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Physician-based physical activity counseling for middle-aged and older adults: A randomized trial

  • Published:
Annals of Behavioral Medicine

Abstract

Sedentary behavior among older adults increases risk for chronic diseases. Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients. The Physically Active for Life (PAL) project was a randomized, controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels. The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory. Twenty-four community-based primary care medical practices were recruited into the study; 12 were randomized to the Intervention condition and 12 to the Control condition. Physicians in the Intervention practices received training in the delivery of brief physical activity counseling. Subjects in the Intervention practices (n=181) received brief activity counseling matched to their stage of motivational readiness for physical activity, a patient manual, a follow-up appointment with their physician to discuss activity counseling, and newsletter mailings. Subjects in the Control practices (n=174) received standard care. Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly (PASE) were administered to subjects in both conditions at baseline, 6 weeks following their initial appointment, and at 8 months. Results showed that at the 6-week follow-up, subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition. This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores. Results suggest that more intensive, sustained interventions may be necessary to promote the adoption of physical activity among sedentary, middle-aged, and older adults in primary care medical practices.

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References

  1. U.S. Preventive Services Task Force:Guide to Clinical Preventive Services (2nd Ed.). Baltimore, MD: Williams & Wilkins 1996, 611–624.

    Google Scholar 

  2. Caspersen C, Kriska A, Dearwater S: Physical activity epidemiology as applied to elderly populations.Bailleres Clinical Rheumatology. 1994,8:7–27.

    Article  CAS  Google Scholar 

  3. Elward K, Larson D: Benefits of exercise for older adults.Clinical Geriatric Medicine. 1992,8:35–50.

    CAS  Google Scholar 

  4. Pate RR, Pratt M, Blair SN, et al: Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.Journal of the American Medical Association. 1995,273:402–407.

    Article  PubMed  CAS  Google Scholar 

  5. Simonsick E, Lafferty M, Phillips C, et al: Risk due to inactivity in physically capable older adults.American Journal of Public Health. 1993,83:1443–1450.

    Article  PubMed  CAS  Google Scholar 

  6. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health: Physical activity and cardiovascular health.Journal of the American Medical Association. 1996,276:241–246.

    Article  Google Scholar 

  7. U.S. Centers for Disease Control and Prevention: Prevalence of Sedentary Lifestyle-Behavioral Risk Factor Surveillance System, United States, 1991.Morbidity and Mortality Weekly Report. 1993,42:576–579.

    Google Scholar 

  8. U.S. Department of Health and Human Services:Vital and Health Statistics. Physician Contacts by Sociodemographic and Health Characteristics, United States 1982–1983. DHHS Publication No. (PHS) 87-1589. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, National Center for Health Statistics, 1987.

    Google Scholar 

  9. Logsdon DN, Lazaro CM, Meier RV: The feasibility of behavioral risk reduction in primary medical care.American Journal of Preventive Medicine. 1989,5:249–256.

    PubMed  CAS  Google Scholar 

  10. Lewis BS, Lynch WD: The effect of physician advice on exercise behavior.Preventive Medicine. 1993,22:110–121.

    Article  PubMed  CAS  Google Scholar 

  11. Calfas K, Long BJ, Sallis JF, et al: A controlled trial of physician counseling to promote the adoption of physical activity.Preventive Medicine. 1996,25:225–233.

    Article  PubMed  CAS  Google Scholar 

  12. Grueninger UL, Duffy FD, Goldstein MG: Patient education in the medical encounter: How to facilitate learning, behavior change, and coping. In Lipkin M, Putnam S, Lazare A (eds),The Medical Interview. New York: Springer-Verlag, 1995.

    Google Scholar 

  13. Prochaska JO, DiClemente CC: States and processes of self-change in smoking: Towards an integrative model of change.Journal of Consulting and Clinical Psychology. 1983,51:390–395.

    Article  PubMed  CAS  Google Scholar 

  14. Bandura A: Self-efficacy. Toward a unifying theory of behavioral change.Psychological Review. 1977,84:191–215.

    Article  PubMed  CAS  Google Scholar 

  15. Green L: Health education models. In Matarazzo J, Weiss S, Herd J, Miller N, Weiss S (eds),Behavioral Health: A Handbook for Health Enhancement. New York: Wiley, 1984, 181–198.

    Google Scholar 

  16. Marcus BH, Pinto BM, Clark MM, et al: Physician delivered interventions for dietary and exercise promotion.Medicine, Exercise, Nutrition & Health. 1995,4:325–334.

    Google Scholar 

  17. Pinto BM, Goldstein MG, Marcus BH: Activity counseling by primary care physicians.Preventive Medicine. 1998,27:506–513.

    Article  PubMed  CAS  Google Scholar 

  18. Marcus BH, Goldstein MG, Jette A, et al: Training physicians to conduct physical activity counseling.Preventive Medicine. 1997,26:382–388.

    Article  PubMed  CAS  Google Scholar 

  19. Pinto BM, Goldstein MG, DePue JD, Milan FB: Acceptability and feasibility of physician-based activity counseling: The PAL Project.American Journal of Preventive Medicine. 1998,15:95–102.

    Article  PubMed  CAS  Google Scholar 

  20. Folio Associates:Folio's Medical Directory of Connecticut and Rhode Island (6th Ed.). Boston, MA: Folio Associates, Inc, 1990.

    Google Scholar 

  21. Glynn TJ, Manley MW:How to Help Your Patients Stop Smoking. A National Cancer Institute Manual for Physicians. Bethesda, MD: Smoking Tobacco and Cancer Program, Division of Cancer Prevention and Control, National Cancer Institute, 1989.

