How to make exercise counseling more effective: lessons from rural America

Exercise counseling by primary care physicians has been shown to improve physical activity in patients. However, the prevalence and effectiveness of physician counseling is unknown in rural populations that are at increased risk for chronic diseases.

Using a population-based telephone survey at baseline and again at 1-year follow-up, we assessed physical activity behavior among 1141 adults (75% female, 95% white) living within 12 rural communities of Missouri, Tennessee, and Arkansas. We tested the association between physician counseling and patients meeting current physical activity recommendations using logistic regression analysis controlling for demographic variables.

Participants who saw a doctor for regular care were 54% more likely to be physically active (adjusted odds ratio [aOR]=1.54; 95% confidence interval [CI], 1.04-2.28). Overweight adults (body mass index [BMI]=25-29.9 kg/m2) who had been advised by their physician to exercise more were nearly 5 times more likely to meet physical activity recommendations if their doctor helped develop an exercise plan (aOR=4.99; 95% CI, 1.69-14.73). Overweight individuals who received additional follow-up with the exercise plan from their doctor had a 51/2-fold increase in likelihood of meeting physical activity recommendations (P<.05). In the overall sample, patients were significantly more likely to initiate (P=.01) and maintain (P=.002) physical activity when the physician prescribed and followed up on an exercise plan.

This longitudinal study provides evidence that exercise counseling is most effective when the physician presents the counseling as a plan or prescription and when he or she follows up with the patient on it.