Tools for physical activity counseling in medical practice

Ameliorating Racial Disparities in Vascular Risk Factor Management With Aggressive Medical Management in the SAMMPRIS Trial

BACKGROUND

The WASID trial (Warfarin-Aspirin Symptomatic Intracranial Disease) and the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) evaluated optimal management of symptomatic intracranial atherosclerotic stenosis. The aim of this retrospective, observational study was to determine whether aggressive medical management used in the SAMMPRIS trial ameliorated disparities in risk factor control between Black and non-Black patients.

METHODS

The SAMMPRIS trial was a randomized controlled trial that enrolled patients with symptomatic intracranial atherosclerotic stenosis between November 2008 and April 2011. The frequency of risk factors at study entry (baseline) and mean levels of systolic blood pressure, diastolic blood pressure, LDL (low-density lipoprotein), hemoglobin A1c, and exercise level (quantified by physician-based assessment and counseling for exercise score) at baseline and at 1 year of follow-up were compared between Black (n=104) versus non-Black patients (n=347).

RESULTS

Significant differences at baseline in Black patients (listed first) versus non-Black patients were age (57.5 versus 61.0 years; P=0.004), hypertension (95.2% versus 87.5%; P=0.027), diabetes (52.9% versus 39.7%; P=0.017), mean diastolic blood pressure (82.4 versus 79.5 mm Hg; P=0.035), and mean physician-based assessment and counseling for exercise score (2.7 versus 3.3; P=0.002). The mean diastolic blood pressure and mean physician-based assessment and counseling for exercise scores at 1 year in Black versus non-Black patients were 74.7 versus 75.5 mm Hg (P=0.575) and 4.2 versus 4.1 (P=0.593), respectively. No disparities in other modifiable risk factors emerged at 1 year.

CONCLUSIONS

Significant differences in important risk factors (physical activity and diastolic blood pressure) at baseline between Black and non-Black patients resolved at 1 year, suggesting that aggressive medical management may have an important role in ameliorating disparities in risk factor control between Black and non-Black patients.

Effectiveness of the 5A Counseling Model-Based Interventions on Physical Activity Indicators in Adults: A Systematic Review

BACKGROUND

To identify and appraise the effectiveness of the 5A-counseling-model-based interventions on indicators of physical activity in adults.

METHODS

A systematic review was conducted from systematic searches in Embase, Lilacs, Pubmed, Scielo, Scopus, Sportdiscus and Web of Science, involving studies published from its inception until May 2022. To avoid potential losses, searches also were made in Google Scholar and in reference lists. The assessment of studies, data extraction, and synthesis were carried out independently by two researchers.

RESULTS

Four studies composed the synthesis, which involved people with an average age between 40 and 55 years, most of the samples being women. It was observed that counseling was carried out in conjunction with other strategies, such as drawing up an action plan, sending text messages, and offering educational material. Only one study showed a statistically significant difference between the intervention and control groups in the "daily number of steps" indicator.

CONCLUSIONS

Based on available studies, 5A-counseling-model-based interventions did not reflect significant findings in relation to physical activity. However, given the potential of the model, future studies are recommended with a better description of the strategies, as well as a more robust methodology, to strengthen the evidence.

Interoception and alexithymia are related to differences between the self-reported and the objectively measured physical activity in patients with chronic musculoskeletal pain

OBJECTIVE

Patients with chronic musculoskeletal pain (CMP) have difficulty estimating their level of physical activity (PA). Factors associated with this difficulty have yet to be identified; however, identification could allow for increased accuracy in large-scale PA surveys, and enhanced self-management. The purpose of this study was to determine the relationship of interoception and alexithymia with differences between self-reported and objectively measured PA, and investigate factors as they relate to accurately self-reporting PA.

METHODS

A cross-sectional survey of 33 patients with CMP and 32 healthy individuals was conducted from July 2018 to June 2019. We measured differences in Moderate to Vigorous Physical Activity (D-MVPA) using an accelerometer and self-report. A heartbeat tracking task (HTT) was used to measure interoception, and alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20).