    Google Scholar 

  22. Marcus BH, Banspach SW, Lefebvre RC, et al: Using the stages of change model to increase the adoption of physical activity among community participants.American Journal of Health Promotion. 1992,6:424–429.

    PubMed  CAS  Google Scholar 

  23. Marcus BH, Emmons KM, Simkin-Silverman LR, et al: Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace.American Journal of Health Promotion. 1997,12:246–253.

    Google Scholar 

  24. Marcus BH, Rossi JS, Selby VC, Niaura RS, Abrams DB: The stages and processes of exercise adoption and maintenance in a worksite sample.Health Psychology. 1992,11:386–395.

    Article  PubMed  CAS  Google Scholar 

  25. Washburn RA, Smith KW, Jette AM, Janney CA: The Physical Activity Scale for the Elderly (PASE): Development and evaluation.Journal of Clinical Epidemiology. 1993,48:153–162.

    Article  Google Scholar 

  26. Ware JE, Sherbourne CD: The MOS 36-Item Short-Form Health Survey (SF-36).Medical Care. 1992,30:473–483.

    Article  PubMed  Google Scholar 

  27. Marcus BH, Rakowski W, Rossi JS: Assessing motivational readiness and decision-making for exercise.Health Psychology. 1992,11:257–261.

    Article  PubMed  CAS  Google Scholar 

  28. Marcus BH, Selby VC, Niaura RS, Rossi JS: Self-efficacy and the stages of exercise behavior change.Research Quarterly for Exercise and Sport. 1992,63:60–66.

    PubMed  CAS  Google Scholar 

  29. Marcus BH, Simkin LR: The stages of exercise behavior.Journal of Sports Medicine and Physical Fitness. 1993,33:83–88.

    PubMed  CAS  Google Scholar 

  30. American College of Sports Medicine: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults.Medicine and Science in Sports and Exercise. 1990,22:265–274.

    Google Scholar 

  31. Wolfinger R, O'Connel M: Generalized Linear Mixed Models: A pseudo-likelihood approach.Journal of Statistical, Computation and Simulation. 1993,48:233–243.

    Article  Google Scholar 

  32. King AC, Oka R, Pruitt L, Phillips W, Haskell WL: Developing optimal exercise regimens for seniors: A clinical trial.Annals of Behavioral Medicine. 1997,19(Suppl.):S56.

    Google Scholar 

  33. Adams PF, Benson V: Current estimates from the National Health Interview Survey, 1990.Vital Health Statistics. 1991,10:1–212.

    Google Scholar 

  34. Paffenbarger RS, Hyde RT, Wing AL, Hsieh C: Physical activity, all-cause mortality, and longevity of college alumni.New England Journal of Medicine. 1986,314:606–613.

    Google Scholar 

  35. Sallis JF, Haskell WL, Wood PD, et al: Physical activity assessment methodology in the five-city project.American Journal of Epidemiology. 1985,121:91–106.

    PubMed  CAS  Google Scholar 

  36. Hollis JF, Lichtenstein E, Vogt TM, Stevens VJ, Biglan A: Nurse-assisted counseling for smokers in primary care.Annals of Internal Medicine. 1993,118:521–525.

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. The Miriam Hospital, Providence, USA

    Michael G. Goldstein, Bernardine M. Pinto, Bess H. Marcus & Judith D. DePue

  2. Brown University, Providence, USA

    Michael G. Goldstein, Bernardine M. Pinto, Bess H. Marcus, William Rakowski, Judith D. DePue, Felise B. Milan & Catherine Dubé

  3. Bayer Institute for Health Care Communication, 400 Morgan Lane, 06516, West Haven, CT

    Michael G. Goldstein

  4. Boston University, Boston, USA

    Alan M. Jette

  5. New England Research Institutes, Watertown, USA

    Susan McDermott & Sharon Tennstedt

Authors
  1. Michael G. Goldstein
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  2. Bernardine M. Pinto
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  3. Bess H. Marcus
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  4. Henry Lynn
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  5. Alan M. Jette
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  6. William Rakowski
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  7. Susan McDermott
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  8. Judith D. DePue
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  9. Felise B. Milan
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  10. Catherine Dubé
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  11. Sharon Tennstedt
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Additional information

Rho Inc.

Preparation of this manuscript was supported in part by funding from the National Institute of Aging (RO1 AG12025) to the PAL project and Dr. Goldstein.

Thanks to Paula Pistocco, R.N., M.A., Janine Costa-Grigelevich, B.A., Kalene Hafey, B.S., Lisa Kopel, B.A., and Michael Vaughan, M.D., for assisting with the implementation of the study. We thank Barbara Doll for manuscript preparation. Thanks also to Steven Blair, P.E.D., Karen Calfas, Ph.D., Allen Dietrich, M.D., Charles Eaton, M.D., Thomas Kottke, M.D., Barbara Long, M.D., and Richard Washburn Ph.D. for reviewing the patient and physician intervention materials, and to Daniel Forman, M.D., for consultation during the trial. We acknowledge the assistance of physicians and office staffs that participated in the PAL project and Bristol-Myers Squibb for providing meals for the physician-training sessions.

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Goldstein, M.G., Pinto, B.M., Marcus, B.H. et al. Physician-based physical activity counseling for middle-aged and older adults: A randomized trial. ann. behav. med. 21, 40–47 (1999). https://doi.org/10.1007/BF02895032

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  • DOI: https://doi.org/10.1007/BF02895032

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