Training in exercise counseling

Physical activity counseling in primary care: who has and who should be counseling?

OBJECTIVE

To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA.

METHOD

MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings.

RESULTS

Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (>6 months). There was substantial variation in the location and counseling approach employed by allied health professionals.

CONCLUSION

We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors.

PRACTICE IMPLICATIONS

With physical activity counselors' specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance.

Teaching resident physicians to provide exercise counseling: a needs assessment

PURPOSE

To determine the behaviors, knowledge, and attitudes of resident physicians regarding exercise counseling.

METHOD

In 1997, a self-administered questionnaire was sent to 313 internal medicine resident physicians at six U.S. training programs. Pearson correlation coefficients examined associations between the resident physicians' practices, attitudes, and personal habits. Stepwise multiple linear regression identified predictors of exercise counseling by the resident physicians.

RESULTS

A total of 251 resident physicians responded. Only 15.5% reported counseling more than 80% of the clinic patients about exercise. Over 93% understood the benefits of exercise, and almost all (96%) felt that it was a physician's responsibility to counsel patients about exercise. Only 29% felt successful at getting their patients to start exercising, and only 28% felt confident in their skills to prescribe exercise for patients. Ninety-one percent felt that training in exercise counseling would be worthwhile. The significant predictors of physician exercise counseling were perception of exercise counseling as a priority (p <.001), confidence in exercise-counseling skills (p <.001), and postgraduate year of training (p <.05) (R(2) =.18). The significant predictors of physicians' confidence in exercise-counseling skills included physician's gender (i.e., men) (p <.001), perception that exercise is important for a healthy 35-year-old (p <.01), feeling successful at exercise counseling (p <.001), perceiving less interference with counseling by barriers (p <.001), and prior training in exercise counseling (p <.05) (R(2) =.44).

CONCLUSIONS

Resident physicians' perceptions of exercise counseling as a priority, confidence in counseling skills, and postgraduate year of training are important predictors of their providing exercise counseling. These factors should be addressed in future educational programs.

Talking to patients about aerobic exercise for disease prevention: an educational exercise for medical students

Numerous data demonstrate the importance of physical activity in reducing obesity and cardiovascular mortality and morbidity. Research demonstrates the beneficial impact of physician counseling on health promoting behaviors. Unfortunately, few physicians or medical students receive formal training in exercise counseling. We describe an educational activity used to provide medical students with the tools needed to begin to engage patients in activity counseling.

Activity counseling by primary care physicians

Modifying patients' sedentary lifestyle, a risk factor for many chronic diseases, is a challenge to health professionals. Although physicians can play a vital role in promoting physical activity among sedentary patients, the prevalence of physician-based exercise counseling is low. This paper presents a review of studies that have targeted physicians as agents of behavior change. Changing sedentary behavior is more likely to be effective when the intervention is grounded in theory. This paper outlines an integration of two theoretical models that have potential for enhancing behavior change, and it describes specific techniques for physicians interested in promoting a more active lifestyle among their patients.