Putting Prevention Into Practice: An Evidence-Based Approach

Behavioral Counseling in Primary Care to Promote Physical Activity

Am Fam Physician. 2003 May 1;67(9):1975-1976.

Case Study

SR, a 40-year-old woman with no significant medical history other than smoking, comes to you for a check-up. You counsel her on smoking cessation and review her preventive health needs. You wonder if you should counsel SR regarding physical activity. You know that physical activity has health benefits but question whether counseling will result in a sustained increase in her physical activity level.

Case Study Questions

  1. Which of the following statements concerning physical activity is/are correct?

    • A. Regular physical activity helps prevent cardiovascular disease, hypertension, and type 2 diabetes.

    • B. The benefits of exercise are equal, regardless of the level of activity achieved.

    • C. Forty percent of U.S. adults achieve 30 minutes of moderate physical activity daily.

    • D. Many organizations recommend physical activity counseling based on the health benefits of physical activity rather than the effectiveness of counseling.

  2. Which one of the following statements regarding the U.S. Preventive Services Task Force (USPSTF) recommendations on behavioral counseling to promote physical activity is correct?

    • A. The USPSTF recommends behavioral counseling to promote physical activity for adults in primary care settings.

    • B. The USPSTF recommends behavioral counseling to promote physical activity for children in primary care settings.

    • C. The USPSTF does not recommend for or against behavioral counseling in primary care settings to promote physical activity.

    • D. The USPSTF recommends behavioral counseling to promote physical activity for adults and children in primary care settings.

    • E. The USPSTF recommends behavioral counseling to promote physical activity for adults aged 40 and older in primary care settings.

Answers

1. The correct answers are A and D. Regular physical activity has been shown to help prevent cardiovascular disease, hypertension, type 2 diabetes, obesity, and osteoporosis. It also may decrease all-cause morbidity and increase life span. Benefits from physical activity are seen even at modest levels, and they increase with increasing levels of activity. The Healthy People 2010 recommended level of moderate exercise is 30 minutes, preferably daily. Currently, only about 20 percent of adults achieve this level. Many recommendations that promote physical activity counseling are based on the health benefits rather than the effectiveness of counseling.

2. The correct answer is C. Whether routine counseling and follow-up by primary care physicians result in increased physical activity among their patients is unclear. Therefore, the USPSTF concluded that the evidence is insufficient to recommend for or against routine behavioral counseling in primary care settings to promote physical activity. Existing studies limit the conclusions that can be drawn about efficacy, effectiveness, and feasibility of physical activity counseling. Most of the evaluated studies tested brief, minimal, and low-intensity interventions. However, studies testing multi-component interventions combining provider advice with behavioral interventions to facilitate and reinforce healthy levels of physical activity appeared promising. Examples include tailored physical activity programs, patient goalsetting, written exercise prescriptions, and mailed or telephone follow-up; these may be enhanced if linked with community-based programs. The USPSTF found no completed studies that examined the effectiveness of physical activity counseling for children or adolescents, although several such studies are in progress.

SOURCES

Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM. Counseling by clinicians: does it improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:208–15.

Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM. Clinical counseling to promote physical activity. Systematic Evidence Review No. 9 (prepared by Oregon Health & Science University Evidence-Based Practice Center, Portland, Oregon under Contract No. 290-97-0018). AHRQ Publication No. 02-S002. Rockville, Md.: Agency for Healthcare Research and Quality, 2002.

U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: recommendations and rationale. Rockville, Md.: Agency for Healthcare Research and Quality, 2002.

The case study and answers to the following questions about behavioral counseling in primary care to promote physical activity are based on the recommendations of the current U.S. Preventive Services Task Force (USPSTF), part of the Put Prevention into Practice program of the Agency for Healthcare Research and Quality (AHRQ). This recommendation was released in 2002 and is an update of the 1996 recommendation on behavioral counseling to promote physical activity. More detailed information on this subject is available in the Systematic Evidence Review, Summary of the Evidence, and USPSTF Recommendations and Rationale on the AHRQ Web site (www.ahrq.gov). The Summary of the Evidence and the USPSTF Recommendations and Rationale are available in print through the AHRQ Publications Clearinghouse (800-358-9295).

This case study is part of AFP's CME. See “Clinical Quiz” on page 1865.


Copyright © 2003 by the American Academy of Family Physicians.
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