Exercise counseling by primary care physicians in the era of managed care

Background: Recommendations from the Centers for Disease Control and Preven tion (CDC) and the American College of Sports Medicine (ACSM) advise all ad ults to accumulate at least 30 minutes of moderate intensity physical activ ity on most, if not all, days of the week, but many U.S. adults engage in n o leisure-time physical activity. Since primary care providers can play an important role in exercise counseling and prescription, we wanted to assess the proportion of primary care physicians from four hospitals who asked ab out exercise habits, counseled about exercise, and prescribed exercise; and the factors that were associated with their counseling and prescription ha bits. Design: Survey of 326 internists, family practitioners, and internal medici ne and family practice residents. Results: One hundred seventy-five physicians completed the questionnaire (5 4% response rate). Two thirds of physicians reported asking more than half of their patients about exercise, 43% counseled more than half of their pat ients about exercise, but only 14% prescribed exercise for more than half o f their patients. Only 12% of physicians were familiar with the new ACSM re commendations. Physicians aged 35 and over were more likely than physicians less than 35 year old to ask about (82% versus 60%), counsel about (58% ve rsus 37%), and prescribe (30% versus 8%) exercise. Family practitioners wer e more likely to ask about (85% versus 62%) and counsel about (59% versus 3 9%) exercise than internists. Physicians who felt they had adequate exercis e knowledge were more likely to ask about (72% versus 49%) and counsel abou t (48% versus 29%) exercise than those who felt their knowledge was inadequ ate. Finally, physicians who felt that they were successful in changing beh avior were more likely to ask about and counsel about exercise. The most im portant barriers to exercise counseling were not having enough time and nee ding more practice in effective counseling techniques. Conclusions: Many primary care physicians are not asking about, counseling about, or prescribing exercise for their patients. Since primary care physi cians are in the best position to provide individualized exercise prescript ions for their patients, future research should focus on training physician s in effective counseling techniques that can be done as brief intervention s. (C) 1999 American Journal of Preventive Medicine.