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Physical Activity Curricula in Medical Schools
Abstract
Regular physical activity has many known health benefits, yet relatively few physicians counsel their patients about physical activity or exercise. The cited barriers to performing this type of counseling include lack of knowledge and skill, and data show that physicians are more likely to counsel patients about physical activity if they have adequate knowledge of the subject. Health promotion and disease prevention are watchwords in medical education today, yet with regard to these there are relatively few data on exercise or physical activity curriculum in medical schools. A recent survey showed that only 13% of U.S. medical schools provide a curriculum in physical activity. The authors discuss the need for changing the medical school curriculum to increase knowledge of the benefits of physical activity and develop counseling skills for modifying patients' behaviors.
... International evidence shows that medical counseling is highly associated with personal knowledge and lifestyle, more specifically, physicians' engagement in physical activity 12,13,2,14 . Studies also report that the ideal timing to increase the knowledge about physical activity benefits among physicians is during undergraduate years 15,18 . ...
... There are few evaluations on the presence of health-related physical activity in Medical schools curricula 19 . An American study reports 18 that, from 102 medicine schools, only 13% discussed physical activity health benefits topics during undergraduate education. Another study showed that in the United Kingdom, 56% of courses taught the current physical activity and health guidelines to their students 20 . ...
... Another study showed that in the United Kingdom, 56% of courses taught the current physical activity and health guidelines to their students 20 . Apparently, this knowledge is not discussed satisfactorily among undergraduate students, but no information is available from low and middle-income countries 18,20 . The aim of the present study is to describe the presence of health-related physical activity content in the curriculum of Brazilian Medicine courses and to evaluate if the characteristics of each institution are associated with this outcome. ...
Physical activity engagement is a key strategy to improve population health and quality of life. However, studies show that physical activity counseling by physicians is low, and one of the main barriers reported is lack of specific knowledge. The aim of this study is to describe the existence of health-related physical activity content in the curricula of Brazilian Medicine undergraduate courses. A census-type descriptive study was carried out. Online documentation available in institutional websites of all Brazilian Medicine courses curricula were assessed and, when not available, faculty members were contacted. In 2015 we identified 233 medicine courses in Brazil, using data from the Brazilian Ministry of Education. We assessed the documentation in detail of 158 courses (67.8%). We observed that only 12% of curricula presented health-related physical activity and/or physical exercise contents. This proportion was higher in public Medical schools compared to private ones (21.5% vs. 5.4%; p = 0.002). Teaching of health-related physical activity in Brazilian Medicine courses is scarce. We highlight the need for adjustment of curricula considering the well-established benefits of physical activity for public health.
... This may stem from the level of PA instruction being offered in medical school. In an assessment of US medical schools conducted in 2002, only 12.7% of programs reported including PA instruction in their curricula [16]. A recent analysis of US medical education curricula posted online found that a majority of programs did not require their students to take any courses in Correspondence PA [17]. ...
... We developed a structured interview, based on items used in previous studies [16,18], to elicit information on the level of PA training in each school's medical education curriculum. The interview script was vetted by a panel of PA experts and medical school administrators for clarity and completeness. ...
... However, a lower proportion of programs reported including essential tools for PA counseling, such as education on the national recommendations for aerobic activity (61%) and strength training (44%). Our findings suggest an increasing trend in the level of PA training being offered to US medical students since the last study in 2002 when only 13% of US medical schools reported offering this instruction [16]. However, the level of training reported in this study remains lower than levels reported by programs in other countries [18] and in other disciplines, such as nutrition education [20]. ...
Background:
Medical professionals serve as influential sources of information and guidance for their patients. Medical school may be an opportune time to provide future physicians with training in physical activity (PA) so that it can be more effectively addressed in clinical practice.
Methods:
To assess the inclusion and amount of PA training in US medical school curricula, we attempted to conduct structured interviews with the program directors of the 171 accredited US medical education programs in the spring of 2013.
Results:
Seventy-four schools (allopathic, n = 64; osteopathic, n = 10) completed the structured interviews. Fifty-eight programs (78.4%) reported having PA training included as a part of their curriculum. Thirty-five (61.4%) and 25 (43.9%) programs included instruction on national aerobic and strength training guidelines, respectively. Thirty-one programs (56.4%) felt that they offered a sufficient level of PA-related training for their students to successfully counsel their patients in the future. Over the 4 years of medical school, an average of 8.1 (± 9.8) h of mandatory PA training was offered.
Conclusion:
Though many medical schools report providing some level of PA content, the time dedicated for this training is still low in comparison to other topics, such as nutrition education, which are featured more prominently. New and innovative ideas are needed for the integration of more, higher quality PA training for our next generation of medical practitioners.
... The major recommendation from most guidelines is to see your "physician/ healthcare provider", which assumes that your specific healthcare provider has the appropriate knowledge and training to develop and implement an individually tailored exercise program. However, lack of time and limited knowledge has repeatedly emerged from the literature as barriers for physicians to prescribe exercise to individuals [15][16][17][18]. Given that current exercise guidelines are designed for the general/healthy population or geared towards those living with a single pathology, there is limited guidance to ensure safety with exercise prescription for individuals living with more than a single pathology. ...
... Therefore this lack of integrative information begs the question of how to prescribe exercise when an individual has more than one chronic disease. Furthermore, guidelines often recommend simply for these types of patients to speak to their healthcare provider about a safe exercise regimen, yet a lack of time coupled with limited knowledge and education about exercise prescription are noted barriers to this tailoring approach [15][16][17][18]. Instead, in order for individuals with chronic diseases to reap the benefits of physical activity with reduced risk, safe ranges of physiological markers can be identified for clinicians to guide their exercise prescription efforts. ...
... This is an inadequate recommendation because it assumes that the healthcare provider has sufficient knowledge to create and implement a patient-specific exercise program for individuals with multiple chronic diseases. Recent articles have noted that physicians often do not have exercise science training and therefore rely on disease specific guidelines for recommendations [15][16][17][18]. This systematic review acts as a steppingstone for the emergence of safe yet individualized exercise prescription. ...
Background: Although the benefits of exercise are well-known, guidelines often target the general public or individuals living with single pathologies. Currently, there is no systematic exercise prescription approach for individuals with multiple chronic diseases.
Objective: To determine overlapping physiological and subjective markers for use by clinicians to define safe exercise for individuals with multiple chronic diseases.
Methods: Eight databases were used to complete a comprehensive systematic review. Thirty-nine articles met the inclusion criteria for chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD) and type two diabetes mellitus (T2DM). Four reviewers extracted all qualitative and quantitative data.
Results: Findings show that: 1) aerobic and resistance training done 2-3 times per week is beneficial for individuals with chronic diseases, and 2) overlapping ranges of physiological and subjective markers can be used to determine safe exercise prescription. Exercise for the chronic diseases searched is safe with overlapping markers including: systolic and diastolic blood pressure, Borg scale, VO2Max, and heart rate. Each disease state did have unique markers that must be monitored to ensure safety during exercise. Specifically, with COPD SpO2 should be kept above 90%, for CAD exercise heart rate should be kept 10 bpm below causing angina symptoms, and for diabetes blood glucose should be kept between 100-300 mg/dl.
Conclusion: This review shows initial evidence for a multi-system approach to exercise prescription, which suggests screening key physiological markers from various body systems in order to safely prescribe exercise to individuals with multiple chronic diseases.
... The major recommendation from most guidelines is to see your "physician/ healthcare provider", which assumes that your specific healthcare provider has the appropriate knowledge and training to develop and implement an individually tailored exercise program. However, lack of time and limited knowledge has repeatedly emerged from the literature as barriers for physicians to prescribe exercise to individuals [15][16][17][18]. Given that current exercise guidelines are designed for the general/healthy population or geared towards those living with a single pathology, there is limited guidance to ensure safety with exercise prescription for individuals living with more than a single pathology. ...
... Therefore this lack of integrative information begs the question of how to prescribe exercise when an individual has more than one chronic disease. Furthermore, guidelines often recommend simply for these types of patients to speak to their healthcare provider about a safe exercise regimen, yet a lack of time coupled with limited knowledge and education about exercise prescription are noted barriers to this tailoring approach [15][16][17][18]. Instead, in order for individuals with chronic diseases to reap the benefits of physical activity with reduced risk, safe ranges of physiological markers can be identified for clinicians to guide their exercise prescription efforts. ...
... This is an inadequate recommendation because it assumes that the healthcare provider has sufficient knowledge to create and implement a patient-specific exercise program for individuals with multiple chronic diseases. Recent articles have noted that physicians often do not have exercise science training and therefore rely on disease specific guidelines for recommendations [15][16][17][18]. This systematic review acts as a steppingstone for the emergence of safe yet individualized exercise prescription. ...
