Annals of Behavioral Medicine

, Volume 30, Issue 2, pp 146–154

Physical activity counseling in primary care and patient well-being: Do patients benefit?

  • Roger T. Anderson
  • Abby King
  • Anita L. Stewart
  • Fabian Camacho
  • W. Jack Rejeski
Article

Abstract

Background: Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease. Benefits to health-related quality of life (HRQL) and subjective well-being may be as important and take less time to accrue.Purpose:We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial (ACT), both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention.Methods: In ACT, 395 female and 479 male inactive patients ages 35 to 75 years were randomized to one of: physician advice, advice plus behavioral counseling during primary care visits, or advice plus behavioral counseling that also included telephone contact and behavioral classes. Participants were assessed at baseline, 6 months, and 24 months. HRQL was assessed as perceived quality of life, perceived stress, depression, and general health. Satisfaction with function and appearance, self-efficacy, and social support were also assessed.Results: At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms. These results mirrored V02max changes observed per group. Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months.Conclusions: Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. (1).
    National Center for Health Statistics:Healthy People 2000 Review 1994. Hyattsville, MD: Public Health Service, 1995.Google Scholar
  2. (2).
    King AC, Pruitt LA, Phillips W, et al.: Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults.Journal of Gerontology: Medical Sciences. 2000,55A: M74-M83.Google Scholar
  3. (3).
    Dunn AL, Trivedi MH, O’Neal HA: Physical activity dose-response effects on outcomes of depression and anxiety.Medical Science Sports Exercise. 2001,33(6, Suppl.):587S-597S.CrossRefGoogle Scholar
  4. (4).
    Mokdad AH, Bowman BA, Ford ES, et al.: The continuing epidemics of obesity and diabetes in the United States.Journal of the American Medical Association. 2001,286:1195–1200.PubMedCrossRefGoogle Scholar
  5. (5).
    Coakley EH, Kawachi I, Manson JE, et al.: Lower levels of physical functioning are associated with higher body weight among middle-aged and older women.International Journal of Relative Metabolic Diseases. 1998,22:958–965.CrossRefGoogle Scholar
  6. (6).
    Hill JO, Wyatt HR, Reed GW, Peters JC: Obesity and the environment: Where do we go from here?Science. 2003,7:853–855.CrossRefGoogle Scholar
  7. (7).
    Rejeski WJ, Brawley LR, Shumaker SA: Physical activity and health-related quality of life.Exercise and Sport Science Reviews. 1996,24:71–108.Google Scholar
  8. (8).
    Fontaine KR, Barofsky I: Obesity and health-related quality of life.Obesity Reviews. 2001,2:173–182.PubMedCrossRefGoogle Scholar
  9. (9).
    Anderson RT, Hogan P, Appel L, Rosen R, Shumaker SA: Baseline correlates of quality of life among men and women with medically controlled hypertension: The TONE study.Journal of the American Geriatrics Society. 1997,4:1080–1085.Google Scholar
  10. (10).
    Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP: Self-reported body mass index and health-related quality of life: Findings form the behavioral risk factor surveillance system.Obesity Research. 2001,9:21–31.PubMedGoogle Scholar
  11. (11).
    Shumaker SA, Anderson RT, Czajkowski SM: Psychological tests and scales. In Spilker B (ed),Quality of Life Assessments in Clinical Trials. New York: Raven, 1990, 95–113.Google Scholar
  12. (12).
    McAuley E: Physical activity and psychosocial outcomes. In Bouchard C, Shephard RJ, Stephens T (eds),Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement. Champaign, IL: Human Kinetics, 1994, 551–568.Google Scholar
  13. (13).
    Norris R, Carroll D, Cochrane R: The effects of aerobic and anaerobic training on fitness, blood pressure and psychological stress and well-being.Journal of Psychosomatic Research. 1990,34:367–375.PubMedCrossRefGoogle Scholar
  14. (14).
