Incorporating physical activity advice into primary care - Physician-delivered advice within the Activity Counseling Trial

Introduction: The Activity Counseling Trial (ACT) was designed to compare t he effectiveness of physician advice alone with physician advice plus behav ioral counseling, provided by ACT-trained health educators, to increase lev els of physical activity in healthy, sedentary patients. The objective was to determine health care providers' adherence to the ACT protocol for deliv ering initial "physician" advice on physical activity and to determine prov iders' satisfaction with the protocol. Methods: Fifty-four physicians or physician assistants from 11 primary care practices located in California, Texas, and Tennessee volunteered to parti cipate as ACT-trained physicians. Providers were trained to integrate 3 to 4 minutes of initial physical activity advice into the routine office visit s of sedentary patients, aged 35 to 75 years, with no acute or serious chro nic conditions. This advice included assessment of current physical activit ies, advising the patient about an appropriate physical activity goal, and referring the patient to the health educator. Providers initialed forms to document delivery of advice, and ACT health educators recorded their advice on a computerized tracking system. A provider survey measured length of ti me spent advising patients about physical activity and provider satisfactio n with the program. Results: Ninety-nine percent of patients received the initial physician adv ice about physical activity. Eighty-three percent of the providers spent le ss than 5 to 6 minutes, and 46% spent the recommended 3 to 4 minutes provid ing advice. Sixty-three percent said the advice resulted in little or no in crease in the length of an office visit, and 83% said participation was an asset to their clinics. Conclusions: Providers incorporated brief physical activity advice into rou tine primary care visits with little disruption. Their response to the ACT advice protocol was positive and participation in the study was viewed as b eneficial.