RESULTS

The CMP group (median 43.5 min/day, IQR 20.6-77.6) showed significantly higher D-MVPA values than the control group (median 22.5 min/day, IQR 6.7-34.9) (p < .001). In patients with CMP, D-MVPA positively correlated with TAS-20 (rho = 0.470, p = .006) and correlated negatively with HTT (rho = -0.390, p = .025).

CONCLUSION

Inaccurate self-reported measurements of PA in patients with CMP are associated with alexithymia and interoception. This finding suggests that behavioral interventions targeting alexithymia and interoception in CMP patients could lead to improved self-monitoring.

Does Muscular Power Predict Bone Mineral Density in Young Adults?

The aim of this study was to explore the relationships between maximum power and bone variables in a group of young adults. Two hundred and one young adults (53 men and 148 women) whose ages range from 18 to 35 years voluntarily participated in this study. Weight and height were measured, and body mass index was calculated. Body composition, bone mineral content (BMC) and bone mineral density (BMD) were determined for each individual by dual-energy X-ray absorptiometry. Vertical jump was evaluated using a validated field test (Sargent test). The highest vertical jump was selected. Maximum power (P max, in watts) of the lower limbs was calculated accordingly. In young men, maximum power was positively correlated to whole body (WB) BMC (r = 0.65; p < 0.001), WB BMD (r = 0.41; p < 0.01), L1-L4 BMC (r = 0.54; p < 0.001), total hip (TH) BMC (r = 0.50; p < 0.001), femoral neck (FN) BMC (r = 0.35; p < 0.01), FN cross-sectional area (CSA) (r = 0.33; p < 0.05) and FN cross-sectional moment of inertia (CSMI) (r = 0.50; p < 0.001). In young women, maximum power was positively correlated to WB BMC (r = 0.48; p < 0.001), WB BMD (r = 0.28; p < 0.001), L1-L4 BMC (r = 0.34; p < 0.001), TH BMC (r = 0.43; p < 0.001), TH BMD (r = 0.21; p < 0.01), FN BMC (r = 0.42; p < 0.001), FN BMD (r = 0.31; p < 0.001), FN CSA (r = 0.41; p < 0.001), FN CSMI (r = 0.40; p < 0.001) and FN Z (r = 0.41; p < 0.01). The current study suggests that maximum power is a positive determinant of WB BMC, WB BMD, FN CSA, and FN CSMI in young men. It also shows that maximum power is a positive determinant of WB BMC, WB BMD, TH BMD, FN BMD, FN CSA, FN CSMI, and FN Z in young women.

Physical activity promotion by health practitioners: a distance-learning training component to improve knowledge and counseling

Aim To report an evaluation of health professionals' participation in a distance-learning physical activity training course developed in a low socio-economic region of São Paulo city, Brazil.

BACKGROUND

In countries with public universal health systems, physical activity promotion in primary health care settings can reap results, particularly given that such interventions have the potential to reach a large percentage of the population. However, few studies proposed physical activity training for health professionals in low- and middle-income countries. Brazil is a continental country and has the Unified Health System which incorporates family health teams in over 85% of Brazilian cities.

METHODS

The physical activity training was part of the fifth module of an educational intervention throughout a distance-learning course focusing on health professionals at M'Boi Mirim district in São Paulo city. The training totaled 3 h and had five themes of physical activity: (1) concepts, definitions benefits; (2) evaluation; (3) recommendation; (4) interventions; (5) physical activity counseling. The opinion of health professionals was evaluated after training by two open questions. Findings Out of 106 professionals who took part of the course, only 22.6% (n=24) had accessed the fifth module. These professionals were predominantly female (79.2%), nurses (66.7%) and aged 30 years or older. Responses highlighted the course approach focused on physical activity for improving patient's quality of life and well-being, disease prevention and health improvements. Regarding the themes for improvement, the health professionals identified that there was a need to experience physical activity classes first-hand, and the need to link physical activity counseling to the local venues that provide structured physical activity programs. We recommend that further training courses can be conducted based on this model for health professionals to promote physical activity to the community in Brazil.