    Tyni-Lenne T, Gordon A, Europe E, Jansson E, Sylven C: Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and quality of life in both women and men with chronic heart failure.Journal of Cardiac Failure. 1998,4:9–17.PubMedCrossRefGoogle Scholar
  15. (15).
    McGowan RW, Pierce EF, Jordan D: Mood alterations with a single bout of physical activity.Perceptual and Motor Skill. 1991,72:1203–1209.CrossRefGoogle Scholar
  16. (16).
    North TC, McCullagh P, Tran ZV: Effect of exercise on depression.Exercise and Sport Science Reviews. 1990,18:379–415.Google Scholar
  17. (17).
    Gauvin L, Rejeski J: The Exercise-Induced Feeling Inventory: Development and initial validation.Journal of Exercise Psychology. 1993,15:403–423.Google Scholar
  18. (18).
    Moses J, Steptoe A, Matthews A, Edwards S: The effects of exercise training on mental well-being in the normal population: A controlled study.Journal of Psychosomatic Research. 1989,33:47–61.PubMedCrossRefGoogle Scholar
  19. (19).
    Stewart KJ, Lelemen MH, Ewart C: Relationships between self-efficacy and mood before and after exercise training.Journal of Cardiopulmonary Rehabilitation. 1994,14:35–42.CrossRefGoogle Scholar
  20. (20).
    Martin JE, Dubbert PM: Exercise applications and promotion in behavioral medicine: Current status and future directions.Journal of Consulting and Clinical Psychology. 1982,50:1004–1017.PubMedCrossRefGoogle Scholar
  21. (21).
    King A, Taylor CB, Haskell W, Debusk RF: Influence of regular aerobic exercise on psychological health: A randomized, controlled trial of health in middle-aged adults.Health Psychology. 1989,8:305–324.PubMedCrossRefGoogle Scholar
  22. (22).
    Taylor CB, Sallis J, Needle R: The relation of physical activity and exercise to mental health.Public Health Reports. 1985,100:195–202.PubMedGoogle Scholar
  23. (23).
    Morgan K, Bath PA: Customary physical activity and psychological well-being: A longitudinal study.Age and Aging. 1998,27(Suppl. 3):35S-40S.Google Scholar
  24. (24).
    The ACT Writing Group: Effects of physical activity counseling in primary care. The Activity Counseling Trial: A randomized controlled trial.Journal of the American Medical Association. 2001,286:677–687.CrossRefGoogle Scholar
  25. (25).
    Smith BJ, Bauman AE, Bull FC, Tooth ML, Harris MF: Promoting physical activity in general practice: a controlled trial of written advice and information materials.British Journal of Sports Medicine. 2000,34:262–267.PubMedCrossRefGoogle Scholar
  26. (26).
    Norris SL, Grothaus LC, Burchner DM, Pratt M: Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO.Preventive Medicine. 2000,30:513–523.PubMedCrossRefGoogle Scholar
  27. (27).
    Pinto B, Lynn H, Marcus BH, Goldstein MG: Physician-based activity counseling: Intervention effects on mediators of motivational readiness for physical activity.Annals of Behavioral Medicine. 2001,23:2–10.PubMedCrossRefGoogle Scholar
  28. (28).
    Blair SN, Applegate WB, Dunn AL, et al.: Activity Counseling Trial (ACT): Rationale, design, and methods. Activity Counseling Trial Research Group.Medical Science and Sports Exercise. 1998,30:1097–1106.CrossRefGoogle Scholar
  29. (29).
    Simons-Morton DG, Hogan P, Dunn AL, et al.: Characteristics of inactive primary care patients: Baseline data from the activity counseling trial. For the Activity Counseling Trial Research Group.Preventive Medicine. 2000,31:513–521.PubMedCrossRefGoogle Scholar
  30. (30).
    King AC, Pruitt, LA, Phillips W, et al.: Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults.Journal of Gerontology: A Biological Medical Science. 2000,55:M74-M83.Google Scholar
  31. (31).
    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.PubMedCrossRefGoogle Scholar
  32. (32).
    American College of Sports Medicine: The recommended quantity and quality of exercise for developing and maintaining cardio respiratory and muscular fitness in healthy adults.Medical Science Sports. 1990,82:265–274.Google Scholar
  33. (33).
    Cohen S, Williamson GM: Perceived stress in a probability sample of the United States. In Spacapan S, Oskamp S (eds),The Social Psychology of Health. Newbury Park, CA: Sage, 1988, 31–67.Google Scholar
  34. (34).
