Randomized trial of three strategies to promote physical activity in general practice

Abstract

Objective

To evaluate three strategies for promoting physical activity (PA) in a primary care setting.

Method

Data were collected between 2002 and 2004 from 136 patients attending two general practices in Brisbane, Australia. Inactive patients (50–70 years) were randomly allocated to one of three hierarchical intervention groups: the general practitioner (GP) group received ‘brief’ advice; the GP+ES group also received behavior change advice from an exercise scientist (ES); and the GP+ES+P group also received a pedometer. Self-reported PA and its determinants were measured at baseline and weeks 12 and 24. Cardio-respiratory variables were measured at baseline and week 12.

Results

Overall, mean PA time increased by 84 and 128 min/week at weeks 12 and 24 (p < .01) with no significant group differences. Small improvements in blood pressure and post-exercise heart rate were observed. At week 24, the GP+ES+P group were more likely to report meeting PA guidelines than the GP group (OR = 2.39 95% CI: 1.01, 5.64).

Conclusion

PA levels can be increased in mid- to older-age adults, either by brief advice from motivated GPs alone, or from collaboration between GPs and ESs. The most intense intervention (GP+ES+P) showed the most promising results.

Introduction

Reviews of physical activity interventions have identified general practice as a potentially effective setting for population level physical activity promotion strategies (Hillsdon et al., 2005, Sorensen et al., 2006). Some early trials showed short-term increases in physical activity following brief verbal advice from a general practitioner (GP) with (Bull et al., 1999) or without (Lewis and Lynch, 1993) supplementary print materials (in Australia Primary Care Physicians are known as GPs). Building on the concept that health advice delivered in the form of a written prescription is a familiar way for patients to receive information from a GP, studies including written physical activity prescriptions have shown trends towards increased physical activity after 6 weeks (Goldstein et al., 1999, Swinburn et al., 1998) and 6 to 10 weeks in inactive patients (Smith et al., 2000).

Although evidence suggests long-term maintenance of physical activity behavior change can be enhanced by multiple contacts, tailored advice, use of behavior change strategies (e.g., problem solving, goal setting) and program supervision (Eaton and Menard, 1998, Simons-Morton et al., 1998) many GPs report a lack of time, confidence or skills to deliver individually tailored physical activity advice (Bull et al., 1995, Lawlor et al., 1999, McKenna et al., 1998, Petrella and Wight, 2000, Walsh et al., 1999, Williford et al., 1992). Additional barriers reported by GPs include a belief that counseling will be ineffective and that patients prefer drug therapy, access to assessment resources and lack of financial incentive (Bull et al., 1995, Lawlor et al., 1999, McKenna et al., 1998, Petrella and Wight, 2000, Walsh et al., 1999, Williford et al., 1992). One way of overcoming these barriers is to develop collaborative partnerships and referral pathways between GPs and allied health professionals (Eakin et al., 2000, Goldstein et al., 1999, Hillsdon et al., 2005, Kahn et al., 2002, Simons-Morton et al., 1998).

Several studies have investigated practice nurse delivered physical activity advice (Steptoe et al., 2000) or GP advice supplemented with counseling from health educators (Calfas et al., 1996, Writing Group for the Activity Counseling Trial Research Group, 2001). For example, one contolled trial reported significant increases in walking time (40 min/week) 4–6 weeks post-intervention, compared with a control group (Calfas et al., 1996). A larger randomized controlled trial found a significant increase in weekly physical activity sessions up to 12 months after receiving behavioral counseling from the practice nurse, compared with usual care (Steptoe et al., 2000).

Recently there has been interest in exploring the effects of collaboration between GPs and exercise ‘specialists’. In Australia these specialists are known as Exercise Scientists (ESs). They have University level training in human movement studies (kinesiology), including knowledge of contemporary theories and models of behavior change, physical activity ‘prescription’ for primary and secondary prevention, and tertiary management of most of the common chronic health problems experienced by older adults. The New Zealand Green Prescription study found that brief verbal and written GP advice supplemented with follow-up contact from an ES resulted in significant increases in physical activity 12-months post-intervention (Elley et al., 2003). Pedometers have shown promise as motivational tools in physical activity behavior change (Moreau et al., 2001) and have been trialed in general practice settings in Australia (Eakin et al., 2004).

As is the case in other Western countries, fewer than half the Australian adult population report participating in sufficient physical activity for health benefits (Bauman et al., 2001). Participation declines with age, with the lowest levels seen in middle-aged and older adults. The aim of this study was therefore to build on promising results from previous GP-based interventions and evaluate the efficacy of three strategies to promote physical activity to mid-age and older people in a general practice setting.