Relationship between risk factor control and vascular events in the SAMMPRIS trial

OBJECTIVE

The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study is the first stroke prevention trial to include protocol-driven intensive management of multiple risk factors. In this prespecified analysis, we aimed to investigate the relationship between risk factor control during follow-up and outcome of patients in the medical arm of SAMMPRIS.

METHODS

Data from SAMMPRIS participants in the medical arm (n = 227) were analyzed. Risk factors were recorded at baseline, 30 days, 4 months, and then every 4 months for a mean follow-up of 32 months. For each patient, values for all risk factor measures were averaged and dichotomized as in or out of target.

RESULTS

Participants who were out of target for systolic blood pressure and physical activity, as well as those with higher mean low-density lipoprotein cholesterol and non-high-density lipoprotein, were more likely to have a recurrent vascular event (stroke, myocardial infarction, or vascular death) at 3 years compared to those who had good risk factor control. In the multivariable analysis, greater physical activity decreased the likelihood of a recurrent stroke, myocardial infarction, or vascular death (odds ratio 0.6, confidence interval 0.4-0.8).

CONCLUSIONS

Raised blood pressure, cholesterol, and physical inactivity should be aggressively treated in patients with intracranial atherosclerosis to prevent future vascular events. Physical activity, which has not received attention in stroke prevention trials, was the strongest predictor of a good outcome in the medical arm in SAMMPRIS.

CLINICALTRIALSGOV IDENTIFIER

NCT00576693.

Cardiovascular Risk Reduction: We Have the Will, But Do We Have the Way?

As Rippe, Angelopoulos, and Zuckley pointed out, coronary heart disease “represents the quintessential lifestyle disease of developed countries,” offering both opportunities and challenges for the routine practice of lifestyle medicine. Although the empirical evidence provides a compelling rationale for the modification of preventable cardiovascular risks, their review prompts discussion of the continuing tendency for practice to lag behind knowledge, the persisting challenges to narrowing this knowledge-practice divide, and the emerging trends that may further advance cardiovascularrisk reduction efforts.

Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls. A systematic review

Objective: To gain an insight into the daily physical activity levels of patients with chronic pain or fatigue compared with asymptomatic controls.

Data sources: MEDLINE, EMBASE, PsycINFO, Picarta, Cochrane Database of Systematic Reviews, reference tracking and a manual search of relevant journals.

Review methods: A systematic, computerized database search of the medical databases up to September 2006 was performed. In addition, a hand search of relevant journals was carried out. Appropriate studies reported on the daily physical activities of adult patients with chronic pain or fatigue and included an asymptomatic control group. Two reviewers independently carried out methodological quality assessment and data extraction. A qualitative analysis was performed.

Results: Twelve studies were included, involving five different syndromes. Results show large heterogeneity in methods used and syndromes investigated, which limited evidence. Eleven different methods were used to assess daily physical activities resulting in 16 different outcome parameters. There seem to be differences between the different syndromes, but results are not conclusive. Eight studies reported a lower physical activity level in patients compared with controls. There seems to be a difference in results between studies using objective versus those using subjective methods.

Conclusions: Results reported in the literature with respect to the activity level of patients with chronic pain or fatigue compared with controls were too heterogeneous to give sufficient evidence and were not conclusive.

A pilot study - the potential value of an activity-based feedback system for treatment of individuals with chronic lower back pain

PURPOSE

The aim of this pilot study was to evaluate the potential value of a new personalized activity-based feedback treatment.

