Advice from Primary Care Providers about Physical Activity: A Recommendation from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Behavioral Counseling in Primary Care To Promote Physical Activity: Recommendation and Rationale" and "Does Counseling by Clinicians Improve Physical Activity? A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 6 August 2002 issue of Annals of Internal Medicine (volume 137, pages 205-207 and pages 208-215). The first report was written by the U.S. Preventive Services Task Force; the second report was written by KB Eden, CT Orleans, CD Mulrow, NJ Pender, and SM Teutsch. The complete USPSTF recommendation and rationale statement and the complete information on which this statement is based are available at http://www.preventiveservices.ahrq.gov.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Compared with physically active people, inactive people develop more health problems, such as heart disease, high blood pressure, diabetes, and depression. People should aim to exercise at a moderate level (for example, walking) for at least 30 minutes on at least 5 days per week or at a vigorous level (for example, running) for at least 20 minutes on at least 3 days per week. Unfortunately, only about one quarter of Americans exercise this much. One way to encourage physical activity may be for doctors and nurses to advise exercise as part of the counseling they routinely provide to patients. To decide whether it is worthwhile to ask doctors and nurses to advise patients about exercise, the USPSTF considered the evidence showing that such advice increases the amount people exercise.

How did the USPSTF develop this recommendation?

The USPSTF reviewed studies in which doctors or nurses provided advice about physical activity. To be considered as evidence, the study had to provide information about activity levels and had to meet the USPSTF criteria for good- or fair-quality research. Eight studies met these conditions. The USPSTF collected information about each study, including the methods used to advise patients and the amount of physical activity before and after the advice.

What did the authors find?

The eight studies involved 9054 adults. In all of the studies, each patient's personal doctor or nurse delivered the advice about physical activity. In some studies, patients completed a survey about activity levels before seeing their doctor or nurse. In other studies, a research assistant asked the patient about activity levels and put this information in the patient's chart before the patient saw the doctor or nurse. The studies later measured the effect of advice by asking patients about their activity levels. Some of the studies showed that patients who got advice were more active than those who did not, and other studies did not show any effect of advice.

What does the USPSTF suggest that patients do?

People should exercise at a moderate level for at least 30 minutes at least 5 days per week or at a vigorous level for at least 20 minutes at least 3 days per week. Routine advice by a doctor or nurse to exercise has not been proven to increase patients' physical activity over the long term. Because the effect of advice about exercise remains uncertain, the USPSTF did not recommend routine counseling about physical exercise. Instead, it suggested that doctors and nurses decide for themselves whether to advise patients to exercise.

What are the cautions related to these recommendations?

This statement does not mean that the benefits of exercise are uncertain. Exercise clearly improves health. The uncertainty is whether advice to exercise from a doctor or nurse causes patients to become physically active. Of note, interventions aimed at the community rather than at individuals in the clinical setting have been proven to increase physical activity.