Physical Activity Counseling and Prescription Among Canadian Primary Care Physicians | Lifestyle Behaviors | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Lee  IMSherrett  PJ Physical activity and all-cause mortality: what is the dose-response relation?  Med Sci Sports Exerc 2001;33 (6) ((suppl)) S459- S471PubMedGoogle ScholarCrossref
Petrella  RJKovall  JJCunningham  DAPaterson  DH Can primary care doctors prescribe exercise to improve fitness? the Step Test Exercise Prescription (STEP) Project.  Am J Prev Med 2003;24 (4) 316- 322PubMedGoogle ScholarCrossref
US Census Bureau, Health and nutrition, No. 195: visits to office based physicians, 1996.  Statistical Abstract of the United States 1998;118th ed. Washington, DC US Census Bureau1998;132 Accessed May 1, 2000Google Scholar
Bull  FCLSchipper  ECCJamrozik  KBlanksby  BA How can and do Australian doctors promote physical activity?  Prev Med 1997;26 (6) 866- 873PubMedGoogle ScholarCrossref
Eden  KBOrleans  CTMulrow  CDPender  NJTeutsch  SM Does counseling by clinicians improve physical activity? a summary of the evidence for the US Preventive Services Task Force.  Ann Intern Med 2002;137 (3) 208- 215PubMedGoogle ScholarCrossref
Swinburn  BAWalter  LGArroll  BTilyard  MWRussell  DG The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners.  Am J Public Health 1998;88 (2) 288- 291PubMedGoogle ScholarCrossref
Walsh  JMESwangard  DMDavis  TMcPhee  SJ Exercise counseling by primary care physicians in the era of managed care.  Am J Prev Med 1999;16 (4) 307- 313PubMedGoogle ScholarCrossref
Kottke  TESolberg  LIBrekke  MLCabrera  AMarquez  M Will patient satisfaction set the preventive services implementation agenda?  Am J Prev Med 1997;13 (4) 309- 316PubMedGoogle Scholar
Pender  NJSallis  JFLong  BCalfas  K Health care provider counseling to promote physical activity. Dishman  RK Advances in Exercise Adherence. Champaign, IL Human Kinetics1994;213- 235Google Scholar
Wallace  PGHaines  AP General practice and health promotion: what patients think.  Br J Med (Clin Res Ed) 1984;289 (6444) 534- 536PubMedGoogle ScholarCrossref
Elley  CRKerse  NArroll  BRobinson  E Effectiveness of counseling patients on physical activity in general practice: cluster randomized controlled trial.  BMJ 2003;326 (7393) 793- 798PubMedGoogle ScholarCrossref
Abramson  SStein  JSchaufele  MFrates  ERogan  S Personal exercise habits and counseling practices of primary care physicians: a national survey.  Clin J Sport Med 2000;10 (1) 40- 48PubMedGoogle ScholarCrossref
Wechsler  HLevine  SIdellson  RKSchor  ELCoakley  E The physician's role in health promotion revisited: a survey of primary care practitioners.  N Engl J Med 1996;334 (15) 996- 998PubMedGoogle ScholarCrossref
Valente  CMSobal  JMuncie  HLLevine  DMAntlitz  AM Health promotion: physicians' beliefs, attitudes, and practices.  Am J Prev Med 1986;2 (2) 82- 88PubMedGoogle Scholar
Lawlor  DAKeen  SNeal  RD Increasing population levels of physical activity through primary care: GP's knowledge, attitudes and self-reported practice.  Fam Pract 1999;16 (3) 250- 254PubMedGoogle ScholarCrossref
Podl  TRGoodwin  MAKikano  GEStange  KC Direct observation of exercise counseling in community family practice.  Am J Prev Med 1999;17 (3) 207- 210PubMedGoogle ScholarCrossref
Reed  BDJensen  JDGorenflo  DW Physicians and exercise promotion.  Am J Prev Med 1991;7 (6) 410- 415PubMedGoogle Scholar
Williford  HNBarfield  BRLazenby  RBScharff Olson  MS A survey of physician's attitudes and practices related to exercise promotion.  Prev Med 1992;21 (5) 630- 636PubMedGoogle ScholarCrossref
Sherman  SEHershman  WY Exercise counseling: how do general internists do?  J Gen Intern Med 1993;8 (5) 243- 248PubMedGoogle ScholarCrossref
Catford  JCNutbeam  D Prevention in practice: what Wessex general practitioners are doing.  Br Med J (Clin Res Ed) 1984;288 (6420) 832- 834PubMedGoogle ScholarCrossref
Writing Group for the Activity Counseling Trial Research Group, Effects of physical activity counseling in primary care: the Activity Counseling Trial: a randomized controlled trial.  JAMA 2001;286 (6) 677- 687PubMedGoogle ScholarCrossref
Orleans  CTGeorge  LKHoupt  JLBrodie  KH Health promotion in primary care: a survey of US family practitioners.  Prev Med 1985;14 (5) 636- 647PubMedGoogle ScholarCrossref
Petrella  RJWight  D An office-based instrument for exercise counseling and prescription in primary care: the Step Test Exercise Prescription (STEP).  Arch Fam Med 2000;9 (4) 339- 344PubMedGoogle ScholarCrossref
Dillman  D Mail and Telephone Surveys: The Total Design Method.  New York, NY John Wiley & Sons1978;250- 258
Petrella  RJKoval  JJCunningham  DAPaterson  DH A self-paced step test to predict aerobic fitness in older adults in the primary care clinic.  J Am Geriatr Soc 2001;49 (5) 632- 638PubMedGoogle ScholarCrossref
Cohen  MFerrier  BMWoodward  CAGoldsmith  CH Gender differences in practice patterns of Ontario family physicians (McMaster medical graduates).  J Am Med Womens Assoc 1991;46 (2) 49- 54PubMedGoogle Scholar
Maheux  BDufort  FBéland  FJacques  ALévesque  A Female medical practitioners: more preventive and patient oriented?  Med Care 1990;28 (1) 87- 92PubMedGoogle ScholarCrossref
Kennedy  MFMeeuwisse  WH Exercise counseling by family physicians in Canada.  Prev Med 2003;37 (3) 226- 232PubMedGoogle ScholarCrossref
Wells  KBLewis  CELeake  BWare  JE  Jr Do physicians preach what they practice? a study of physicians' health habits and counseling practices.  JAMA 1984;252 (20) 2846- 2848PubMedGoogle ScholarCrossref
Heaton  PCFrede  SM Patients' need for more counseling on diet, exercise, and smoking cessation: results from the National Ambulatory Medical Care Survey.  J Am Pharm Assoc 2006;46 (3) 364- 369PubMedGoogle ScholarCrossref
Original Investigation
September 10, 2007