Background: Although the benefits of exercise are well-known, guidelines often target the general public or individuals living with single pathologies. Currently, there is no systematic exercise prescription approach for individuals with multiple chronic diseases.
Objective: To determine overlapping physiological and subjective markers for use by clinicians to define safe exercise for individuals with multiple chronic diseases.
Methods: Eight databases were used to complete a comprehensive systematic review. Thirty-nine articles met the inclusion criteria for chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD) and type two diabetes mellitus (T2DM). Four reviewers extracted all qualitative and quantitative data.
Results: Findings show that: 1) aerobic and resistance training done 2-3 times per week is beneficial for individuals with chronic diseases, and 2) overlapping ranges of physiological and subjective markers can be used to determine safe exercise prescription. Exercise for the chronic diseases searched is safe with overlapping markers including: systolic and diastolic blood pressure, Borg scale, VO2Max, and heart rate. Each disease state did have unique markers that must be monitored to ensure safety during exercise. Specifically, with COPD SpO2 should be kept above 90%, for CAD exercise heart rate should be kept 10 bpm below causing angina symptoms, and for diabetes blood glucose should be kept between 100-300 mg/dl.
Conclusion: This review shows initial evidence for a multi-system approach to exercise prescription, which suggests screening key physiological markers from various body systems in order to safely prescribe exercise to individuals with multiple chronic diseases.
... 6) However, for all of its known benefits, physical activity appears to have a rather sparse presence in the medical school curriculum. Nine English language studies have examined this topic over the past 42 years (Table 1), 4 of which were conducted in the United States, [12][13][14][15] with the others occurring in Canada, [16][17][18] the United Kingdom, 19 and the United Kingdom and Ireland. 20 Regardless of the country of origin or research approach employed, the take home message of these studies has been remarkably consistent: ...
... As previously noted, 4 studies published between 1975 to 2002 have addressed this topic in the United States. [12][13][14][15] Three were surveys of medical school administrators and 1 was a review of medical school bulletins (ie, content analysis). All were conducted among allopathic schools of medicine (MD). ...
... The 5 content domains and potential types of instruction emerged from our literature review. [12][13][14][15][16][17][18][19][20] Procedures Data were extracted from each institution's website in 2013 and recorded in a spreadsheet (Excel; Microsoft, Bellevue, WA). • Seven institutions (26.9%) taught sport and exercise medicine content within their formal core curriculum; an additional 6 (23.1%) offered it as an optional module. ...
This study provides an update on the amount and type of physical activity education occurring in medical education in the United States in 2013. It is the first study to do so since 2002.
Applying content analysis methodology, we reviewed all accessible accredited doctor of medicine and doctor of osteopathic medicine institutions' websites for physical activity education related coursework (N = 118 fully accessible; 69.41%).
The majority of institutions did not offer any physical activity education-related courses. When offered, they were rarely required. Courses addressing sports medicine and exercise physiology were offered more than courses in other content domains. Most courses were taught using a clinical approach. No differences were observed between MD and DO institutions, or between private and public institutions.
Over half of the physicians trained in the United States in 2013 received no formal education in physical activity and may, therefore, be ill-prepared to assist their patients in a manner consistent with Healthy People 2020, the National Physical Activity Plan, or the Exercise is Medicine® initiative. The Bipartisan Policy Center, American College of Sports Medicine, and the Alliance for a Healthier Generation called for a reversal of this situation on June 23, 2014.
... However, few medical schools include exercise medicine in their curriculum. [30][31][32][33][34][35][36] American studies indicate that 13% of medical schools in the US offer instruction in PA, 6% have core coursework, and 87% of schools offer no curriculum in exercise medicine whatsoever. 32 Within medical education there has been an identifiable gap in exercise medicine training, with 64% of medical school deans reporting educating trainees in PA was their responsibility, yet most believed only 10% of their graduates were competent in exercise prescription. ...
... [30][31][32][33][34][35][36] American studies indicate that 13% of medical schools in the US offer instruction in PA, 6% have core coursework, and 87% of schools offer no curriculum in exercise medicine whatsoever. 32 Within medical education there has been an identifiable gap in exercise medicine training, with 64% of medical school deans reporting educating trainees in PA was their responsibility, yet most believed only 10% of their graduates were competent in exercise prescription. 31 This is starting to change, albeit slowly, in specific institutions, such as the integration of PA into all four years of medical school curriculum at the University of South Carolina 37 , or the establishment of the Institute of Lifestyle Medicine through Harvard Medical School. ...
Background:
Physical activity (PA) is a key intervention for chronic disease, yet few physicians provide exercise prescription (EP). EP is an important component in larger strategies of reducing non-communicable disease (NCD). Our objective was to assess Family Medicine Residents (FMR) knowledge, competence, and perspectives of EP to help inform future curriculum development.
Methods:
A 49-item cross-sectional survey was administered to 396 University of British Columbia FMR. Residents' EP knowledge, competence, attitudes/beliefs, current practices, personal physical activity levels, and perspectives of training were assessed using, primarily, a 7-point Likert scale.
Results:
The response rate was 80.6% (319/396). After eliminating 25 that failed to meet the inclusion criteria, 294 were included in the final analysis. The majority 95.6% of FMR reported EP as important in their future practice, despite having low knowledge of the Canadian PA Guidelines (mean score 1.77/4), low self-reported competence prescribing exercise as prevention (mean score 13.35/21), and rating themselves "somewhat incompetent" prescribing exercise to patients with chronic disease (mean score 11.26/21). FMR believe PA is integral to their patients' health (98.0%), sedentary behaviour is harmful (97.9%), and feel a responsibility to discuss PA with patients (99.7%). Few FMR (14.9%) perceived their training in EP as adequate and 91.0% desire more.
Conclusions:
FMR report EP is important, yet do not perceive they are sufficiently prepared to provide EP. In future curricular development, medical educators should consider residents' low knowledge, competence, perceived program support, and their expressed desire for more training in exercise prescription.
... Medical education curriculums need to include the promotion of physical activity [35]. This can be achieved through the addition of physical activity training to the current preventative medicine education curriculum, while remaining sensitive to funding concerns [36]. Given the attention that preventative medicine and physical activity commands in society today, this represents a golden opportunity to train new generations of physicians to avoid the 'knee jerk reaction' of prescribing medication as a first response to the many diseases of inactivity [35]. ...
... However, a 2002 survey of US allopathic medical schools (the biological-based approach to healing; e.g., if a patient has high blood pressure, an allopathic physician might give him/her a drug that lowers blood pressure) revealed that only 13 of 102 responding schools provided instruction in the health benefits of physical activity, and only six of the 13 required the curriculum. In those 13 medical schools the median number of hours spent on instruction was 11 h [36]. Medical students and residents are becoming practicing physicians without gaining confidence in the prescription of physical activity, something medical school/residency training could provide. ...
Physicians are accustomed to prescribing multiple prescriptions to adults of all ages, but particularly to the older adult population. In 2010, US retail pharmacies filled out on average 31.1 prescriptions for adults aged 65 years and older compared with 11.3 prescriptions to adults aged 19-64 years. Older adults find themselves at the pharmacy counter more often than younger generations due to an increase in chronic diseases and disabling conditions. Many of these diseases and conditions are often well treated and controlled via prescription drugs. However, a different type of prescription should be written on physicians prescription pads worldwide, one that could potentially lower the risk of diseases and disabling conditions altogether. This prescription is commonly referred to as an 'exercise prescription. The overall intent of this paper is to discuss successful strategies implemented by physicians who have prescribed physical activity/exercise to their older adult patients and to help healthcare providers better understand and establish successful exercise prescription counseling habits. It is also aimed to shed light on the barriers facing primary care providers in an effort to help physicians overcome these barriers. Information regarding Exercise is Medicine® and the Exercise is Medicine® Credential program for exercise specialists is provided. Older adult and public health advocates will also find this paper valuable in that they too will learn the recommended physical activity guidelines, associated benefits of engaging in the recommended dose of physical activity, and perhaps how to promote exercise prescription by their physician, physician organizations, or engage other members of the medical team, including health and fitness professionals, to strive for a common goal of patients receiving this 'new medicine called exercise.
... [5][6][7][8][9][10][11] Most traditional medical school curricula address these topics in the preclinical years without reemphasis or building of additional skills. 12,13 A lack of sufficient faculty trained in nutrition and physical activity, a lack of time in an ever expanding curriculum, a lack of funding for the development of new curricula, and a lack of a critical mass of role models are institutional barriers to including PAC and NC in the curriculum. 14 If PAC and NC are to improve in physician practice, medical schools must target the elements of health behavior counseling that can be effected by curriculum and instructional changes. ...
