Making fitness a focus of day-to-day patient care is the goal of an AAFP Foundation research project for which the PepsiCo Foundation has pledged more than $1.9 million. The AAFP Foundation, the grant recipient, will subcontract work on the three-year project to AAFP's National Research Network, or NRN, and the Academy's fitness initiative, Americans in Motion, or AIM.
AAFP-Based Fitness Research Gains $1.9 Million Pledge
By Jane Stoever
1/24/2007
Twenty-four yet-to-be-selected practices will each enroll 30 or more patients in the project, which is called Americans in Motion-Healthy Intervention, or AIM-HI. The project will study the effects of brief primary care counseling and novel physiological measures on patients' physical and emotional health.
The project's goals are to
The project's goals are to
- tailor current AIM patient education materials so they are culturally appropriate for various audiences and better support counseling to improve patients' physical activity, diet and emotional well-being;
- evaluate the effects of encouraging clinicians and office staff to use the materials in their own efforts to change fitness-related behaviors and determine how this process affects their interventions with patients concerning behavior change; and
- evaluate the success patients have through interventions that include patient education materials and physiologic measures.
"The whole model of AIM is that you need to live a healthy lifestyle if you're going to preach a healthy lifestyle," says Wilson Pace, M.D., NRN's director and a professor in the family medicine department at the University of Colorado at Denver and Health Sciences Center. Pace will act as principal investigator for the new project.
"A pilot study, 'Leaders in Effective Activity Planning,' showed that when clinicians and staff members made small changes in their own lifestyles, they incorporated those better into their patient care," says Pace. "That's what we're trying to show with the new AIM-HI project. It will use a randomized, controlled trial, so the results should be highly evidence-based and not likely to have the biases associated with demonstration projects."
The project description says the study "is intended to help shift the paradigm of family physicians' use of common advice-giving methods to more effective patient-centered lifestyle counseling."
"Common advice includes 'Increase your physical activity' and 'Get rid of your doughnuts,'" says Pace. "When we try, instead, to build from people's lifestyles and have them share in the decision-making, we ask, 'What floor do you work on in your office? Have you considered walking up five flights and then taking the elevator the rest of the way?' Concerning diet, for people who don't drink diet soda, we suggest they could cut 240 calories a day if they cut out one soda -- they can substitute water, tea or flavored water with no calories. These suggestions are specific and practical."
The PepsiCo Foundation is the charitable arm of PepsiCo Inc., which has been a core supporter of AIM since 2005. This new project directly applies to one of PepsiCo Foundation's key audiences -- health professionals -- for promoting people's health and wellness, says Claire Lyons, manager of global grant programs for the PepsiCo Foundation.
"We thought family physicians, as opposed to single-issue or single-disease practitioners, have a more holistic relationship with their patients and are particularly effective channels for engaging people around healthy lifestyles," says Lyons. The PepsiCo Foundation decided to back the project because it targets health professionals; it will generate science-based evidence; and it will tailor fitness messages to Hispanics, blacks and Native American populations, says Lyons.
The research project will study how physicians, office staff and patients integrate healthy activities into their lives, says Sarah McMullen, AIM's director. "For example, we'll look at who the 24 practices employ and do a review of office staff members to help them integrate behavior change within their daily lives," whether it relates to nutrition, exercise or emotional well-being, says McMullen. "Then we'll invest in helping them make changes at the practice level that will translate into helping patients improve their health."
To enroll in the study, patients should be at least 18 years old and should have a body mass index of 30 or more, the threshold for obesity. "People with a BMI that high are more likely than others to have at least mild insulin resistance and adverse lipoprotein profiles," says Pace.
To show change as patients progress, clinicians will use a homeostatic assessment for insulin resistance, or HOMA-IR, and a nuclear magnetic resonance lipoprotein profile, or NMR lipoprotein profile. "You can see a change in the HOMA-IR and NMR lipoprotein profile more easily than in standard lipid studies," says Pace, explaining that shifts in the physiologic measures at three-month intervals may encourage patients to keep on the health track.
In addition, the 24 practices will take BMI readings at all patient visits. The project description also calls for the practices to engage all patients in brief discussions of one or more of the study topics -- nutrition, physical activity and emotional well-being. "All patients in the practice could potentially benefit from our intervention," says the project description.
Family physicians who want to know whether their practices might qualify for the project should contact Deborah Graham, NRN's associate research director, at (800) 274-2237, Ext. 3176.
"A pilot study, 'Leaders in Effective Activity Planning,' showed that when clinicians and staff members made small changes in their own lifestyles, they incorporated those better into their patient care," says Pace. "That's what we're trying to show with the new AIM-HI project. It will use a randomized, controlled trial, so the results should be highly evidence-based and not likely to have the biases associated with demonstration projects."
The project description says the study "is intended to help shift the paradigm of family physicians' use of common advice-giving methods to more effective patient-centered lifestyle counseling."
"Common advice includes 'Increase your physical activity' and 'Get rid of your doughnuts,'" says Pace. "When we try, instead, to build from people's lifestyles and have them share in the decision-making, we ask, 'What floor do you work on in your office? Have you considered walking up five flights and then taking the elevator the rest of the way?' Concerning diet, for people who don't drink diet soda, we suggest they could cut 240 calories a day if they cut out one soda -- they can substitute water, tea or flavored water with no calories. These suggestions are specific and practical."
The PepsiCo Foundation is the charitable arm of PepsiCo Inc., which has been a core supporter of AIM since 2005. This new project directly applies to one of PepsiCo Foundation's key audiences -- health professionals -- for promoting people's health and wellness, says Claire Lyons, manager of global grant programs for the PepsiCo Foundation.
"We thought family physicians, as opposed to single-issue or single-disease practitioners, have a more holistic relationship with their patients and are particularly effective channels for engaging people around healthy lifestyles," says Lyons. The PepsiCo Foundation decided to back the project because it targets health professionals; it will generate science-based evidence; and it will tailor fitness messages to Hispanics, blacks and Native American populations, says Lyons.
The research project will study how physicians, office staff and patients integrate healthy activities into their lives, says Sarah McMullen, AIM's director. "For example, we'll look at who the 24 practices employ and do a review of office staff members to help them integrate behavior change within their daily lives," whether it relates to nutrition, exercise or emotional well-being, says McMullen. "Then we'll invest in helping them make changes at the practice level that will translate into helping patients improve their health."
To enroll in the study, patients should be at least 18 years old and should have a body mass index of 30 or more, the threshold for obesity. "People with a BMI that high are more likely than others to have at least mild insulin resistance and adverse lipoprotein profiles," says Pace.
To show change as patients progress, clinicians will use a homeostatic assessment for insulin resistance, or HOMA-IR, and a nuclear magnetic resonance lipoprotein profile, or NMR lipoprotein profile. "You can see a change in the HOMA-IR and NMR lipoprotein profile more easily than in standard lipid studies," says Pace, explaining that shifts in the physiologic measures at three-month intervals may encourage patients to keep on the health track.
In addition, the 24 practices will take BMI readings at all patient visits. The project description also calls for the practices to engage all patients in brief discussions of one or more of the study topics -- nutrition, physical activity and emotional well-being. "All patients in the practice could potentially benefit from our intervention," says the project description.
Family physicians who want to know whether their practices might qualify for the project should contact Deborah Graham, NRN's associate research director, at (800) 274-2237, Ext. 3176.
