What’s the best way to motivate patients to exercise?

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Clinical Inquiries

What’s the best way to motivate patients to exercise?

J Fam Pract. 2010 January;59(1):43-44

By

Sean N. Martin, DO

Brian K. Crownover, MD

Fran E. Kovach, MLIS, AHIP

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References

1. Physical activity and fitness (chapter 22). In: Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: US Department of Health and Human Services; 2000. Available at: www.healthypeople.gov/Document/HTML/Volume2/22Physical.htm#_Toc490380800. Accessed July 6, 2009.

2. Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity.A systematic review. Am J Prev Med. 2002;22(4 suppl):73-107.

3. Elley CR, Kerse N, Arroll B, et al. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ. 2003;326:793.-Available at: www.bmj.com/cgi/reprint/326/7393/793.pdf. Accessed July 6, 2009.

4. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298:2296-2304.

5. Peters JC, Melanson EL, Knoll JR, et al. Predicting the net energy cost of walking at self-selected speeds in healthy adults. Med Sci Sports Exerc. 2003;35(suppl 1):S155.-

6. van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. Br J Sports Med. 2008;42:653-657.

7. Beets MW, Beighle A, Erwin HE, et al. After-school program impact on physical activity and fitness: a meta-analysis. Am J Prev Med. 2009;36:527-537.

8. National Institute for Health and Clinical Excellence (NICE). Four Commonly Used Methods to Increase Physical Activity: Brief Interventions in Primary Care, Exercise Referral Schemes, Pedometers and Community-Based Exercise Programmes for Walking and Cycling. London, UK: National Institute for Health and Clinical Excellence; 2006 (Public health intervention guidance; no. 2). Available at: www.nice.org.uk/nicemedia/pdf/PH002_physical_activity.pdf. Accessed July 6, 2009.

EVIDENCE-BASED ANSWER

THERE IS NO SINGLE BEST STRATEGY, given the lack of data from rigorous comparison studies. There are, however, several interventions for adults that are effective. They include:

writing a patient-specific behavioral health "green" prescription
encouraging patients to join forces with accountability partners or support groups
recommending the use of pedometers (strength of recommendation [SOR]: A, meta-analyses).

In children and adolescents, multicomponent strategies that include school-based interventions combined with either family or community involvement increase physical activity (SOR: A, systematic review).

Evidence summary

The Healthy People 2010 report calls for increasing the proportion of Americans who engage in moderate physical activity (activities that use large muscle groups and are at least equivalent to brisk walking) from 15% to 30%.¹The report doesn’t describe how best to achieve this objective.

Systematic review reveals approaches worth trying
The US Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC) conducted a systematic review of 94 qualifying trials and assigned interventions to 1 of 3 approaches: “information based,” “behavioral and social,” and “facilities and activities.”²

Behavioral and social interventions have the best data support.²Within this category, strong evidence backed school-based physical education and accountability partners or exercise support groups. School-based physical education resulted in a median net increase in physical activity time of 50.3% (range 6.0%-125.3%); accountability partners or support groups produced a mean net increase of 44.2% (interquartile range 19.9%-45.6%).

FAST TRACK

Adults benefit from patient-specific behavioral prescriptions, accountability partners or support groups, and pedometers.

“Green” prescriptions are primary care behavioral interventions that include measurable goals, self-reward, structured problem-solving, social network reinforcement, and relapse prevention counseling. In the DHHS review, 10 trials studied green prescriptions; the median net increase in physical activity time was 35.4% (interquartile range 16.7%-83.3%).²A trial in 42 rural and urban New Zealand general practices that added 3 telephone follow-up sessions to the green prescription showed a 10% increase in achieving 150 minutes of vigorous exercise weekly among green prescription participants compared with controls (number needed to treat=10).³

Evidence-based answers from the Family Physicians Inquiries Network

What’s the best way to motivate patients to exercise?

References

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