... According to the AAMC 2000 graduation questionnaire, 90 % of students felt physicians could have a greater impact in the areas of disease prevention and health promotion, but believed they were inadequately trained in risk assessment and counseling techniques. 13 These beliefs are maintained through out residency as 93% of internal medicine residents felt it was their duty to counsel patients but only 28% felt confident of their skills. 15 Using adult learning theory to teach 29 a patientcentered/stage of change counseling strategy leads to an increased self-confidence score for physical activity and nutritional counseling skills among first year medical students. ...
Introduction:
Few Americans follow recommendations regarding nutrition or physical activity, and few physicians provide nutritional counseling (NC) or physical activity counseling (PAC) to patients. Clinical, systems-based, and institutional barriers to teaching and providing NC and PAC exist, but theoretical models of behavior change and principles of adult learning theory (ALT) can enable medical educators to overcome these barriers.
Methods:
We developed an educational intervention consisting of interactive lectures and two standardized patient experiences to provide first-year medical students with practical experience in PAC and NC. Students completed pre and post educational assessments of attitudes, knowledge, and self-efficacy with the counseling techniques.
Results:
Knowledge scores increased from 6.1 to 8.5 (p<.001) on a 13-item test. Self-confidence scores for NC increased from 45 to 78 (p<.001), and self-confidence scores for PAC increased from 51 to 82 (p<.001). While overall attitudes regarding the necessity and utility of counseling with specific disease states were not different pre/ post test (necessity pre/post 6.3 to 6.2 p= .71; utility pre/post 5.8 to 5.7 p=.88), necessity and utility scores for disease states treated primarily with counseling were different compared to disease states students perceive to be primarily pharmacologically treated (counseling vs. pharmacological necessity 5.9 vs. 6.6 p<.001; utility 5.4 vs. 6.1 p<.001).
Conclusion:
An educational intervention based on theoretical models of behavior change and ALT can increase knowledge and self confidence scores regarding counseling for NC and PAC.
... The importance of physical activity as a vital sign and key determinant for health, public health, quality of life, and even happiness has been acknowledged by numerous global, national, and international medical organizations (5,7Y10, 19,24,28). However recent studies suggest health care professionals are not being taught why and how to effectively assess, prescribe, and promote regular physical activity to their patients (6,25). It is therefore hardly surprising that health care professionals are not prescribing and promoting physical activity (1,27). ...
... It is unacceptable that physical inactivity is the fourth leading preventable global killer, and physical inactivity accounts for approximately 5.3 million deaths per year (16). Yet physician understanding of the importance of physical inactivity as a cause of disease, use of physical activity prescription in the prevention, management and treatment of disease, and the skills required to deliver effective physical activity promotion are neglected hugely in medical education in the United States and United Kingdom (6,25). Health care education boards and examination boards may have the greatest responsibility to ensure that tomorrow's health care professionals are best prepared to assess and prescribe exercise in accordance with health guidelines. ...
Physical inactivity's propensity to cause preventable morbidity and mortality grossly is under-recognized by both the public and by health care professionals. If health care professionals are serious about doing the best for every patient every patient visit, then we must be skilled in assessing physical activity levels as well as providing appropriate advice and must be able to guide patients through options and to activity. We have a professional duty and responsibility to know and deliver best treatments as well as keep ourselves up to date with and strive for the current best practice. Physical activity is central to health, and doing nothing is not a responsible option for our patients or health care professionals. More importantly, there is an urgent need for all health care professionals to embrace physical activity and strive for systems change, at governmental, organizational, educational, and medical leadership levels.
... Integration of skills into routine clinical practice remains a challenge [10][11][12]; partly due to infrequent and inadequate training during medical education. Medical schools reported including PA [13,14] or exercise prescription [15] as part of the curriculum. However, the medical curriculum is insufficiently focused on prevention, is rarely evaluated, and is occasionally adopted [16]. ...
Objective
To evaluate the impact of a curricular intervention to promote health-related fitness (HRF) among medical students in Bogota, Colombia.
Method
The study was conducted between May 2014 and December 2015 as part of the medical physiology course, in which 208 medical students were enrolled.The curricular intervention included two lectures on physical activity (PA) and student-led group presentations on the physiological effects of exercise on human physiology. An academic incentive (10% of final grade) was given to students who reported and documented regular PA practice during the semester. This study assessed students’ HRF variables, perceptions of the curriculum intervention, and PA practices using quantitative and qualitative approaches.
Results
55% of the students were female, with a mean age of 19.5 years. Body fat, estimated maximum oxygen consumption (VO2max), handgrip, and sit-up strength showed statistically significant improvements at the end of the intervention. Students reported that PA practice was positively influenced by the curriculum intervention, particularly the academic incentive and the HRF tests. Students reported a wide variety of PA practices, which were mainly done with friends, classmates, or family members. Lack of time was the main reported barrier to PA practice.
Conclusion
The curricular intervention was effective in improving HRF and promoting PA. It remains to be investigated whether these gains are sustained over time.
... This is particularly true for PA. For example, few medical schools reported including PA [15,16] or exercise prescription [17] as part of the curriculum. In addition, the medical curriculum is insu ciently focused on prevention, is rarely evaluated, and is occasionally adopted [18]. ...
OBJECTIVE
To evaluate the impact of a curricular intervention to promote health-related fitness (HRF) among medical students in Bogota, Colombia.
METHOD
The study was conducted between May 2014 and December 2015 as part of the medical physiology course, in which 208 medical students were enrolled. The curricular intervention included two lectures on physical activity (PA) and student-led group presentations on the physiological effects of exercise on human physiology. An academic incentive (10% of final grade) was given to students who reported and documented regular PA practice during the semester. This study assessed students' HRF variables, perceptions of the curriculum intervention, and PA practices using quantitative and qualitative approaches.
RESULTS
Fifty-five percent of the students were female, with a mean age of 19.5 years. Body fat, estimated maximum oxygen consumption (VO2max), handgrip and sit-up strength showed statistically significant improvements at the end of the intervention. Students reported that PA practice was positively influenced by the curriculum intervention, particularly the academic incentive and the HRF tests. Students reported a wide variety of PA practices, which were mainly done with friends, classmates or family members. Lack of time was the main reported barrier to PA practice.
CONCLUSION
The curricular intervention was effective in improving HRF and promoting PA. It remains to be investigated whether these gains are sustained over time.
... The broad nature of barriers in postgraduate education are consistent with undergraduate medical education, including a lack of curriculum space, time, and qualified educators (19,23,30). However, medical education needs to adapt. ...
Background
Despite the known benefits of physical activity (PA), one third of adults in the UK fail to meet recommended levels of PA. PA promotion in primary care has been shown to be effective at improving PA in patients but implementation of PA promotion by GPs remains poor. Research has shown a need to improve PA education in undergraduate medical education, but no review of postgraduate medical education has been performed.
Aim
Assess the knowledge and values towards PA promotion in General Practice specialist trainees (GPST) in Scotland.
Design & setting
Cross-sectional survey distributed to GPSTs trainees in Scotland.
Method
A mixed methods cross-sectional survey, informed by previous research, was developed, and distributed, to all (n = 1205) GPSTs in Scotland in December 2022. Descriptive statistics were used to analysis quantitative data. A content analysis of free text responses was also performed.
Results
A total of 168 GPSTs responded, representing 13.4% of all GPSTs in Scotland. Of respondents, 93.5% reported no previous experience in Sports and Exercise Science/Medicine. Overall, 38.9% of respondents stated they were unaware of the current UK PA guidelines, with 33.9% unable to correctly identify the UK PA guidelines when presented with multiple choice options. 83% felt they had been inadequately trained to deliver PA advice during their medical training.
Conclusion
This study highlights a lack of knowledge, confidence, and education in PA promotion in GPSTs in Scotland. Given the importance of primary prevention, this urgently needs to be addressed.
... As Jaques and Loosemore asked, "Why is PA medicine not adequately included in the undergraduate curriculum" 72 ? Impediments include lack of curricular space, time, and qualified educators [75][76][77]79 It is a fact that PA is seen as part of other topics in medical schools and can be worked on within various curricular units. ...