METHOD

A prognostic cohort study was carried out in the daily environment of the patients. Seventeen individuals with chronic lower back pain (CLBP) symptoms for >3 months were included. Patients were from the Netherlands, aged 18-65 years. Patients wore an accelerometer and a Personal Digital Assistant (PDA) for 15 d. Patients received continuous and time-related personalized feedback and were instructed to follow the activity pattern as displayed on the PDA. Technical performance and compliance with the system were rated. Objective and subjective activity scores were compared for exploring awareness. The absolute difference between the activity pattern of the patient and the norm value used was calculated and expressed as mean difference. Pain intensity was measured using the VAS.

RESULTS

The technical performance and compliance with the system were rated moderate. More than half of the patients were aware of their activity level during the feedback days (67%). A positive effect of the feedback was seen in a trend which showed a decrease in the absolute difference between the activity pattern of the patient and the norm value (p = 0.149) and a significant decrease in pain intensity levels (p = 0.005).

CONCLUSIONS

This pilot study suggested that an individual-tailored feedback system that focuses on the activity behavior of the patient has potential as the treatment of individuals with CLBP. Implications for Rehabilitation Activity-based feedback for individuals with chronic low back pain: Many patients are not aware of their activity patterns. The activity patterns of patients differ from those of healthy controls. It is important to make patients aware of their activity patterns in order to change activity behavior. An individual-tailored feedback system seems promising in decreasing pain intensity levels for a subgroup of patients.

Web-based therapeutic exercise resource center as a treatment for knee osteoarthritis: a prospective cohort pilot study

BACKGROUND

Although beneficial effects of exercise in the management of knee osteoarthritis (OA) have been established, only 14 -18% of patients with knee OA receive an exercise from their primary care provider. Patients with knee OA cite lack of physician exercise advice as a major reason why they do not exercise to improve their condition. The purpose of this pilot study was to investigate use of a web-based Therapeutic Exercise Resource Center (TERC) as a tool to prescribe strength, flexibility and aerobic exercise as part of knee OA treatment. It was hypothesized that significant change in clinical outcome scores would result from patients' use of the TERC.

METHODS

Sixty five individuals diagnosed with mild/moderate knee OA based on symptoms and radiographs were enrolled through outpatient physician clinics. Using exercise animations to facilitate proper technique, the TERC assigned and progressed patients through multiple levels of exercise intensity based on exercise history, co-morbidities and a validated measure of pain and function. Subjects completed a modified short form WOMAC (mSF-WOMAC), World Health Organization Quality of Life (WHO-QOL) and Knee Self-Efficacy Scale (K-SES) at baseline and completion of the 8 week program, and a user satisfaction survey. Outcomes were compared over time using paired t-tests and effect sizes calculated using partial point biserial (pr).

RESULTS

Fifty two participants completed the 8 week program with average duration of knee pain 8.0 ± 11.0 yrs (25 females; 61.0 ± 9.4 yrs; body mass index, 28.8 ± 6.3 kg/m2). During the study period, all outcome measures improved: mSF-WOMAC scores decreased (better pain and function) (p<.001; large effect, pr=0.70); WHO-QOL physical scores increased (p=.015; medium effect, pr=0.33); and K-SES scores increased (p<.001; large effect, pr=0.54). No significant differences were found in study outcomes as a function of gender, age, BMI or symptom duration. Patients reported very positive evaluation of the TERC (94% indicated the website was easy to use; 90% specified the exercise animations were especially helpful).

CONCLUSION

This pilot study demonstrated the web-based TERC to be feasible and efficacious in improving clinical outcomes for patients with mild/moderate knee OA and supports future studies to compare TERC to current standard of care, such as educational brochures.

Correlation between pedometer and the Global Physical Activity Questionnaire on physical activity measurement in office workers

Background

This study aimed to examine the correlation of physical activity levels assessed by pedometer and those by the Global Physical Activity Questionnaire (GPAQ) in a population of office workers.

Methods

A cross-sectional study was conducted on 320 office workers. A self-administered questionnaire was distributed to each office worker by hand. Physical activity level was objectively assessed by a pedometer for 7 consecutive days and subjectively assessed by the GPAQ. Based on the pedometer and GPAQ outcomes, participants were classified into 3 groups: inactive, moderately active, and highly active.