    Pbert L, Doerfler L, DeCosimo D: An evaluation of the Perceived Stress Scale in two clinical populations.Journal of Psychopathology and Behavioral Assessment. 1992,14:363–375.CrossRefGoogle Scholar
  35. (35).
    Beck AT, Steer RA, Garbin MC: Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.Clinical Psychology Review. 1988,8:77–80.CrossRefGoogle Scholar
  36. (36).
    Patrick D, Danis M, Southerland LI, Hong G: Quality of life following intensive care.Journal of General Internal Medicine. 1988,3:218–223.PubMedCrossRefGoogle Scholar
  37. (37).
    Ray KM, Hector LL, Lynes LK, et al.: Assessment of satisfaction with physical fitness in kidney transplant recipients [Abstract].Medicine and Science in Sports and Exercise. 1996,28(Suppl.):S7.Google Scholar
  38. (38).
    Reboussin BA, Rejeski WJ, Martin KA, et al.: Correlates of satisfaction with body function and body appearance in middle-and older adults: The activity counseling trial (ACT).Psychology and Health. 2000,15:239–254.CrossRefGoogle Scholar
  39. (39).
    Ware J, Kosinski M, Keller S: A 12-item Short Form Health Survey. Construction of scales and preliminary tests of reliability and validity.Medical Care. 1996,34:220–233.PubMedCrossRefGoogle Scholar
  40. (40).
    Blair SN, Haskell WL, Ho P: Assessment of habitual physical activity by a seven—day recall in a community survey and controlled experiments.American Journal Epidemiology. 1985,122:794–804.Google Scholar
  41. (41).
    Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR: The development of scales to measure social support for diet and exercise behaviors.Preventive Medicine. 1987,16:825–836.PubMedCrossRefGoogle Scholar
  42. (42).
    Barron RM, Kenny DA: The moderator—mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology. 1986,51:1173–1182.CrossRefGoogle Scholar
  43. (43).
    Holmbeck GN: Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures.Journal of Consulting and Clinical Psychology. 1997,65:599–610.PubMedCrossRefGoogle Scholar
  44. (44).
    Margitic S, Sevick MA, Miller M, et al.: Challenges faced in recruiting patients from primary care practices into a physical activity intervention trial. Activity Counseling Trial Research Group.Preventive Medicine. 1999,4:277–286.CrossRefGoogle Scholar
  45. (45).
    Lazarus RS, Folkman S:Stress, Appraisal, and Coping. New York: Springer, 1984.Google Scholar
  46. (46).
    Baker DB: The study of stress at work.Annual Review of Public Health. 1985,6:367–381.PubMedCrossRefGoogle Scholar
  47. (47).
    Rejeski WJ, Brawley LR, Ambrosius WT, et al.: Older adults with chronic disease: Benefits of group-mediated counseling in the promotion of physically active lifestyles.Health Psychologist. 2003,22:414–423.CrossRefGoogle Scholar
  48. (48).
    Lorig K, Seleznick M, Lubeck D, et al.: The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change.Arthritis and Rheumatis. 1989,32:91–95.CrossRefGoogle Scholar
  49. (49).
    Lorig K, Sobel DS, Ritter P, Laurent D, Hobbs M: Effects of a selfmanagement program on patients with chronic disease.Effective Clinical Practice. 2001,4:256–262.PubMedGoogle Scholar
  50. (50).
    Lorig K, Sobel D, Stewart A, et al.: Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial.Medical Care. 1999,37:5–14.PubMedCrossRefGoogle Scholar
  51. (51).
    Lorig K, González V, Ritter P: Community—based Spanish language arthritis education program: A randomized trial.Medical Care. 1999,37:957–963.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2005

Authors and Affiliations

  • Roger T. Anderson
    • 1
  • Abby King
    • 2
  • Anita L. Stewart
    • 3
  • Fabian Camacho
    • 4
  • W. Jack Rejeski
    • 5
  1. 1.Department of Public Health SciencesWake Forest University School of MedicineWinston-Salem
  2. 2.Stanford Prevention Research CenterStanford University School of MedicineUSA
  3. 3.Institute for Health & AgingUniversity of California San FranciscoUSA
  4. 4.Department of Public Health SciencesWake Forest University School of MedicineUSA
  5. 5.Department of Health and Exercise ScienceWake Forest University—Reynolda CampusUSA

Personalised recommendations