Introduction: Physical activity is essential for preventing and treating many diseases. Although physicians are the most influential health professionals in advising their patients on the benefits of physical activity, most medical degree programs in Brazil do not seem to include physical activity topics in their curricula. Objective: This study aimed to investigate physical activity topics on active medical curricula in Brazil. Method: The research was conducted separately in April 2015 and February 2019 using a governmental resource, the e-MEC system, and search in internet databases. Data were split into categories according to the type of enrollment (mandatory or optional) of the courses that have subjects or thematic modules with topics on physical activity, type of activities (theoretical, practical, or theoretical-practical), and emphasis on the content (health, performance, or health and performance). Results: Of the 223 medical curricula compiled in 2015 and 286 in 2019, respectively, only 24 (10.8%) and 19 (6.7%) had at least one subject or thematic module concerning physical activity with emphasis on health. Conclusion: In Brazil, the number of undergraduate medical curricula covering physical activity topics is still small and suffered a reduction between 2015 and 2019, which should warn medical education institutions about the need to include physical activity longitudinally distributed contents, with theoretical and - if possible - practical approaches, and emphasis on health promotion and treatment of diseases, in mandatory curricular units.
... In a study conducted in the United Kingdom and Ireland, the authors found that only seven medical schools taught sport and exercise medicine within the core curriculum in a formal context, and in six other schools, sport and exercise medicine was an optional module (21). In the United States, 87% of medical schools do not have any physical activity or exercise content in their curricula (22). This percentage is very close to the 100% that we found in relation to the curricula of the Brazilian undergraduate programs in medicine, none of which present sports-related exercises in their curricula. ...
Bolstered by evidence of the health benefits of exercise, health professionals advise their patients about it. Thus these professionals should have a basic knowledge of exercise physiology. In Brazil, a graduate degree is not mandatory, so for many health providers, the only opportunity to receive information on exercise physiology content is during their undergraduate study. Therefore, it is imperative that health science undergraduate programs include content on exercise physiology. The aim of the study was to verify the presence of exercise physiology (or similar coursework) in the curricula of seven health science undergraduate programs (biomedicine, physical education, nursing, physiotherapy, medicine, nutrition, and psychology). The study was divided into three phases: 1) a survey of the total number of undergraduate programs (n = 4,940) through an electronic system of the Brazilian Ministry of Education (e-MEC); 2) a random selection of 10% of the total undergraduate programs (n = 494) for further analysis of the curriculum; and 3) analysis of the curricula of the selected undergraduate programs. Of 494 undergraduate programs, we did not find curricula for 77 of them. Therefore, the final sample consisted of 417 undergraduate programs. In total, 65.9% of the undergraduate programs did not offer coursework in exercise physiology. The chi-square test revealed a significant association between undergraduate curricula in health science and the presence or absence of exercise physiology coursework [X2(6, n = 417) = 293.0, P < 0.0001]. We did not find exercise physiology coursework in most of the analyzed undergraduate programs. Alternatives to solve the lack of exercise physiology coursework would be the inclusion of content related to exercise physiology in professional/graduate education or in continuing education programs.
... Despite this, both Brazilian general practitioners and nurses self-rated their knowledge as insufficient and incorrectly responded to physical activity recommendations 15 . A lack of knowledge on how to conduct physical activity counseling seems to be a common obstacle that hinders efforts in physical activity promotion in primary health care services 13,22 , probably as a result of poor curriculum in medical schools 34,35 . In contrast, changes in curricula of medical and other health schools are not appropriately addressed, and an opportune way for improving physical activity counseling is by means of in-service training of all primary care workers, which is in consonance with the National Permanent Health Education Policy 36 . ...
This study aimed to determine the prevalence and associated factors with physical activity counseling among Brazilian Family Health Strategy workers. This is a cross-sectional study conducted with a random sample of 591 health workers who work in the Family Health Teams of João Pessoa-PB, Brazil. Counseling for physical activity was defined as any advising targeted for increasing patients’ physical activity levels conducted for at least six months. The following factors were considered: time working in health care units, amount of daily attendance, continuing education, perceived barriers, self-efficacy, attitude, self-rated health, physical activity level and nutritional status. Prevalence of counseling was 46.3%, being higher among physicians (74.5%; 95%CI: 59.6-85.2) and nurses (60.3%; 95%CI: 48.0-71.4) compared to community health workers (42.9%; 95%CI: 38.2-47.7) and nurses assistants (31.5%; 95%CI: 20.2-45.4). The results showed health professionals with positive self-rated health, without perception of barriers, having a positive attitude and high self-efficacy were more likely to perform physical activity counseling. Knowledge and actions on factors associated with physical activity counseling can help broaden the involvement of primary health care providers in health education.
... For instance, in their systematic review, Hebert and colleagues reported that having "too little time" to address PA was reported by PCPs in 14/19 studies and insufficient training in 8/19 (Hebert et al., 2012). These findings are less surprising considering that less than 15% of medical schools include PA in their curricula, and less than half of PCPs report any PA-related training (Garry et al., 2002;Cardinal et al., 2015). As a result, few PCPs report successfully promoting PA among their patients or endorsing the belief that their patients would become more active if provided with PA advice and counseling (Hebert et al., 2012;Walsh et al., 1999). ...
Despite the inverse relationship between physical activity (PA) and physical function, few older adults achieve PA recommendations. In response to observations that “lack of time” underlies reduced PA among older adults, recent work suggests even short bouts of PA can improve health and fitness. In addition, because they are frequently visited by older adults, an important potential conduit for PA could be the primary care physician (PCP). However, most PCPs receive little PA related training, rendering it difficult for them to offer meaningful counseling. Therefore, we explored the feasibility and impact of a PCP-prescribed one-minute daily functional exercise program, consisting of 30s each of bodyweight push-ups and squats, among 24 patients 60 years of age or older. 42% of patients who were contacted started the exercise prescription and, over 24-weeks, completed approximately 114 sessions, while 75% completed at least half of the possible daily exercise sessions. As a group, the patients demonstrated significant increases in both maximal push-up and squat performance, though these increases plateaued following week-12. These results suggest that a PCP prescription of one-minute of daily functional exercise among older adult patients was feasible, acceptable, and effective for improving functional physical fitness. Given these positive findings, formal controlled research with recruitment from multiple clinics, random assignment to treatment conditions, and blinded assessments of objective functional physical performance should be pursued.
... Currently, 47% of medical students surveyed agree with the importance of writing exercise prescriptions but only 10% feel capable [18]. Thirteen percent of U.S. medical schools feature PA education within their curricula, and most U.S. medical school graduates lack the competence and confidence to counsel patients on exercise after graduation [18,19]. ...
Objective: To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.
Study Design: cross-sectional study
Methods: 4500 randomly selected pediatricians, family practice, and sports medicine physicians in the United States were surveyed (11% response rate). Main outcome measures were questionnaire answers on clinical effort, attitudes, and barriers surrounding PA, medical education in exercise science, and awareness of ICD-9 diagnostic codes pertaining to physical inactivity.
Results: Approximately 15% of patient interaction time was spent on the evaluation and treatment of physical inactivity for a normal weight child. For an overweight or obese child, clinical time spent on PA almost doubles. Regardless of weight, sports medicine physicians spent significantly more time on the evaluation of physical activity compared to family/internal medicine physicians and pediatricians. Mean percentage of time family/internal medicine physicians spent on PA evaluation and treatment was consistently less than sports medicine physicians, and consistently more than pediatricians. Most physicians strongly agreed that PA assessment and treatment is important for disease prevention; only 28% had ever made the diagnosis of childhood physical inactivity. Limited clinical time was identified as a primary barrier to diagnosing childhood physical inactivity. 85% of respondents were unaware of ICD-9 codes for reimbursement of PA evaluation. 81% reported a paucity of exercise science education in medical school.
Conclusion: While physicians report that PA evaluation is important in practice, behavior patterns surrounding time evaluating PA and treating childhood physical inactivity are discrepant. Pediatricians showed less favorable attitudes and effort surrounding PA compared to other primary care disciplines. The majority of physicians are unaware of physical inactivity diagnostic codes, have never made the diagnosis of childhood physical inactivity, and may not be receiving basic pediatric exercise science training required for evaluating and treating childhood physical inactivity.
... 31 A 2002 survey of U.S. allopathic medical schools found that only 13% included physical activity and wellness in the curriculum. 32 Veterans Affairs physicians state that the biggest obstacle faced for providing counseling about diet and exercise was insufficient obesity education in medical school and residency. 33 Fortunately, VA physicians who practiced positive personal habits were more likely to counsel their patients on positive habits, and patients were more likely to accept advice from VA physicians who were not themselves obese. ...