Results

No correlation in the physical activity level assessed by the pedometer and GPAQ was found (r_s = .08, P = 0.15). When considering the pedometer as the criterion for comparison, 65.3% of participants had underestimated their physical activity level using the GPAQ, whereas 9.3% of participants overestimated their physical activity level.

Conclusions

Physical activity level in office workers assessed by a subjective measure was greatly different from assessed by an objective tool. Consequently, research on physical activity level, especially in those with sedentary lifestyle, should consider using an objective measure to ensure that it closely reflects a person’s physical activity level.

The exercise prescription: a tool to improve physical activity

The current epidemic of sedentary behavior is a serious public health issue that requires the attention of the medical community. Although the benefits of physical activity are well established, research indicates that Americans are not heeding the message, and new strategies are warranted to bring about change in this arena. The health care community can and should play a key role in this movement. Patients respect their physicians as credible sources of information and look to them for health-related guidance. Unfortunately, many physicians are not talking to their patients about physical activity and are missing a unique opportunity to raise awareness about its benefits. Exercise needs to be discussed as a serious form of treatment, similar to medication, and should be thoughtfully prescribed to every patient. Physicians need to be familiar with the level of exercise necessary to achieve health benefits as defined by the Physical Activity Guidelines for Americans. Furthermore, they should be competent in their ability to identify a patient's level of risk for starting or increasing exercise and provide guidance on the frequency, intensity, time, and type of activity necessary to safely elicit maximal health benefits. These basic competencies can be easily understood by physicians and incorporated into their practices. Resources have been established to help support physicians in this process. Physiatrists are uniquely positioned to lead the effort for change in this area because they are well-established proponents of exercise and are trained to prescribe therapeutic exercise to address the complex medical issues of their patients. This skill-set should be used for every patient in an effort to reduce the widespread prevalence of the "chronic disease" physical inactivity.

Behavioral Counseling for Cardiovascular Disease Prevention in Primary Care Settings

Cardiovascular disease carries a substantial public health burden. Physician advice on modifying behavioral risk factors is effective, yet the practice of and factors associated with behavioral counseling in primary care have not been systematically investigated. The authors conducted a systematic review that identified 18 studies providing data on 6,338 physicians. The provision of preventive services differed by patients’ individual risk. Physicians’ counseling on smoking cessation was most commonly reported. The proportions of physicians counseling about nutrition and physical activity were notably lower and few physicians took further action by using more intensive counseling approaches. As studies were mainly based on self-reports, current delivery of preventive services may be overestimated. There is a need to increase the frequency of behavioral counseling in primary care settings, particularly for nutrition and physical activity, and to emphasize that counseling may also benefit individuals without cardiovascular disease risk factors.

Barriers in the Implementation of a Physical Activity Intervention in Primary Care Settings

Barriers encountered in implementing a physical activity intervention in primary health care settings, and ways to address them, are described in this paper. A randomized comparison trial was designed to examine the impact of health care providers’ written prescriptions for physical activity, with or without additional physical activity resources, to adult, nonpregnant patients on preventive care or chronic disease monitoring visits. Following abysmal recruitment outcomes, the research protocol was altered to make it more appealing to all the participants, i.e., health care providers, office personnel, and patients. Various barriers—financial, motivational, and executive—to the implementation of health promotion interventions in primary health care settings were experienced and identified. These barriers have been classified by the different participants in the research process, viz., healthcare providers, administrative personnel, researchers, and patients. Some of the barriers identified were lack of time and reimbursement for health promotion activities, and inadequate practice capacity, for health care providers; increased time and labor demands for administrative personnel; constrained access to participants, and limited funding, for researchers; and superseding commitments, and inaccurate comprehension of the research protocol, for patients. Solutions suggested to overcome these barriers include financial support, e.g., funding for researchers, remuneration for health care organization personnel, reimbursement for providers, payment for participants, and free or subsidized postage, and use of health facilities; motivational strategies such as inspirational leadership, and contests within health care organizations; and partnerships, with other expert technical and creative entities, to improve the quality, efficiency, and acceptability of health promotion interventions.

