Advertisement

Canadian Journal of Public Health

, Volume 99, Issue 1, pp 26–30 | Cite as

Examining Physician Counselling to Promote the Adoption of Physical Activity

  • Kevin S. Spink
  • Bruce Reeder
  • Karen Chad
  • Kathleen Wilson
  • Darren Nickel
Article

Abstract

Background

While the benefits of physical activity are generally recognized, over half of adult Canadians are not active enough to receive those benefits. Physicians may influence patient activity through counselling; however, research is inconsistent regarding their effectiveness in doing so. Increasing patients’ use of self-regulatory skills in managing their activity and additional telephone support are suggested as two means of improving physician counselling. When assessing the effectiveness of physician counselling, it may be important to measure both outcome and treatment adherence. We compared physician-directed activity counselling (modified PACE protocol) with a modified PACE protocol augmented with telephone-based counselling for patient support for both outcome and treatment adherence.

Methods

Physicians counselled 90 patients using a modified PACE protocol that included self-regulatory skills. Physical activity was assessed by questionnaire at baseline (prior to counselling) and one month later. Participants were divided into two groups: counselling (modified PACE counselling) and enhanced counselling (modified PACE counselling plus telephone support).

Results

The main outcome (mean energy expenditure) and secondary outcomes of treatment adherence (frequency, frequency of moderate activity, and duration) significantly increased over time (p<0.05). No significant interactions between group and time were found.

Interpretation

Our results support the effectiveness of physician counselling for activity that included the use of self-regulation skills. The effectiveness of telephone support over and above that of physician counselling was not supported. Our results demonstrate that assessing treatment adherence provides a means of discerning whether the counselling intervention was delivered as intended.

Keywords

Directive counselling exercise physicians 

Résumé

Contexte

Bien que les avantages de l’activité physique soient généralement reconnus, plus de la moitié des Canadiens adultes n’en tirent pas parti, car ils ne sont pas suffisamment actifs. Les médecins peuvent influencer le niveau d’activité de leurs patients par des conseils, mais les chercheurs ne s’entendent pas sur l’efficacité de ce counseling. Deux moyens sont suggérés pour améliorer les conseils des médecins: accroître l’utilisation des techniques d’autorégulation du conditionnement physique par les patients et leur offrir un soutien téléphonique supplémentaire. Lorsqu’on évalue l’efficacité du counselling des médecins, il peut être important de mesurer à la fois les résultats et l’assiduité au traitement. Nous avons donc comparé les conseils sur l’activité physique donnés par les médecins (selon un protocole PACE1 modifié) et les mêmes conseils agrémentés d’un soutien téléphonique aux patients, en mesurant à la fois les résultats obtenus et l’assiduité au traitement.

Méthode

Des médecins ont conseillé 90 patients à l’aide d’un protocole PACE modifié incluant des techniques d’autorégulation. Les niveaux d’activité physique ont été évalués au moyen d’un questionnaire de départ (avant le counselling) et un mois plus tard. Les participants ont été divisés en deux groupes, selon qu’ils avaient reçu le counselling PACE modifié ou le counselling amélioré (protocole PACE modifié et soutien téléphonique).

Résultats

Le résultat principal (la force moyenne dépensée) et les résultats secondaires, liés à l’assiduité au traitement (fréquence, fréquence des activités physiques d’intensité modérée, durée), ont considérablement augmenté au fil du temps (p<0,05). Aucune interaction significative n’a été observée entre les données selon le groupe et les données selon la date d’administration du questionnaire.

Interprétation

Les résultats confirment l’efficacité des conseils des médecins en matière d’activité physique lorsqu’ils incluent des techniques d’autorégulation. L’efficacité du soutien téléphonique en plus des conseils des médecins n’est pas confirmée. Ces résultats montrent que l’évaluation de l’assiduité au traitement est un moyen de déterminer si l’intervention de counselling a été offerte comme il le fallait.