Introduced by the American College of Preventive Medicine and released by the American Medical Association House of Delegates in 2017, Resolution 959 (I-17) supports policies and mechanisms that incentivize and/or provide funding for the inclusion of lifestyle medicine education and social determinants of health in undergraduate, graduate and continuing medical education. Resolution 959 was passed to help address the current healthcare costs of lifestyle-related, noncommunicable chronic diseases that exert a devastating economic burden on the U.S. healthcare system. Approximately 86% of $2.9 trillion is spent annually on obesity, cardiovascular disease, type 2 diabetes, and some cancers, with very poor return on investment for health outcomes. Lifestyle medicine provides an evidence-based solution to the noncommunicable chronic disease epidemic; however, medical education in lifestyle medicine is minimal to nonexistent. This paper provides the case for healthcare innovation to include lifestyle medicine in the prevention and treatment of noncommunicable chronic diseases. Our medical education system recommendation is to provide lifestyle medicine training for prevention and treatment of noncommunicable chronic diseases. Exemplar lifestyle medicine schools are showcased and guidance for reform is highlighted that can be used to aid lifestyle medicine integration across the medical school education continuum. With a transformation of curriculum and development of new policies to support a focus on lifestyle medicine education in medical education across the continuum, a new healthcare model could be successful against noncommunicable chronic diseases and U.S. citizen wellness could become a reality.
... The American College of Sports Medicine (ACSM) has also implemented a program called, "Exercise is Medicine®", to encourage physicians to assess a patient's activity level at every visit. Despite these encouraging programs, there has been a decline in the amount of education regarding the benefits of physical activity and health behavior guidelines provided to medical students (Wolf and Scurria, 1995;Garry et al., 2002;Cardinal et al., 2015). There are currently no recommendations by the Association of American Medical Colleges (AAMC) to incorporate nutrition or wellness education into the medical school curriculum (Cardinal et al., 2015;Adams et al., 2010). ...
This study examined the use of activity trackers alone or combined with weekly communication through email to improve activity and body composition over one academic year in medical students. This randomized clinical trial conducted at the New York Institute of Technology from July 7, 2016 through June 4, 2017 enrolled 120 medical students. The first group (Fitbit-Plus) wore activity trackers and received weekly emails offering fitness challenges and lifestyle modification challenges. The second group (Fitbit-Only) received only activity trackers and did not receive weekly emails. The third group (Control) was asked not to purchase an activity tracker of any kind throughout the study. All groups had a body composition analysis prior to the start of the academic year and at the end of the first academic year. Outcome measures included step count and body composition (body fat percentage and lean body mass). The results showed the overall mean daily steps were greater in the Fitbit-Plus group than the Fitbit-Only group for the academic year (7429 ± 2833 vs. 6483 ± 2359) with only months April and May showing a significant difference between the groups (p = 0.011; p = 0.044). Body fat percentage decreased in the Fitbit-Plus overweight women (2.1 ± 1.6%) lean body mass increased in the Fitbit-Plus group in overweight men (2.4 ± 4.6 lbs.). A subsequent finding of this study showed improved body composition in a small sub-group of over-weight students. Weekly behavioral challenges combined with an activity tracker increased step count in medical students compared to an activity tracker alone.
Clinicaltrials.gov Identifier: NCT02778009.
... A study in the united states done by (Garry et al., 2002) showed that majority of medical schools without a physical activity course in the curriculum had no plans to implement one. The study also suggested that substantive change in undergraduate medical education in the area of exercise prescription will not occur any time soon. ...
Exercise is healthy, and it plays a practical and safe means to decrease the burden of non-communicable diseases. Physical activity(PA) and exercise are key interventions for use in primary and secondary prevention of chronic diseases and especially when physical activity and exercise are part of a medical management plan. There is a need for PA promotion interventions in primary care and evidence that providers want to provide PA information to their patients. Several quasi-experimental and randomized trials have been conducted evaluating the efficacy and effectiveness of primary care PA promotion interventions. While not all primary care PA promotion interventions were successful from the review, the majority of studies support this approach to increasing PA. The health care system should play a role in supporting patients and the population at large to increase their PA to sufficient level for prevention and control of these chronic diseases. Even though being physically active for health and well-being is accepted by much of the general population, the majority of people in developed countries fail to meet even minimal requirements. Considering the numerous preventative and therapeutic health benefits associated with a physically active lifestyle, the effectiveness of exercise to treat various chronic diseases, the limited side effects associated with exercise in comparison to pharmaceutical therapies and the role health providers can play in the promotion of physically active lifestyles, health providers should take an active role in exercise prescription for the patient's sake. The Exercise is Medicine Initiative is being used in other parts of the world however, is has not fully taken off in many developing countries.
... In 2005, the American College of Preventive Medicine issued a position statement Dept. of Health Promotion and Sport Science, School of Public laboratory Technology. Masinde Muliro University of Science and Technology, Kakamega, Kenya "that primary care providers should incorporate PA counseling into routine patient visits" (Jacobson other professional organizations echo the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the American Heart Association, National Institutes of Health, and the Surgeon General (Garry 2002;Jacobson et al., 2005). The ACSM is yet another organization that recognizes and endorses the importance of primary care PA counseling through its initiative, "Exercise is Medicine" (Sallis, 2009). ...
The results show that most interventions delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions. in primary care significantly increases physical activity levels, as measured by self insufficient evidence to recommend exercise referral schemes over advice or counselling interventions. The two objectives were to determine whether physical activity or fitness in sedentary adults, and whether exercise referral interventions were more effective than other interventions Copyright©2017, Oloo Micky Olutende et al. This is an open access unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
... In Riyadh, Saudi Arabia, Al-Rafaee et al. (21) stated lack of time due to heavy university study schedule as a significant barrier to the physical activity. ...
... Lack of education has been identified as a primary barrier for many health professionals with regard to PA counselling in clinical settings (19,34). Twentyfour percent of U.S. medical school Deans believe that their students are well prepared to counsel patients on PA after graduation, despite the fact that the majority (i.e., 64%) believe that medical education should provide future doctors with the skills and knowledge to effectively provide PA counseling (13). However, 51.7% of medical schools do not offer any courses related to PA counseling to their students (6). ...
Purpose: The study aimed to assess the current attitudes, beliefs, confidence and knowledge of students in health-related fields with regard to physical activity (PA) promotion, and to measure changes in these variables following an evidence-based PA education intervention. Methods: A single group pre-post test design was used to explore the impact of the intervention on changes in attitudes, beliefs, confidence, and knowledge about PA counselling and beliefs about obesity. The pre-post questionnaires contained measures of barriers to PA counselling and participants' attitudes, beliefs, confidence, and knowledge about PA counselling and obesity. Results: Findings demonstrated that the PA intervention increased participants' attitudes (M change = 0.15, p = 0.031), beliefs (M change = 0.35, p = 0.002), and knowledge (M change = 0.27, p = 0.001) with regard to PA counselling, and negatively impacted obesity-related beliefs (M change =-1.92, p = 0.029). Significant increases in participants' confidence to perform counselling based on personal knowledge (M change = 7.71, p = 0.001), confidence to assess a client's readiness for PA (M change = 6.96, p = 0.032), and confidence to refer patients requiring additional clearance or information were also observed (M change = 11.25, p = 0.001). Conclusion: These findings suggest that a one-hour PA intervention can be effective in improving the attitudes, beliefs, confidence and knowledge of students in health-related fields with regard to PA promotion, but that more attention needs to be given to how PA is framed within obesity discourse.
... Therefore, physically active MDs appear to have more knowledge about exercise prescription. We and others have identified the strong link between personal PA behaviors and PA counseling practices [39][40][41][42]. The findings in the present study also seem to provide support to this theory driven by the fact that one of the main barriers MDs face is not feeling confident enough to give PA recommendations in an intellectual as well as a practical level. ...
Abstract Background The physical inactivity pandemic and related non-communicable diseases have made it imperative for medical doctors (MDs) to effectively provide lifestyle counseling as part of prevention and treatment plans for patients. A one-day certification workshop was designed to improve MDs PA prescription knowledge, as part of the Exercise is Medicine® (EIM®) global health initiative. The objective was to determine knowledge gain of MDs participating in a standardized, one-day PA prescription workshop performed throughout Latin America (LA). Methods A 20-question multiple-choice test on PA topics, based on international guidelines, was completed before and after the workshop. Pre and post-test analyses, without a control group, were performed on 1044 MDs after the 8-h workshop that was delivered 41 times across 12 LA countries, from January 2014 to January 2015. Knowledge improvement was determined using the class-average normalized gain and individual relative gain. T-tests with 95% confidence interval levels were conducted to analyze differences between MD specialties. Results Test scores improved on average from 67 to 82% after the workshop (p
... In medical schools training on PA promotion is scarce. For example, in US, only 13% of 102 medical schools in 2002 included PA and health in their curricula (Garry, Diamond, & Whitley, 2002). In Catalan Universities, PA promotion has not been included on the medical curriculum since 2010. ...