The association between physical activity and neck and low back pain: a systematic review

The effect of physical activity on neck and low back pain is still controversial. No systematic review has been conducted on the association between daily physical activity and neck and low back pain. The objective of this study was to evaluate the association between physical activity and the incidence/prevalence of neck and low back pain. Publications were systematically searched from 1980 to June 2009 in several databases. The following key words were used: neck pain, back pain, physical activity, leisure time activity, daily activity, everyday activity, lifestyle activity, sedentary, and physical inactivity. A hand search of relevant journals was also carried out. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Seventeen studies were included in this review, of which 13 were rated as high-quality studies. Of high-quality studies, there was limited evidence for no association between physical activity and neck pain in workers and strong evidence for no association in school children. Conflicting evidence was found for the association between physical activity and low back pain in both general population and school children. Literature with respect to the effect of physical activity on neck and low back pain was too heterogeneous and more research is needed before any final conclusion can be reached.

Community-based disability prevention programs for elders: predictors of program completion

Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. Program completion remains an important barrier to their effectiveness. We examined the association between provider relationships and client variables, and program completion in senior centers. Our mixed methods design used secondary data for 719 clients and primary data through telephone interviews with 20 nurses, 23 social workers, and 18 site managers. Quantitative data showed that higher client baseline self-efficacy positively influenced completion and minority status negatively influenced completion. Qualitative data showed that higher focus on provider-client relationships was associated with high completion.

The effect of exercise counselling with feedback from a pedometer on fatigue in adult survivors of childhood cancer: a pilot study

Objective

The aim of this study was to evaluate the results of home-based exercise counselling with feedback from a pedometer on fatigue in adult survivors of childhood cancer.

Patients

Adult survivors of childhood cancer were recruited from the long-term follow-up clinic of the University Medical Centre Groningen, The Netherlands. A score of 70 mm on a visual analogue scale (scale, 0–100 mm) for fatigue was used as an inclusion criterion. Controls were recruited by the survivors among their healthy siblings or peers.

Methods

During 10 weeks, the counselor encouraged the survivors to change their lifestyle and enhance daily physical activity such as walking, cycling, housekeeping and gardening. As a feedback to their physical activity, the daily number of steps of each survivor was measured by a pedometer and registered using an online step diary at the start of the programme and after 4 and 10 weeks. Fatigue was the primary outcome measure, assessed with the Checklist Individual Strength (CIS) at start (T0), 10 weeks (T10) and 36 weeks (T36). Thirty-three healthy age-matched control persons were asked to complete the CIS.

Results

Out of 486 cancer survivors, 453 were interested and were asked to complete the VAS to measure fatigue; 67 out of 254 respondents met the inclusion criteria, 21 refused, 46 were enrolled and eight dropped out during the study. The mean scores on the CIS in the survivors at T0 was 81.42 (SD ± 20.14) and at T10 62.62 (SD ± 20.68), which was a significant improvement (p < 0.0005). At T36, the end of the study, the mean CIS score was 63.67 (SD ± 23.12); this was a significant improvement compared with the mean CIS at the start (p < 0.0005). There was no significant difference in the mean CIS scores of the controls during the follow-up period.

Conclusion

The stimulation of daily physical activity using exercise counselling and a pedometer over 10 weeks leads to a significant decrease in fatigue in adult survivors of childhood cancer, and this improvement lasts for at least 36 weeks.

State of the Art Reviews: Patient and Physician Communication About Weight Management: Can We Close the Gap?

