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Steven T. Johnson, Clark Mundt, Weiyu Qiu, Allison Soprovich, Lisa Wozniak, Ronald C. Plotnikoff and Jeffrey A. Johnson

Objective:

To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care.

Methods:

Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models.

Results:

198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes.

Conclusions:

A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.

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Jill R. Reed, Paul Estabrooks, Bunny Pozehl, Kate Heelan and Christopher Wichman

opportunity to improve the health and well-being of patients. 23 Finding practical, effective ways of incorporating PA counseling into primary care is paramount. One strategy that could be utilized is the 5A’s model to assist individuals in setting PA goals. 25 The 5A’s model has been shown to be effective

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Julian Reed, Lori Malvern, Suresh Muthukrishnan, Rachael Hardy and Lauren King

Background:

The study examined the effectiveness of primary-care counseling using a 2-pronged intervention to increase physical activity (PA) in a southeastern US city.

Methods:

Two hundred thirty-seven patients were randomly assigned to 1 of 3 groups (experimental [counseling and educational map], control group #1 [counseling only], or control #2 [standard care]) to identify PA differences. The experimental group received physician counseling and an educational map highlighting accessible recreational facilities within a 2-mile radius of the health center.

Results:

Patients in the experimental group increased their weekly PA in comparison with patients in the controls. Significant differences were observed for patients between groups for PA (F = 7.648, df 3,423, P = .000), PA × visits interaction (F = 5.500, df 3,423, P = .001), and the PA × group interaction (F = 3.068, df 6,848, P = .006).

Conclusions:

This approach can perhaps increase the PA levels of underserved adults.

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Elizabeth G. Eakin, Ben J. Smith and Adrian E. Bauman

Background:

This article evaluates the extent to which the literature on primary care-based physical activity interventions informs the translation of research into practice and identifies priorities for future research.

Methods:

Relevant databases were searched for: (1) descriptive studies of physician barriers to physical activity counseling (n = 8), and (2) reviews of the literature on primary care-based physical activity intervention studies (n = 9). The RE-AIM framework was used to guide the evaluation.

Results:

Lack of time, limited patient receptiveness, lack of remuneration, and limited counseling skills are the predominant barriers to physical activity counselling. Issues of internal validity (i.e., effectiveness and implementation) have received much more attention in the literature than have issues of external validity (i.e., reach and adoption).

Conclusions:

The research agenda for primary care-based physical activity interventions needs greater attention to the feasibility of adoption by busy primary care staff, generalizability, and dissemination.

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Katharina Diehl, Manfred Mayer, Frank Mayer, Tatiana Görig, Christina Bock, Raphael M. Herr and Sven Schneider

Background:

In physical activity (PA) counseling, primary care physicians (PCPs) play a key role because they are in regular contact with large sections of the population and are important contact people in all health-related issues. However, little is known about their attitudes, knowledge, and perceived success, as well as about factors associated with the implementation of PA counseling.

Methods:

We collected data from 4074 PCPs including information on physician and practice characteristics, attitudes toward cardiovascular disease (CVD) prevention, and measures used during routine practice to prevent CVD. Here, we followed widely the established 5 A’s strategy (Assess, Advise, Agree, Assist, Arrange).

Results:

The majority (87.2%) of PCPs rated their own level of competence in PA counseling as ‘high,’ while 52.3% rated their own capability to motivate patients to increase PA as ‘not good.’ Nine of ten PCPs routinely provided at least 1 measure of the modified 5 A’s strategy, while 9.5% routinely used all 5 intervention strategies.

Conclusions:

The positive attitude toward PA counseling among PCPs should be supported by other stakeholders in the field of prevention and health promotion. An example would be the reimbursement of health counseling services by compulsory health insurance, which would enable PCPs to invest more time in individualized health promotion.

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Asmita Patel, Grant M. Schofield, Gregory S. Kolt and Justin W.L. Keogh

This study examined whether perceived barriers, benefits, and motives for physical activity differed based on allocation to 2 different types of primary-care activity-prescription programs (pedometer-based vs. time-based Green Prescription). Eighty participants from the Healthy Steps study completed a questionnaire that assessed their perceived barriers, benefits, and motives for physical activity. Factor analysis was carried out to identify common themes of barriers, benefits, and motives for physical activity. Factor scores were then used to explore between-groups differences for perceived barriers, benefits, and motives based on group allocation and demographic variables. No significant differences were found in factor scores based on allocation. Demographic variables relating to the existence of chronic health conditions, weight status, and older age were found to significantly influence perceived barriers, benefits, and motives for physical activity. Findings suggest that the addition of a pedometer to the standard Green Prescription does not appear to increase perceived motives or benefits or decrease perceived barriers for physical activity in low-active older adults.

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Chris Koutures

Column-editor : Robert D. Kersey

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Sarah Hardcastle and Adrian H. Taylor

There has been increasing interest in promoting health-enhancing exercise in primary-care services. One popular approach in the U.K. has been general practitioner (GP) exercise-referral plans in which mostly sedentary patients are referred by GPs to an exercise program at a local leisure center. It is not clear, however, how older women assimilate such a referral system into cognitive processes associated with physical activity involvement. This interpretivist study adopted unstructured interviewing and life-story technique to embrace subjectivity and contextuality in an attempt to capture the complex processes and to explore both common and diverse experience. The study explored referred older women's accounts of their past and current experiences of physical activity and their perceptions of what blocks or motivates them to be active. Fifteen newly referred older women (50–80 years old) were interviewed at various points during their prescribed 10-week exercise program. The findings highlight the importance of psychosocial dimensions and informal networks in the referral processes.

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Karen A. Croteau, Vijiayurani Suresh and Elanna Farnham

The purpose of this pilot study was to determine if using physical activity (PA) mentors has any additional impact on daily steps of older adults participating in the Maine in Motion (MIM) program in the primary care setting. Participants were randomly assigned to a MIM-only group (n = 14) or a MIM+ mentor group (n = 14). The MIM intervention lasted 6 months with follow-up at 12 months. Average age of participants was 64 ± 8.8 years and most participants had multiple chronic illnesses. At baseline, mean body mass index (BMI) was 32.2 ± 5.1 and average daily steps were 4,236 ± 2,266. Repeated-measures ANOVA revealed significant main effects for steps, F(2.324, 59.104) = 4.168, p = .015, but no main effects for group, F(1, 25) = 2.988, p = .096, or time-by-group interaction, F(2.324, 59.104) = 0.905, p = .151. All participants significantly increased daily steps over the course of the intervention, with MIM+ participants maintaining increases at follow-up. No significant findings were found for BMI.

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Sara Wilcox, Deborah Parra-Medina, Gwen M. Felton, Mary Beth Poston and Amanda McClain

Background:

Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers.

Methods:

Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity.

Results:

Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered.

Conclusions:

A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.