Motsclés

counselling directif conditionnement médecins 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bauman A, Owen N. Physical activity of adult Australians: Epidemiological evidence and potential strategies for health gain. J Sci Med Sport 1999;2:30–41.CrossRefGoogle Scholar
  2. 2.
    Haapanen-Niemi N, Vuori I, Pasanen M. Public health burden of coronary heart disease risk factors among middle-aged and elderly men. Prev Med 1999;28:343–48.CrossRefGoogle Scholar
  3. 3.
    Craig CL, Russell SJ, Cameron C, Bauman A. Twenty-year trends in physical activity among Canadian adults. Can J Public Health 2004;95:59–63.Google Scholar
  4. 4.
    Cameron C, Craig CL. Increasing Physical Activity: Building Active Workplaces. Ottawa, ON: Canadian Fitness and Lifestyle Research Institute, 2004.Google Scholar
  5. 5.
    PACE Canada. PACE Canada Online Training Module. Available online at: https://doi.org/www.pace-canada.org/train.htm (Accessed July 12, 2006).
  6. 6.
    U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: Recommendation and rationale. Am J Nurs 2003;103:101–7.Google Scholar
  7. 7.
    Beaulieu MD. Physical Activity Counselling. Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Ottawa: Health Canada, 1994;560–69.Google Scholar
  8. 8.
    Pipe A. Get active about physical activity. Ask, advise, assist: Get your patients moving. Can Fam Phys 2002;48:13–14.Google Scholar
  9. 9.
    Estabrooks P, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA 2003;289:2913–16.CrossRefGoogle Scholar
  10. 10.
    Meichenbaum D, Turk DC. Facilitating Treatment Adherence: A Practitioner’s Guidebook. New York, NY: Plenum Press, 1987.CrossRefGoogle Scholar
  11. 11.
    Marcus BH, Goldstein MG, Jette A, Simkin-Silverman L, Pinto BM, Milan F. Training physicians to conduct physical activity counseling. Prev Med 1997;26:382–88.CrossRefGoogle Scholar
  12. 12.
    Green BB, McAfee T, Hindmarsh M, Madsen L, Caplow M, Buist D. Effectiveness of telephone support in increasing physical activity levels in primary care patients. Am J Prev Med 2002;22:177–83.CrossRefGoogle Scholar
  13. 13.
    Haynes R. Compliance with health advice: An overview with special reference to exercise programs. J Cardiac Rehab 1984;4:120–23.Google Scholar
  14. 14.
    Haynes R, Taylor D, Snow J, Sackett D. Annotated and indexed bibliography on compliance with therapeutic and preventive regimens. In: Haynes R, Taylor D, Sackett D (Eds.), Compliance in Health Care. Baltimore, MD: Johns Hopkins Press, 1979;337–474.Google Scholar
  15. 15.
    Eakin EG, Smith BJ, Bauman AE. Evaluating the population health impact of physical activity interventions in primary care–Are we asking the right questions? J Physical Activity Health 2005;2:197–215.CrossRefGoogle Scholar
  16. 16.
    PACE Canada. Health Provider’s Guide to Counseling for Healthy Active Living. Ottawa: Canadian Fitness and Lifestyle Research Institute, 2000.Google Scholar
  17. 17.
    Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med 1996;25:225–33.CrossRefGoogle Scholar
  18. 18.
    Calfas KJ, Hagler AS. Physical activity. In: Gorin SS, Arnold J (Eds.), Health Promotion in Practice. San Francisco, CA: Jossey-Bass, 2006;192–221.Google Scholar
  19. 19.
    Prochaska JO, Marcus BH. The transtheoretical model: Applications to exercise. In: Dishman RK (Ed.), Advances in Exercise Adherence. Champaign, IL: Human Kinetics, 1994;161–80.Google Scholar
  20. 20.
    Kriska AM, Knowler WC, Laporte RE, Drash AL, Wing RR, Blair SN. Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 1990;13:401–11.CrossRefGoogle Scholar
  21. 21.
    Stevens J. Applied Multivariate Statistics for the Social Sciences, 4th ed. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers, 2002.Google Scholar
  22. 22.
    Burke SM, Carron AV, Eys MA, Estabrooks P. Physical activity interventions delivered to participants at home: The influence of contact from others. J Sport Exerc Psychol 2005;27:S44.Google Scholar
  23. 23.
    Latimer AE, Katulak N, Mowad L, Salovey P. Motivating cancer prevention and early detection behaviors using psychologically tailored messages. J Health Communication 2005;10(Suppl1):137-55.Google Scholar
  24. 24.
    Taylor CB, Coffey T, Berra K, Iaffaldano R, Casey K, Haskell WL. Seven-day activity and self-report compared to a direct measure of physical activity. Am J Epidemiol 1984;120:818–24.CrossRefGoogle Scholar
  25. 25.
    In motion Physical Activity Survey. Saskatoon, SK: Fast Consulting, 2004.Google Scholar

Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Kevin S. Spink
    • 1
  • Bruce Reeder
    • 2
  • Karen Chad
    • 1
  • Kathleen Wilson
    • 1
  • Darren Nickel
    • 1
  1. 1.College of KinesiologyUniversity of SaskatchewanSaskatoonCanada
  2. 2.Department of Community Health and Epidemiology, College of MedicineUniversity of SaskatchewanCanada

Personalised recommendations