The behaviour of individuals, communities and populations is one of the major determinants of their health outcomes. This thesis presents the findings from three research projects related to the need of health care systems to focus in health behaviour change related to physical activity (PA) to manage the current burden of chronic diseases. This set of studies set out to investigate the adherence to the current PA recommendations in Catalan population, which appears to support low levels of inactivity in Catalan adults that add an avoidable burden to the nation’s Public Health system. This was undertaken because existing work in Spain – consistent with that in many other countries - has been based on isolated studies, conducted under different policies and through different economic circumstances. Three studies were conducted with the collective aim of exploring adherence to PA in the Catalan population and in Catalan physicians and to assess the outcomes of a primary care-based programme to promote health change related to PA in Catalonia. Collectively this work focuses on different and important facets of the challenge that underpins the promotion of behaviour change in adults The main findings of the studies were (i) high adherence to health-enhancing PA level based on walking activity by Catalan population but high prevalence of sedentary leisure time, (ii) poor lifestyle behaviours related to physical inactivity and overweight among Catalan physicians and (iii) the effectiveness of a PA referral scheme, promoted by the national program “Plan of Physical Activity, Sport and Health” (PAFES) on PA adherence, and associated improvements in quality of life of primary care patients with chronic conditions. The PAFES program has powerful repercussions for changing health behaviour related to PA in Catalan adults and Catalan physicians. The increases in resources and service delivery improvements generated by PAFES was intended to positively impact on both primary health care providers and Catalan population, to overcome many of the established barriers seen regarding physicians’ barriers to PA counselling, resulting from two main factors; lack of protocols and having little relevant training. Furthermore, PA referral scheme has seen to be an effective and easily practicable method for increased PA and quality of life in routine primary care patients with chronic conditions. In addition, PARS promote increased PA in a wide part of the population who otherwise are hard to reach or have a low motivation for lifestyle changes. In conclusion, adherence to PA in Catalan general population and in Catalan physicians’ population has been positively influenced by implementing the national Plan on Physical Activity, Sport and Health (PAFES) through primary care settings. The PAFES program provides a comprehensive strategy that can be deployed with relative ease for directly addressing the widespread clinical challenges that modern inactive lifestyles create for public health. This effectiveness is wide ranging and can be seen in changed health-related behaviours, which in turn reduce risk, morbidity and mortality.
... The same study found that the remaining 89 medical schools (87%) did not offer such a curriculum and, moreover, 76% noted that their schools had no plans to introduce this type of curriculum. 10 In 2003, Flynn, et al, conducted a study in the United States with physicians licensed in either internal Medicine or Cardiology. The response rate was 16% (n = 639). ...
... Although the value of this endeavor is indisputable, the attention directed toward appraising and strengthening the exercise prescription skills of exercise professionals seems disproportionately low by comparison. This is presumably a reflection of the fact that, while most exercise science academic curricula include courses partly or entirely devoted to exercise prescription (17), this information is absent from most medical curricula (15,20,41). However, as the present evaluation of the knowledge of exercise prescription guidelines among certified exercise professionals demonstrates, there is also considerable room for improvement in this vitally important target group. ...
This survey assessed the knowledge of the "Guidance for prescribing exercise" issued by the American College of Sports Medicine (ACSM) in 2011 among certified exercise professionals. A sample of 1,808 certified exercise professionals (66.70% women, Mage ± SD = 38.28 ± 12.56 years) responded to electronic invitations. The 11-question online questionnaire assessed knowledge of the recommended frequency, duration, and intensity ranges in terms of heart rate, metabolic equivalents, and ratings of perceived exertion. Respondents had 7.45 ± 8.07 years of work experience and represented all 50 US states. On average, participants answered 42.87% ± 1.69% of the questions correctly. Gender, age, and years of professional experience were not associated with overall knowledge of the guidelines. Likewise, having 1, 2, or 3+ certifications made no difference in overall knowledge. On the other hand, there were significant differences between levels of education (F = 7.12, P < 0.001), from 38.72% ± 1.62% for "some college" to 47.01% ± 1.71% for "doctorate". There were also significant differences by primary job role (F = 3.45, P < 0.001) but no category exceeded 49% (e.g., personal trainers: 40.59% ± 1.66%; clinical exercise physiologists: 44.18% ± 1.70%). The respondents rated their knowledge of the exercise prescription guidelines as 7.01 ± 1.69 out of 10 but rated the level of knowledge necessary to practice safely and effectively as 8.32 ± 1.64 (t = 28.60, P < 0.001). This survey, the first at this scale to investigate the knowledge of exercise prescription guidelines among certified exercise professionals, showed that there is room for improvement, considering that the average score was below 50%.
... Despite the strong evidence for the use of physical activity in the treatment of chronic disease (Smits & Otto, 2009), there is only limited use of physical activity counseling in health care settings (Lobelo, Duperly, & Frank, 2009). In medical schools, only 13% of all training includes curricula on physical activity (Garry, Diamond, & Whitley, 2002). ...
... [21][22][23][24] For example, only 13% of 102 US medical schools in 2002 included PA and health in the curriculum. 25 Additionally, doctors' and medical students' personal PA habits are important predictors of their counselling practices 21 26-29 30-35 ; physically inactive doctors are less likely to provide exercise counselling to patients, 30 and provide less credible role models for the adoption of healthy behaviours. 36 37 This paper focuses on the demonstrated principle that clinical providers who act on the advice they give, in this case the health benefits of regular PA, do a better job at counselling and motivating their patients to adopt such health advice. ...
... This lack of training is supported by several reports during the last decade of infrequent and inadequate medical education in PA counseling globally, both in developed (15) and developing (16) countries. A 2002 survey of US medical schools found that only 13% of 102 schools included PA and health in the curriculum, and only 6% had a core course or requirement related to exercise (17). Similarly, the US Institute of Medicine's 2004 statements on improving medical education noted that most medical schools did not effectively include PA in their curriculum (18). ...
Background:
Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools.
Methods:
The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students' awareness of benefits of PA, change in students' attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling.
Results:
Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students' attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students' personal PA behaviors.
Conclusions:
Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.
... ORIGINAL SCIENTIFIC PAPER that they are under-prepared to counsel patients about nutrition and exercise. 6,7 In addition, medical students have been shown to be pessimistic about their ability to learn these skills. 8,9 Medical students' perceptions of the importance of prevention in medicine are related to their own health habits. ...
Aim: This study assessed the impact of a medical undergraduate course which contained nutrition content on medical students’ self-perceived nutrition intake and self-efficacy to improve their health behaviours and counselling practices.
Method: Two hundred and thirty nine medical students enrolled in a 12-week nutrition-related course at the University of Auckland were invited to complete an anonymous questionnaire before and after the course with their before and after course responses linked by student identification numbers. The questionnaires were adapted from a previous evaluation of a Preventive Medicine and Nutrition course and measured students’ self-perceived nutrition intake and self-efficacy to improve their health behaviours and counselling practices. These responses were compared to a control group of 44 undergraduate biomedical science students.
Results: Sixty one medical students completed both questionnaires (25.5%). At baseline, medical students described their eating habits differently from non-medical students (p=0.0261) and reported a higher level of physical activity to the control students (P= 0.0139). Post-course, medical students reported a higher frequency of wholegrain food intake (P=0.0229) and lower levels of physical activity than the controls (P=0.0342). Also post course, medical students felt less comfortable making nutrition recommendations to family or friends (P=0.008). Most medical students (63.9%) perceived that they were more aware of their own dietary choices, and some (15.3%) reported they were more likely to counsel patients on lifestyle behaviour.
Conclusions: Students can increase awareness of their own nutrition behaviour after undertaking a course that includes nutrition in the initial phase of their medical degree. Further investigation of how medical students’ confidence to provide nutrition advice evolves throughout their training and in future practice is required.
... 2 As for ESO, which organised the World Oncology Forum in partnership with The Lancet, most of its funding (77%) comes from its two independent, not-for-profi t foundations. 3 It is certainly true that some of its programmes are carried out with the help of commercial funding. This is done through a Sharing Progress in Cancer Care (SPCC) programme, which is a partnership that currently includes 13 companies, all of which are listed on the ESO website. ...