Physical Activity Counseling and Prescription Among Canadian Primary Care Physicians

Author Affiliations

Author Affiliations: Department of Family Medicine, Faculty of Medicine, and Lawson Health Research Institute (Dr Petrella), and Schools of Kinesiology (Drs Petrella, Lattanzio, and Overend) and Physical Therapy (Dr Overend), Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.

Arch Intern Med. 2007;167(16):1774-1781. doi:10.1001/archinte.167.16.1774

Background  Primary care physicians are ideally positioned to affect a large population at risk for epidemics of sedentary lifestyle; however, it is unclear what type of counseling they provide.

Methods  A questionnaire was used to obtain information on primary care physicians' behaviors with respect to counseling and prescribing physical activity, physician demographics, and practice characteristics. Registered primary care physicians in Canada were contacted in all 10 provinces and 2 territories.

Results  Of 27 980 primary care physicians, 14 319 returned usable questionnaires and 13 166 were eligible for study participation (response rate, 51.2%). Respondents were predominantly male (61.1%), practiced in private office/clinic settings (73.4%), and had graduated from medical school more than 22 years earlier. Eighty-five percent of respondents reported asking patients about their physical activity levels, whereas only 26.2% assessed patient fitness as part of a physical examination or through a fitness test and only 10.9% referred patients to others for fitness assessment or appraisal. Most physicians (69.8%) reported using verbal counseling to promote physical activity, whereas only 15.8% used written prescriptions for a physical activity promotion program. Male and female physicians responded differently. Men more frequently assessed fitness than did women, whereas women more frequently asked and provided verbal and written directions.

Conclusions  This large sample of Canadian primary care physicians regularly asked patients about physical activity levels and advised them using verbal counseling. Few respondents provided written prescriptions, performed fitness assessments, or referred patients. These results suggest possible opportunities to improve physicians' counseling and prescription efforts.