Effectiveness of physician-based assessment and counseling for exercise ina staff model HMO

Background. Few primary care physicians routinely counsel for exercise, des pite the benefits of physical activity and the high prevalence of inactivit y. The objective of this study is to assess the effectiveness of Physician- Based Assessment and Counseling for Exercise (PACE), a brief, behavior-base d tool for primary care providers counseling healthy adults, Methods. This study is a randomized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician off ices at a staff model health maintenance organization. Intervention physici ans were trained to deliver PACE exercise counseling protocols at the index visit, and one reminder telephone call occurred at 1 month. An enhanced in tervention group received additional activity reminders. Results. At the 6-month follow-up, the control group did not differ signifi cantly from the intervention group for energy expended (2048 kcal/week vers us 2108 kcal/week, P = 0.77), time spent in walking or other moderate to vi gorous activities (202 min/week versus 187 min/week, P = 0.99), mental heal th, physical function, or behaviors previously shown to predict activity ch ange. Among the intervention patients, the stages-of-change score for Conte mplators increased significantly compared with controls (P = 0.03), but wit hout a significant change in energy expended, Baseline levels of physical a ctivity counseling were high (50%), as were baseline patient physical activ ity levels (61% exercised at least three times a week). Conclusions. These results suggest that a one-time PACE counseling session with minimal reinforcement, in a setting with high baseline levels of activ ity, does not further increase activity. The finding that Contemplators adv anced in stage of behavior change suggests that further studies are needed to examine long-term, repeated counseling interventions. (C) 2000 American Health Foundation and Academic Press.