Does Counseling by Clinicians Improve Physical Activity? A Summary of the Evidence for the U.S. Preventive Services Task Force
- Karen B. Eden, PhD;
- C. Tracy Orleans, PhD;
- Cynthia D. Mulrow, MD, MSc;
- Nola J. Pender, PhD, RN; and
- Steven M. Teutsch, MD, MPH
- From Oregon Health & Science University, Portland, Oregon; Robert Wood Johnson Foundation, Princeton, New Jersey; University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of Michigan, Ann Arbor, Michigan; and Merck & Co., Inc., West Point, Pennsylvania.
Abstract
Purpose: To determine whether counseling adults in primary care settings improves and maintains physical activity levels.
Data Sources: The Cochrane Database of Systematic Reviews and Registry of Controlled Trials and the MEDLINE, HealthStar, and Best Evidence databases were searched for papers published from 1994 to March 2002.
Study Selection: Controlled trials, case–control studies, and observational studies that examined counseling interventions aimed at increasing physical activity in general primary care populations were reviewed. The researchers included trials in which 1) a patient's primary care clinician performed some of the counseling intervention; 2) behavioral outcomes [physical activity] were reported; and 3) the study was of “good” or “fair” quality, according to criteria developed by the U.S. Preventive Services Task Force.
Data Extraction: Data were abstracted on design and execution, quality, providers, patients, setting, counseling intervention, and self-reported physical activity at follow-up.
Data Synthesis: Eight trials involving 9054 adults met the inclusion criteria. Among six controlled trials with a usual care control group, the effects of counseling on physical activity were mixed. Because most studies had at least one methodologic limitation, it was difficult to rigorously assess the efficacy of the interventions. More research is needed to clarify the effect, benefits, and potential harms of counseling patients in primary care settings to increase physical activity.
Conclusion: Evidence is inconclusive that counseling adults in the primary care setting to increase physical activity is effective.
Article and Author Information
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Note: This manuscript is based on a longer systematic evidence review that was reviewed by outside experts and representatives of professional societies. A complete list of peer reviewers is available on line at http://www.ahrq.gov/clinic/uspstfix.htm.
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Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement of this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or Merck & Co., Inc.
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Acknowledgments: The authors thank Mark Helfand, MD, MS, and Gary Miranda, MA, from the Oregon Health & Science University Evidence-based Practice Center for helpful comments on earlier versions of this review; Evelyn Whitlock, MD, MPH, for help with independent abstraction of several of the trials; Kathryn Pyle Krages, AMLS, MA, and Susan Wingenfeld for administrative and clerical assistance; and Patty Davies, MS, for designing the literature search strategy.
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Grant Support: By the U.S. Agency for Healthcare Research and Quality (contract no. 290-97-0018, task order no. 2), Rockville, Maryland.
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Requests for Single Reprints: Reprints are available from the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs{at}ahrq.gov).
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Current Author Addresses: Dr. Eden: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97201.
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Dr. Orleans: Robert Wood Johnson Foundation, College Road East, Princeton, NJ 08543.
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Dr. Mulrow: University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229.
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Dr. Pender: 22838 Harbor Lane, Plainfield, IL 60544-7777.
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Dr. Teutsch: Merck and Co., Inc., PO Box 4, WP39-168, West Point, PA 19486-0004.
- Copyright ©2004 by the American College of Physicians
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