Prescription of Physical Activity: How Does the Internist Perceive it?

in Journal of Physical Activity and Health
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $115.00

1 year subscription

USD  $153.00

Student 2 year subscription

USD  $218.00

2 year subscription

USD  $285.00

Objective: To assess the meaning of a physical activity prescription (PAP) from the physician’s point of view and to examine current PAP-related clinical practices and stage of change, including the factors that influence them. Methods: Mixed methodology was applied to obtain valid, high-quality data. During the qualitative phase, the “free-listing” technique was used to explore the “cultural domain” of a physician’s perception of PAP, as well as the construction of culturally relevant items used during the last phase of the study. A survey was conducted to evaluate clinical practices, attitudes, and physician state of change regarding PAP. The convenience sample of 58 (qualitative phase) and 350 internists (quantitative phase) who attended the International Congress of Internal Medicine was interviewed. Results: A majority of internist reported having adequate knowledge, positive attitude, being in the maintenance phase with no barriers to prescribe physical activity (PA). Prescription was associated with physician training, their workplace, and experience. However, physicians do not satisfactorily evaluate the level of patient’s PA nor recommend an adequate level of PA, which is necessary to achieve health goals. Conclusions: Physicians had great acceptance of PAP. However, there were low levels of knowledge of current PA guidelines, although most physicians thought they had sufficient knowledge. Training seems to be an excellent way to improve PAP.

Lavielle Sotomayor is with Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Unidad de Investigación en Epidemiologia Clínica, Ciudad de México, Mexico. Huitron Bravo is with Facultad de Medicina, Universidad Autónoma del Estado de México, Estado de México, Mexico. López Fernández and Talavera Piña are with Centro de Adiestramiento en Epidemiología Clínica en Salud del Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, Mexico. Talavera Piña is also with Dirección de Enseñanza e Investigación, Centro Médico ABC, Ciudad de México, Mexico.

Lavielle Sotomayor (lavielle.pilar@gmail.com) is corresponding author.
  • 1.

    World Health Organization. Global recommendations on physical activity for health. 2010. Retrieved from whqlibdoc.who.int/.../9789241599979_eng.pdf. Accessed March 15,2018.

    • PubMed
    • Export Citation
  • 2.

    Lee I-M, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380:219–229. PubMed ID: 22818936 doi:10.1016/S0140-6736(12)61031-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Cadilhac DA, Cumming TB, Sheppard L, Pearce DC, Carter R, Magnus A. The economic benefits of reducing physical inactivity: an Australian example. Int J Behav Nutr Phys Act. 2011;8:99. PubMed ID: 21943093 doi:10.1186/1479-5868-8-99

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    van Sluijs EM, van Poppel MN, Stalman WA, van Mechelen W. Feasibility and acceptability of a physical activity promotion programme in general practice. Fam Pract. 2004;21:429–436. PubMed ID: 15249533 doi:10.1093/fampra/cmh414

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Johansson H, Weinehall L, Emmelin M. “It depends on what you mean”: a qualitative study of Swedish health professionals’ views on health and health promotion. BMC Health Serv Res. 2009;9:191. PubMed ID: 19845948 doi:10.1186/1472-6963-9-191

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Smith BJ, Bauman AE, Bull FC, Booth ML, Harris MF. Promoting physical activity in general practice: a controlled trial of written advice and information materials. Br J Sports Med. 2000;34:262–267. PubMed ID: 10953898 doi:10.1136/bjsm.34.4.262

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Carroll JK, Fiscella K, Meldrum SC, et al. Clinician–patient communication about physical activity in an underserved population. J Am Board Fam Med. 2008;21:118–127. PubMed ID: 18343859 doi:10.3122/jabfm.2008.02.070117

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. PubMed ID: 22451477 doi:10.1136/bmj.e1389

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hallal P, Lee IM. Prescription of physical activity: an undervalued intervention. Lancet. 2013;381:356–357. PubMed ID: 23199848 doi:10.1016/S0140-6736(12)61804-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Carroll JK, Antognoli E, Flocke SA. Evaluation of physical activity counseling in primary care using direct observation of the 5As. Ann Fam Med. 2011;9:416–422. PubMed ID: 21911760 doi:10.1370/afm.1299

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity interventions into practice. Am J Prev Med. 2006;31:S45–S56. PubMed ID: 16979469 doi:10.1016/j.amepre.2006.06.019

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Swinburn BA, Walter LG, Arroll B, Tilyard MW, Russell DG. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners. Am J Public Health. 1998;88:288–291. PubMed ID: 9491025 doi:10.2105/AJPH.88.2.288

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Lobelo F, Stoutenberg M, Hutber A. The Exercise is Medicine Global Health Initiative: a 2014 update. Br J Sports Med. 2014;48:1627–1633. PubMed ID: 24759911 doi:10.1136/bjsports-2013-093080

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Bize R, Cornuz J, Martin B. Opinions and attitudes of a sample of Swiss physicians about physical activity promotion in a primary care setting. Schweizerische Zeitschrift fur Sportmedizin und Sporttraumatologie. 2007;55(3):97–100.

