Exercise counseling by primary care physicians in the era of managed care

Recommendations from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) advise all adults to accumulate at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week, but many U.S. adults engage in no leisure-time physical activity. Since primary care providers can play an important role in exercise counseling and prescription, we wanted to assess the proportion of primary care physicians from four hospitals who asked about exercise habits, counseled about exercise, and prescribed exercise; and the factors that were associated with their counseling and prescription habits.

Survey of 326 internists, family practitioners, and internal medicine and family practice residents.

One hundred seventy-five physicians completed the questionnaire (54% response rate). Two thirds of physicians reported asking more than half of their patients about exercise, 43% counseled more than half of their patients about exercise, but only 14% prescribed exercise for more than half of their patients. Only 12% of physicians were familiar with the new ACSM recommendations. Physicians aged 35 and over were more likely than physicians less than 35 year old to ask about (82% versus 60%), counsel about (58% versus 37%), and prescribe (30% versus 8%) exercise. Family practitioners were more likely to ask about (85% versus 62%) and counsel about (59% versus 39%) exercise than internists. Physicians who felt they had adequate exercise knowledge were more likely to ask about (72% versus 49%) and counsel about (48% versus 29%) exercise than those who felt their knowledge was inadequate. Finally, physicians who felt that they were successful in changing behavior were more likely to ask about and counsel about exercise. The most important barriers to exercise counseling were not having enough time and needing more practice in effective counseling techniques.

Many primary care physicians are not asking about, counseling about, or prescribing exercise for their patients. Since primary care physicians are in the best position to provide individualized exercise prescriptions for their patients, future research should focus on training physicians in effective counseling techniques that can be done as brief interventions.