Purpose. To understand and gain insight into improving communication about weight management between patients and physicians and answer the question, “How should physicians communicate with obese patients about weight management?” Design. Three patient focus groups of 5 participants each and 2 physician focus groups of 6 participants each, segregated by gender, during July and August 2004. Participants. Patients with a body mass index of ≥ 30, English speaking, aged 25 to 75 years. Physicians trained in internal medicine or family medicine from a large multispecialty group. Methods. Focus group discussions were transcribed verbatim, a coding scheme developed, and 4 independent reviewers coded each transcript. Consensus among reviewers was obtained. Results. Patients perceive that physicians do not initiate weight discussions, whereas physicians feel that they initiate these conversations regularly. Patients expressed desire for individualized information and advice about weight loss, yet physicians used 1 or 2 messages with all their patients and felt the individualized plans that some patients want are outside the role of the physician. Conclusion. Our results indicate that a communication gap does exist between patients and physicians about weight management. Individualized weight management advice by physicians for patients may reduce this gap.

Physical activity and physical fitness counseling patterns of adult nurse practitioners

PURPOSE

This descriptive exploratory study examined factors related to physical activity counseling practices of adult nurse practitioners (ANPs) nationwide. The purposes of this study were to (a) examine physical activity assessment and counseling practices, (b) identify barriers to physical activity counseling, (c) describe knowledge and confidence in physical activity assessment and counseling, (d) identify personal physical activity practices, and (e) describe use of objective physical fitness measures in the primary care setting.

DATA SOURCES

Participants were a randomly selected group of ANPs who are members of the American Academy of Nurse Practitioners.

CONCLUSIONS

Most ANPs (95%) counsel patients on physical activity at least once a year. As for assessing physical activity, simply asking about it was the most common method (94%). The most common strategy for counseling was discussion (95%). The most common barriers to counseling were lack of time (48%) and preemption by more important concerns (47%). Of fitness measures, the most commonly used was body composition. Cardiorespiratory, strength, flexibility, and balance fitness tests were used infrequently or rarely.

IMPLICATIONS FOR PRACTICE

NPs can use specific physical fitness measures to help assess, guide, and/or motivate physical activity in their patients.

Construct validity evidence for single-response items to estimate physical activity levels in large sample studies

Valid measurement of physical activity is important for studying the risks for morbidity and mortality. The purpose of this study was to examine evidence of construct validity of two similar single-response items assessing physical activity via self-report. Both items are based on the stages of change model. The sample was 687 participants (men = 504, women = 183) who completed an 8-response (PA8) or 5-response (PA5) single-response item about current level of physical activity. Responses were categorized as meeting or not meeting guidelines for sufficient physical activity to achieve a health benefit. Maximal cardiorespiratory fitness (CRF) and health markers were obtained during a clinical examination. Partial correlation, multivariate analysis of covariance, and logistic regression were used to identify the relations between self-reported physical activity, CRF, and health markers when controlling for gender and age. Single-response items were compared to a detailed measure of physical activity. Single-response items correlated significantly with CRF determined with a maximal exercise test on a treadmill (PA8 = .53; PA5 = .57). Differences in percentage of body fat and cholesterol were in the desired direction, with those self-reporting sufficient physical activity for a health benefit having the lower values. The single-response items demonstrated evidence of construct validity and may provide feasible, cost-effective, and efficient methods to assess physical activity in large-scale studies.

From innovation to practice: initiation, implementation and evaluation of a physician-based physical activity promotion programme in Finland

