model (TM) of behaviour change is commonly used in order to provide tailored interventions. A review published in 2003 concludes that interventions based on the TM prove successful in the short-term yet long-term results are less convincing [13]. Later trials not yet included in the review provide similar evidence [14], [15], [16], [17].

The aim of this project was to evaluate the feasibility of a primary care office based physical activity intervention scheme in Switzerland and compare the effects of mere physician feedback related to a person’s stage of change with additional advice, materials, and the offer of counselling.

Section snippets

Setting

Addresses of 20 general practitioner offices situated in municipalities in the vicinity of Zurich were taken from the list of a medical care network. Physicians were informed about the project by mail and then contacted by phone to ask if they were interested in participating. They were offered 25 CHF (€18) for each questionnaire that would be filled in at their office. Seven physicians agreed to participate. Two chose the option of withdrawing after the initial information and training

Acceptance and feasibility

Individual interviews with all five general practitioners, all three counsellors, and three practice assistants yielded information about the quality and feasibility of the project. Similar information was gained from interviews with 10 people from the advice plus group. Five were randomly selected among the participants of the counselling session and five among those who had decided not to take part in the counselling session.

Furthermore, the practice assistants’ log provided information about

Acceptance and feasibility

The interviews with the professionals involved revealed that the reactions of the patients to the project were predominantly positive with only few—mainly older people—hesitating when being introduced to the topic. Care had to be taken though that “health” and “physical activity” were the key words used for introduction rather than “sports”. Most doctors appreciated having been given materials and an incentive to discuss the issue of physical activity with their patients. The additional

Discussion

The positive reaction of patients and physicians alike showed that this primary care based physical activity scheme was not only feasible but also appreciated by all people involved. The vast majority of patients entering the primary care office filled in a questionnaire. About a third of them were inactive and thus entered into the RCT. A brief feedback on individual physical activity behaviour provided by the physician appeared equally effective as additional advice including an offer of

Acknowledgements

We would like to thank the staff of the following primary care offices for their participation in the project: Dr. Bovet, Dr. Gunsch, Dr. Niesper, Dr. Utzinger, Dr. Zünd. We further thank the health insurance Helsana AG for their financial and administrative support of the study. Finally, we thank Eva Martin and Brigitte Schlatter for reviewing the manuscript of this paper.

References (29)

  • D.G. Simons-Morton et al.

    Effects of interventions in health care settings on physical activity or cardiorespiratory fitness

    Am. J. Prev. Med.

    (1998)
  • B.M. Pinto et al.

    Effects of a computer-based, telephone-counseling system on physical activity

    Am. J. Prev. Med.

    (2002)
  • US Department of Health and Human Services. Physical activity and health—a report of the Surgeon General. Atlanta: US...
  • Marti B, Hättich A. Bewegung—sport—Gesundheit, Epidemiologisches Kompendium [Physical activity—sport—health, an...
  • M. Pratt

    Benefits of lifestyle activity vs. structured exercise

    J. Am. Med. Assoc.

    (1999)
  • R.R. Pate et al.

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

    J. Am. Med. Assoc.

    (1995)
  • B.W. Martin et al.

    Einstellung, Wissen und Verhalten der Schweizer Bevölkerung bezüglich körperlicher Aktivität: Resultate aus dem Bewegungssurvey 1999 [Physical activity related attitude, knowledge, and behaviour in the Swiss population: results from the HEPA Survey 1999]

    Schweiz Z Sportmed Sporttraumatol

    (1999)
  • Stierlin M, editor. Gesundheit und Gesundheitsmotive in ihrer Bedutung für die Bewegungs- und Sportaktivitäten älterer...
  • Whitehead M, editor. Health update—physical activity. London: Health Education Authority;...
  • Bundesamt für Statistik. Schweizerische Gesundheitsbefragung 1997—erste Ergebnisse [Swiss Health Survey 1997—initial...
  • E.G. Eakin et al.

    Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research

    J. Fam. Pract.

    (2000)
  • C.B. Eaton et al.

    A systematic review of physical activity promotion in primary care office settings

    Br. Med. J.

    (1998)
  • K.B. Eden et al.

    Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force

    Ann. Intern. Med.

    (2002)
  • J. Adams et al.

    Are activity promotion interventions based on the transtheoretical model effective? A critical review

    Br. J. Sports Med.

    (2003)
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