    • Search Google Scholar
    • Export Citation
  • 15.

    Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM. Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:208–215. PubMed ID: 12160371 doi:10.7326/0003-4819-137-3-200208060-00015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Johansson H, Weinehall L, Emmelin M. “If we only got a chance.” Barriers to and possibilities for a more health-promoting health service. J Multidiscip Healthc. 2009;3:1–9. PubMed ID: 21197350 doi:10.2147/JMDH.S8104

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Johansson H, Stenlund H, Lundström L, Weinehall L. Reorientation to more health promotion in health services—a study of barriers and possibilities from the perspective of health professionals. J Multidiscip Healthc. 2010;3:213–224. PubMed ID: 21289862 doi:10.2147/JMDH.S14900

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Puig A, McKenna J, Riddoch C. Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system. Eur J Public Health. 2005;15:569–575. PubMed ID: 16051654 doi:10.1093/eurpub/cki045

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Vuori I. Role of primary health care in physical activity promotion. Dtsch Z Sportmed. 2013;2013:176–182. doi:10.5960/dzsm.2012.073

  • 20.

    King A. Exercise counseling in health promotion. Br J Sports Med. 2000;34:80–81. PubMed ID: 10786859 doi:10.1136/bjsm.34.2.80

  • 21.

    Bazeley P. Issues in mixing qualitative and quantitative approaches to research. In: Buber R, Gadner J, Richards L, eds. Applying Qualitative Methods to Marketing Management Research. London, UK: Palgrave Macmillan; 2004.

    • Search Google Scholar
    • Export Citation
  • 22.

    Tashakkori A, Creswell JW. Editorial: exploring the nature of research questions in mixed methods research. J Mixed Methods Res. 2007;1:207–211. doi:10.1177/1558689807302814

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Ryan GW, Nolan JM, Yoder PS. Successive free listing: using multiple free lists to generate explanatory models. Field Methods. 2000;12:83–107. doi:10.1177/1525822X0001200201

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    National Cancer Institute. Theory at a Glance—A Guide for Health Promotion Practice. 2nd ed. Washington, DC: US Department of Health and Human Services; 2005.

    • Search Google Scholar
    • Export Citation
  • 25.

    Burns KJ, Camaione DN, Chatterton CT. Prescription of physical activity by adult nurse practitioners: a national survey. Nurs Outlook. 2000;48:28–33. PubMed ID: 10715079 doi:10.1067/mno.2000.99101

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Fowles J, O’Brien M, Solmundson K, Oh P, Shields C. Exercise is Medicine Canada physical activity counselling and exercise prescription training improves counselling, prescription, and referral practices among physicians across Canada. Appl Physiol Nutr Metab. 2018;43:535–539. PubMed ID: 29316409 doi:10.1139/apnm-2017-0763

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Douglas F, Torrance N, van Teijlingen E, Meloni S, Kerr A. Primary care staff’s views and experiences related to routinely advising patients about physical activity. A questionnaire survey. BMC Public Health. 2006;6:138. PubMed ID: 16719900 doi:10.1186/1471-2458-6-138

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Joy E, Blair S, McBride P, Salis R. Physical activity counselling in sports medicine: a call to action. Br J Sports Med. 2013;47:49–53. PubMed ID: 23149653 doi:10.1136/bjsports-2012-091620

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Leijon ME, Bendtsen P, Nilsen P, Ekberg K, Ståhle A. Physical activity referrals in Swedish primary health care–prescriber and patient characteristics, reasons for prescriptions, and prescribed activities. BMC Health Serv Res. 2008;8:201. PubMed ID: 18828898 doi:10.1186/1472-6963-8-201

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Persson G, Brorsson A, Ekvall Hansson E, Troein M, Strandberg EL. Physical activity on prescription (PAP) from the general practitioner’s perspective—a qualitative study. BMC Fam Pract. 2013;14:128. PubMed ID: 23987804 doi:10.1186/1471-2296-14-128

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22:267–284. PubMed ID: 11988383 doi:10.1016/S0749-3797(02)00415-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 138 138 53
Full Text Views 8 8 3
PDF Downloads 6 6 3