... However, despite recommendations encouraging physicians to counsel women to exercise regularly during pregnancy, a minority of women report receiving advice to do so (11). There are numerous reasons for this: 1) physicians receive inadequate instruction on physical activity promotion during medical school and residency training (9); 2) the current prenatal care delivery system leaves little time to provide lifestyle counseling; 3) the majority of women begin pregnancy not meeting recommended levels of physical activity, making them less likely to engage in regular exercise during their pregnancy (21); and 4) women (and physicians) remain unconvinced that exercise is safe during pregnancy (7). To overcome these barriers, medical school and resident education, as well as continuing medical education, must change to include information on the benefits of physical activity during pregnancy, along with practical information on the integration of counseling into the care of women during pregnancy. ...
A majority of women do not meet the recommended levels of physical activity before and during pregnancy. Physically active women experience fewer complications of pregnancy such as gestational diabetes, hypertensive disorders of pregnancy, and low back pain, to name only a few. Exercise is Medicine encourages adults to achieve a minimum of 150 min·wk of moderate-intensity physical activity, and the same is true for women having uncomplicated pregnancies. Prenatal care is an opportune time to counsel women on how to achieve an active lifestyle to support their own health and the health of their developing fetus.
... Este problema es mucho más notorio si tomamos en cuenta que la estructura curricular de la educación médica en pregrado puede contribuir a romper los hábitos saludables de los estudiantes debido a las exigencias normales de la profesión 23 , lo cual justifica la necesidad de implementar la enseñanza de la AF [24][25][26][27][28] . ...
Objective
To describe medical students physical activity in the Cayetano Heredia Peruvian University.
Introduction:
The benefits of physical activity (PA) are widely recognized; American medical schools have begun to emphasize PA, but the effectiveness of these changes is unclear.
Methods:
We performed a cross-sectional analysis of medical students enrolled in US osteopathic and allopathic medical schools between August 2019 and May 2020. All participants completed an electronic survey about PA instruction across the 4 years of medical school. Objective information including hours and format of PA instruction was collected. Subjectively, participants reported their relative comfort discussing various aspects of PA education with patients.
Results:
A total of 480 medical students completed the survey, representing 82 of the 192 US medical schools (69 allopathic, 13 osteopathic). Students are more comfortable discussing overall exercise benefits than exercise testing, exercise prescription, and exercise physiology (P<.0001). They also report more exposure to general PA guidelines related to overall PA duration than strength training (P<.0001). Students at allopathic and osteopathic schools reported similar outcomes regarding PA education, while students with class sizes under 200 reported increased familiarity with National Physical Activity Guidelines regarding PA duration (P<.0001) and strength training (P=.01).
Conclusion:
Despite recent efforts to improve PA education in medical school, students feel unprepared to apply their knowledge in a clinical setting and remain unaware of national PA guidelines. Future studies should determine how to practically integrate PA education longitudinally into curricula to change PA education from an afterthought to an essential component of medical school education.
Physical activity (PA) counselling by physicians increases patients’ PA levels and improves health outcomes. Physician PA counselling remains low as a result of several barriers which may differ based on a patient’s stage within the Transtheoretical Model (TTM) or by physician career status (i.e. between residents and established physicians). A convenience sample of physicians in Ontario (N = 38, n = 24 residents) completed a cross-sectional, online survey assessing perception of barriers to PA counselling based on hypothetical patients’ TTM stage of change. Compared with other barriers, physicians agree less with feeling adequately reimbursed, having other professionals intervene, and having adequate resources for PA counselling. Based on responses to each barrier, physicians were more likely to counsel patients in the contemplation, preparation and action stages. Compared with established physicians, residents report less agreeance with being adequately reimbursed and having enough time for PA counselling, and greater agreeance with having other professionals intervene. This study communicates physicians’ barriers when counselling patients at different stages of PA behaviour change and the influence of career status on barrier experience. Developing patient-stage- and career-stage-specific medical training, interventions and policy changes may enhance PA counselling among physicians, and ultimately patient PA behaviour and health outcomes.
Background. There is a notable lack of education on nutrition and physical activity guidelines in medical schools and postgraduate training. The purpose of this study is to assess the nutrition and exercise knowledge and personal health behaviors of physicians in the Department of Medicine at a large academic center. Methods. We conducted a survey study in the Department of Medicine at the University of Florida in 2018. The survey instrument included questions on demographics, medical comorbidities, baseline perception of health and fitness, and knowledge of nutrition concepts. The Duke Activity Status Index assessed activity/functional capacity and the validated 14-point Mediterranean Diet Survey evaluated dietary preferences. Data were analyzed using descriptive statistics and the χ ² test was used to perform comparisons between groups. Statistical significance was determined at P < .05. Results. Out of 331 eligible physicians, 303 (92%) participated in the study. While all respondents agreed that eating well is important for health, less than a fourth followed facets of a plant-based Mediterranean diet. Only 25% correctly identified the American Heart Association recommended number of fruit and vegetable servings per day and fewer still (20%) were aware of the recommended daily added sugar limit for adults. Forty-six percent knew the American Heart Association physical activity recommendations and 52% reported more than 3 hours of personal weekly exercise. Reported fruit and vegetable consumption correlated with perceived level of importance of nutrition as well as nutrition knowledge. Forty percent of physicians (102/253) who considered nutrition at least somewhat important reported a minimum of 2 vegetable and 3 fruit servings per day, compared with 7% (3/44) of those who considered nutrition less important (“neutral,” “not important,” or “important, but I don’t have the time to focus on it right now”; P < .0001). Conclusions. This study highlights the need for significant improvement in education of physicians about nutrition and physical activity and need for physicians to focus on good personal health behaviors, which may potentially improve with better education.
Apply It!
• Partnering between health care providers and exercise specialists is needed to promote the successful implementation of physical activity guidelines in patients.
• Using an exercise or physical activity vital sign is the first step in determining a patient’s physical activity levels.
• Exercise prescriptions need to take into account patient preferences and abilities.
• Exercise is Medicine® (EIM) provides resources for clinicians and patients on physical activity implementation and benefits.
North American physicians and medical students tend to report significantly better exercise (among other) habits when compared with same-age peers. As a group, we should encourage physician exercise because it is highly correlated with positive mental and physical health outcomes not only for us but also for our patients. This chapter reviews physicians’ and medical students’ consistently positive exercise habits and the relationships between their personal exercise habits and their inclination to recommend the same to their patients; this “Healthy Doc = Healthy Patient” relationship holds true for many health behaviors. These findings highlight the importance of medical school and physician interventions to increase the numbers of physicians adopting and maintaining regular physical activity in order to increase the rates of physician-delivered exercise prescription. Taken together, these findings and suggestions have obvious and pronounced implications for preventing and managing disease on a global scale.
Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association's My Life Check - Life's Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association's 2020 Impact Goals.
Objective. Physician physical activity (PA) counseling remains low due partly to lack of knowledge, emphasizing the importance of providing learning opportunities to develop competency, given the strong associations between PA and health. This study aimed to describe the behavior change techniques (BCTs) used in an “Exercise Expo” workshop and examine the workshop’s effectiveness for improving social cognitions to discuss exercise with patients. Methods. Second-year medical students (N = 54; Mage ± SD = 25.4 ± 2.95 years) completed questionnaires assessing attitudes, perceived behavior control (PBC), subjective norms, and intentions to provide PA counseling pre- and postworkshop. Repeated-measures analyses of variance evaluated changes in these theory of planned behavior constructs. Results. The most used BCTs included presenting information from credible sources, with opportunities for practicing the behavior and receiving feedback. Significant increases in attitudes, PBC and intentions to discuss PA were observed from pre-post Exercise Expo (P ≤ .01). No statistically significant differences in subjective norms were observed (P = .06). Conclusions. The Exercise Expo significantly improved social cognitions for PA counseling among medical students. Future interventions should target improvements in subjective norms to increase the likelihood the workshop improves PA counseling behavior. The evidence supports the usefulness of a workshop-based educational strategy to enhance medical students’ social cognitions for PA counseling.
In Europe, between 1985 to 1989 and 2000 to 2004, a decline of >30% in cardiovascular disease (CVD) and coronary heart disease mortality was observed.1,2 However, according to the latest figures of the European Heart Network, the annual mortality of CVD still exceeds 4 million (ie, 47% of all deaths) in Europe and 1.9 million (ie, 40% of all deaths) in the European Union.2 Furthermore, despite a falling trend in most European countries, CVD remains the most common cause of death in women and men. The financial burden for the European Union economy is estimated to be almost €196 billion a year, of which 54% is attributable to healthcare costs, 24% to productivity losses, and 22% to the informal care of people with CVD.
