Does counseling help patients get active? Systematic review of the literature.

OBJECTIVE To determine the effect of counseling patients to become more physically active.

DATA SOURCES PubMed was searched for articles during the past 30 years on physicians promoting physical activity. Identified studies were cross-referenced, and experts were consulted for additional articles.

STUDY SELECTION Thirteen articles described primary care counseling on exercise. Six studies were randomized controlled trials (RCTs); seven were quasi-experimental designs. Three of the four RCTs and three of the five quasi-experimental studies were short term (4 weeks to 2 months); the remaining three trials lasted longer than 6 months. Most studies used strategies to address stage of change.

SYNTHESIS Outcome measures included adoption of physical activity, stage of change, and change in physical activity level. Most studies found positive relationships between counseling and these outcomes. No reliable evaluation instruments were found, nor was the long-term effect of interventions established.

CONCLUSION Interventions that included written materials for patients, considered behaviour change strategies, and provided training and materials for physicians were effective at increasing levels of physical activity. New strategies that involve measuring and prescribing specific amounts of exercise might also improve fitness levels and hence improve outcomes of chronic disease. Shortcomings of these studies include lack of long-term data, lack of sustaining activities for family physicians, and scant cost-efficacy analysis.