Effects of physical activity counseling in primary care - The activity counseling trial: A randomized controlled trial

Context Physical activity is important for health, yet few studies have exa mined the effectiveness of physical activity patient counseling in primary care. Objective To compare the effects of 2 physical activity counseling interven tions with current recommended care and with each other in a. primary care setting. Design The Activity Counseling Trial, a randomized controlled trial with re cruitment in 1995-1997, with 24 months of follow-up. Setting Eleven primary care facilities affiliated with 3 US clinical resear ch centers. Participants Volunteer sample of 395 female and 479 male inactive primary c are patients aged 35 to 75 years without clinical cardiovascular disease. Interventions Participants were randomly assigned to 1 of 3 groups: advice (n=292), which included physician advice and written educational materials (recommended care); assistance (n=293),,which included all the components r eceived by the advice group plus interactive mail and behavioral counseling at physician visits; or counseling (n=289), which included the assistance and advice group components plus regular telephone counseling and behaviora l classes. Main Outcome Measures Cardiorespiratory fitness, measured by maximal oxygen uptake ((V)over dotO(2)max) and self-reported total physical activity, mea sured by a 7-day Physical Activity Recall, compared among the 3 groups and analyzed separately for men and women at 24 months. Results At 24 months, 91.4% of the sample had completed physical activity a nd 77.6% had completed cardiorespiratory fitness measurements. For women at 24 months, (V)over dotO(2)max was significantly higher in the assistance g roup than in the advice group (mean difference, 80.7 mL/min; 99.2% confiden ce interval [CI], 8.1-153.2 mL/min) and in the counseling group than in the advice group (mean difference, 73.9 mL/min; 99.2% CI, 0.9-147.0 mL/min), w ith no difference between the counseling and assistance groups and no signi ficant differences in reported total physical activity. For men, there were no significant between-group differences in cardiorespiratory fitness or t otal physical activity. Conclusions Two patient counseling interventions differing in type and numb er of contacts were equally effective in women in improving cardiorespirato ry fitness over 2 years compared with recommended care. In men, neither of the 2 counseling interventions was more effective than recommended care.