In 2001, a collaborative Physical Activity Prescription Programme (PAPP) was started in Finland to increase physical activity (PA) counselling among physicians, especially in primary care. This article describes the initiation, implementation and evaluation of PAPP. Five actions were implemented to reach the programme goal: (i) developing a counselling approach for physicians; (ii) providing easy and open access to counselling material; (iii) facilitating physicians' uptake and adoption of the counselling approach; (iv) disseminating information about the counselling approach to physicians, health and exercise professionals and decision-makers and (v) raising financial resources to cover programme expenses. Evaluation was based on the dimensions of the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance. Effectiveness and adoption were evaluated with two questions added to the annual survey of the Finnish Medical Association to all practising physicians in the year 2002 (n = 16 692) and 2004 (n = 17 170). The 4-year PAPP was successful in reaching health care units (Reach), accomplishing most of the implementation actions (Implementation) and initiating local projects for institutionalizing the prescription-based counselling approach, 'Prex' (Maintenance). However, at the national level, the programme was not effective in increasing the frequency of asking about patients' PA habits (Effectiveness) or the frequency of using 'Prex' or other written material in PA counselling among physicians (Adoption). To improve the latter two, the duration of the programme would have had to be extended with more effort at strengthening physicians' confidence in PA counselling and knowledge about its effectiveness. Also, a more systematic approach would have been necessary to facilitate inter-sectoral network for adopting 'Prex' as a counselling tool at the local level.

A randomized intervention of physical activity promotion and patient self-monitoring in primary health care

OBJECTIVES

To examine the effectiveness of prescription-based counseling and self-monitoring in the promotion of physical activity in primary health care.

METHODS

The study was conducted in Finland during 2003-2004. Physicians from 24 health care units (N = 67) were randomized to a prescription or a non-prescription group. The patients (N = 265) were assigned to the groups according to their physician. Every other patient of the non-prescription physicians received a pedometer and a physical activity log (MON) and feedback about their 5-day-recordings, the rest served as controls (CON). PA was assessed prior and 2 and 6 months after the physician's appointment with a questionnaire.

RESULTS

The mean increase in weekly overall physical activity at 2 months was 1.0 (95% CI 0.0 to 2.0) session more in the prescription group than in controls. In at least moderate-intensity physical activity, the mean difference in changes was 0.8 (95% CI 0.1 to 1.5) sessions at 2 months and 0.9 (95% CI 0.2 to 1.5) sessions at 6 months for the favor of the prescription group. Compared to controls, self-monitoring increased the weekly duration of overall PA at 2 months on average by 217 min (95% CI 23 to 411).

CONCLUSIONS

Prescription can be recommended as a tool for primary health care physicians to promote physical activity. Self-monitoring with an expert feedback can be useful in increasing especially the weekly duration of overall physical activity in the short term.

Self-reported physical activity among South Carolina adults trying to maintain or lose weight

OBJECTIVES

The obesity epidemic is related to widespread physical inactivity in the United States. This study determined the proportion of South Carolinians trying to maintain or lose weight and within that subpopulation, the number who practiced a restricted diet and engaged in physical activity.

METHODS

Data from the 2002 South Carolina Behavioral Risk Factor Surveillance System survey were used to classify adults who were trying to maintain weight or lose weight. Self-reported prevalence of restricted diet and participation in physical activity were investigated. Of those who reported weight control practices, levels of physical activity were analyzed to determine if those trying to maintain weight or lose weight were meeting the national guidelines for moderate or vigorous physical activity.

RESULTS

More than 70% of South Carolina adults reported trying to control their weight and the majority reported using physical activity for weight control. Though the majority reported use of restricted diet and physical activity, more than one-half of those individuals did not meet the minimum standards for physical activity designed for heart health.

CONCLUSIONS

Although most adults who are trying to maintain or lose weight are participating in physical activity, public health efforts need to focus on encouraging these adults to increase their levels of physical activity to meet the minimum standards for health benefits. Health care providers have an opportunity to educate and encourage patients about the recommended levels of physical activity to obtain maximum health benefits.

Physical activity levels among overweight and obese adults in South Carolina

BACKGROUND

Obesity in the United States has reached epidemic proportions and is a major cause of morbidity and mortality.

METHODS

We describe the activity levels of South Carolina adults on the basis of data derived from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System.

RESULTS

Overweight and obese men and women reported less leisure time physical activity than did people of normal weight, with women found to be less active than men.

CONCLUSION

Physical inactivity is more prevalent among obese and overweight men and women than among people of normal weight. Visiting the physician's office offers a unique opportunity to educate patients about the health benefits and appropriate amount of physical activity.