Counselling Patients on Physical Activity

A systematic review 4 including 9 studies with a total of 3162 subjects was abstracted in DARE. In three of the four UK-based studies, significant benefits were seen in the intervention compared with the control group at the first point of follow-up but, in general, these benefits were not sustained long term. One of the five non-UK-based studies reported a significant benefit of the intervention compared with the control.

After screening, 74 % (117/159) of general practitioners and 66% (878/1322) of eligible patients participated in a cluster-randomized study 1 on oral and written advice ('the green prescription') on physical activity. Mean total energy expenditure increased by 9.4 kcal/kg/week, and leisure exercise by 34 minutes/week more than in the control group. SF-36 measures of self rated general health, role physical, vitality, and bodily pain improved significantly (p<0.05). A trend towards decreasing blood pressure was observed.

A technology assessment report 2to determine whether counselling adults in primary care settings improves and maintains physical activity levels was abstracted in the Health Technology Assessment Database 3. Nine trials involving 9,227 adults met the inclusion criteria for the systematic review. Most counselling interventions in the studies were relatively brief (3-5 minutes). Two of six fair to good quality trials reported statistically significant improvements in physical activity for intervention patients compared with patients receiving usual care. The remaining three trials compared two or more interventions (contained no usual care comparison). These trials reported an increased effect: when the patient was given advice in combination with a written prescription; for female patients, when the intervention included behavior counselling and extended phone call support; or when the patient (male or female) set a physical activity goal. Most studies had limitations in design, follow-up, analysis or reporting. These methodological problems made it hard to rigorously assess the efficacy or effectiveness of the interventions, so the evidence if counselling adults in the primary care setting increases physical activity was inconclusive.

Comment: The quality of evidence is downgraded by limitations in study quality and by inconsistency (variability in results across studies).

References

• Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ 2003 Apr 12;326(7393):793. [PubMed]
• Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM. Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002 Aug 6;137(3):208-15. [PubMed]
• Health Technology Assessment Database: HTA-20031108. The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
• Morgan O. Approaches to increase physical activity: reviewing the evidence for exercise-referral schemes. Public Health 2005 May;119(5):361-70. [PubMed] [DARE]