Older Patient–Physician Discussion About Exercise

Abstract

This cross-sectional observational study examined the frequency of older patient–physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician’s being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.

Practicing What They Preach? Physical Activity Promotion among Clergy

“…The literature regarding PA counseling practices among physicians provides a potential parallel to our findings regarding PA: receiving health-related education [23,24] and PA behavior [23,24,25,26] have been identified as important influences on whether physicians counsel their patients on PA behavior. Also similar to our findings, female physicians are more likely to counsel their patients about exercise [27,28]. In our study, gender differences in PA promotion may be attributable in part to our finding (not reported) that female clergy were more likely to report meeting PA guidelines.…”

The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models

“…49 Specifically, a study with older adults found female physicians who cared for patients with a higher education (more than high school) to be significant predictors of the physicians' likelihood of providing PA counseling among older patients. 32 Very few studies reported nonphysician HCPs' counseling for PA 36,37,41,44 ; however we found that these groups, especially nurses and social workers, include regular preventive counseling recommendations more frequently than physicians into their practice.…”

“…49 Specifically, a study with older adults found female physicians who cared for patients with a higher education (more than high school) to be significant predictors of the physicians’ likelihood of providing PA counseling among older patients. 32 …”

“…Some studies defined counseling as the frequency of talking to their patients about PA or exercise habits (ie, "How frequently do you talk about PA with your patients? "), [32][33][34][35] others defined it as a composite of measures between assessment (fitness, anthropometry) and education (providing pamphlets and discussion), 36 and fewer studies went into details such as counseling for intensity and type of activity. 36,37 Out of the 47 studies included in this review, all but one 38 were crosssectional and described either HCPs' personal PA habits (n = 8), HCPs' PA counseling practices (n = 13), both (n = 2), or the association between personal PA habits and related PA counseling (n = 24; Figure 1).…”

“…In this review, we found a total of 24 analytic studies (Table 3) describing HCPs' own PA habits as a correlate of the PA counseling they provide to their patients. Out of these 24 studies, 19 reported a significant positive * References 15,[32][33][34][35][36][37]41,42,45,47,49,50,53,54. association between HCPs' PA habits and counseling frequency, self-efficacy, or perceived importance.…”