Response by Mendes on p 2537
In the United States, an even greater decrease in cardiovascular mortality of 67% was achieved between 1969 and 2013. In addition, during this time period, age-standardized years of potential life lost per 1000 decreased by 68%.3
Despite this meaningful improvement, >50 years after the first coronary artery bypass grafting (CABG) in 19644 and almost 40 years after the first percutaneous coronary intervention in 1977,5 the incidence and prevalence of CVD remain high. So does the annual rate of CABG, even though it continues to drop, for example, to 1081 CABGs per 1 million adults in 2007 to 2008 in the United States.6
Obviously, coronary revascularization is widely appreciated for alleviating symptoms and improving prognosis. However, as a structural intervention, it does not address disease progression, which is why revascularization must be paired with measures of secondary prevention to maximize benefit. Given the social and economic burden of coronary artery disease, optimization of evidence-based treatment is paramount. According to current guidelines, treatment of …
Regular physical activity has numerous documented health benefits for the general population. Improved metabolic, physiologic, psychological, and cognitive health is evidenced by decreased morbidity and mortality in those who maintain an active lifestyle. While it may seem intuitive that exercise would promote similar benefits among pregnant and postpartum women, applicable research and recommendations have historically lagged behind those targeted to the general adult population. Recent advances in perinatal research have begun to demonstrate similar beneficial effects for both the mother and offspring in relation to pregnancy outcomes, chronic disease risk, and general physical and psychological well-being. Federal and American College of Obstetrics and Gynecology guidelines now recommend regular physical activity/exercise for pregnant and postpartum women given the many health benefits, and absence of risks, from exercise in these women. However, many women do not meet these physical activity guidelines. Knowledge dissemination of the importance of regular physical activity in these populations is crucial to promote the health benefits for both mother and offspring. Future research is needed to help solidify the physical activity parameters most effective for optimization of prenatal, postpartum, and offspring health outcomes.
Physical activity, is an integral health promoting behavior that patients should receive counseling on to improve or maintain their health. Counseling in the clinical setting is a strategy recommended to increase physical activity. Student nurses who receive appropriate education and practice related to physical activity counseling can potentially impact the effort to promote physical activity. Purpose: The purpose of this study was to explore undergraduate baccalaureate nursing student’s knowledge, self-efficacy, beliefs and practices for engaging in physical activity counseling. Methods: Baccalaureate undergraduate nursing students (N = 539) were surveyed to examine 1) knowledge of the current physical activity guidelines, 2) self-efficacy in counseling patients on physical activity, and 3) beliefs and practices related to physical activity. Additionally, the influence of the student’s academic status, type of program in which they are enrolled and their personal engagement in physical activity was explored to determine the effect on factors one through 3. Results:48% of the students would recommend an amount of physical activity that is consistent with the current physical activity guidelines. Self-efficacy for physical activity counseling was moderate-to-strong despite reporting limited opportunities to engage in physical activity counseling. Students (97%) reported that physical activity counseling was a role of the nurse. Physical activity counseling was ranked 4th among 9 other lifestyle behaviors requiring counseling but was not a priority when ranked amongst 9 other nursing care responsibilities (ranked 9th). The academic status of the student did influence the student knowledge of the guidelines, their self-efficacy, beliefs and practices. The program in which the student was enrolled influenced self-efficacy, with second degree program reporting more self-efficacy for physical activity counseling than traditional nursing program. The nursing student’s personal physical activity engagement did influence their self-efficacy and prioritization given to physical activity counseling; however, the pattern of these findings was inconsistent. Conclusion: Modifications to nursing curricula may be required to enable the nursing student to gain better knowledge, skills and experiences related to counseling patients on physical activity. This would be important for effective physical activity counseling within health care settings.
Providing clinicians with a comprehensive, evidence-based summary of musculoskeletal health in pregnancy and postpartum, this is the first book of its kind to describe the physiologic changes, prevalence, etiology, diagnostic strategies, and effective treatments for the most common musculoskeletal clinical conditions encountered during this phase of life. Lumbopelvic pain, upper and lower extremity diagnoses, labor and delivery considerations, including the impact on the pelvic floor, and medical therapeutics will be discussed. Additionally, the importance and influence of exercise in pregnancy, the long-term implications of musculoskeletal health in pregnancy and current and future directions for research will be addressed.
The childbearing period is a time of remarkable reproductive and musculoskeletal change, predisposing women to potential injury, pain, and resultant disability. Musculoskeletal Health in Pregnancy and Postpartum offers musculoskeletal medicine specialists, obstetricians and any clinicians involved in the care of pregnant or postpartum women the tools necessary to prepare for, treat and prevent these concurrent injuries during an already challenging time. http://www.springer.com/us/book/9783319143187
WellnessRx is a health initiative focusing on healthy living through education, knowledge translation, and community engagement. Stakeholders of WellnessRx identified web-based education learning modules on nutrition and physical education as a priority to be integrated into existing health sciences curricula, as well as adapted for use by health professionals. Five learning modules were created with essential knowledge, skills, attitudes and resources or tools for health professional students and practitioners. As part of the 'developmental evaluation framework' for WellnessRx, two of these modules were piloted within two health professional student programs. This paper describes the pilot-evaluation experience involving student surveys, focus groups and interviews, and faculty perspectives. For both modules, student pre-post knowledge assessments indicated some improvements in post-module knowledge. Post module evaluations by students indicated benefits with the online delivery being flexible for access, self-health, case-based assessments and useful nutrition and physical activity guides. Challenges for students included their time to do the modules and the activity expectations. Instructors felt each module could be better targeted to different years within an undergraduate program. Through developmental evaluation, the pilot results along with recommendations and lessons learned provided the direction needed to further develop the WellnessRx logic model and proposed learning modules.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Educating medical students and other health professionals in training on the importance of healthy lifestyles for prevention and treatment of disease is essential to transforming healthcare. At the University of South Carolina School of Medicine Greenville (USC SOM Greenville), we are incorporating the 'Exercise is Medicine' Knowledge, Skills and Abilities into all 4 years of the undergraduate medical curriculum to inform future physicians on the medical benefits of exercise and physical activity. As a partner with the Greenville Health System (GHS), USC SOM Greenville is striving to transform healthcare for the benefit of the people and communities it serves by healing compassionately, teaching innovatively and improving constantly. In addition, USC SOM Greenville and GHS are fostering relationships with the local YMCAs to improve healthcare delivery in upstate South Carolina using the 'Exercise is Medicine' solution. The overarching goal is to demonstrate how physician-counselling and referrals for physical activity and exercise play a well-documented role in primary and secondary prevention for reducing morbidity and mortality from non-communicable chronic diseases. In partnership with the Institute of Lifestyle Medicine (ILM) at Harvard Medical School, USC SOM Greenville also strives to spearhead a ripple effect in exercise curriculum by modelling for other medical school leaders throughout the country on how to adopt similar changes in curriculum and training for medical school students. Physician education regarding the benefits of exercise is vital for transforming healthcare.
The paucity of training in physical activity (PA) promotion in UK medical schools is a barrier to health professionals' promotion of PA to their patients. Doctors who are more physically active are more likely to counsel patients in this regard. We used a randomised controlled trial (RCT) to examine the effect of an intervention which engaged students in goal-setting, using pedometer step counts, on their PA behaviour and intentions to promote PA in future practice.
We invited fourth-year medical students to participate in the study during their four-week placement in primary care. Following baseline pedometer measurement of daily step counts for one week, students were randomly allocated to intervention (individual step count goal-setting) or control groups. Using pedometers, both groups monitored their PA during the following week. Intentions to promote PA were assessed using a questionnaire based on the theory of planned behaviour at baseline, four weeks and nine weeks. Focus groups explored the students' experiences of PA measurement, goalsetting for behaviour change and health promotion teaching.
One-hundred and thirty-six students participated (70 intervention; 66 control). The mean change in daily step count was greater ( P =0.001) in the intervention group (1245, 95% CI 762 to 1727) than in the control group (-65, 95% CI -644 to 573). Scores for perceived behavioural control over PA counselling increased in both groups, with a trend for higher scores in the intervention group. Intervention group students described how experience of personal PA behaviour change gave insights into barriers patients may face and improved their confidence in PA counselling.
Medical students' personal experience of goal setting in increasing PA appears to lead to a more positive perception of their ability to deliver effective PA promotion in future practice. Inclusion of this learning experience within the undergraduate curriculum may improve doctors' skills in health promotion.
Objective:
To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
Participants:
A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented.
Evidence:
The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles.
Consensus process:
Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine.
Conclusion:
Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
Objective.
—To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
OBJECTIVE--To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. PARTICIPANTS--A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. EVIDENCE--The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. CONSENSUS PROCESS--Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise \"public health message was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. CONCLUSION--Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the weekType: CONSENSUS DEVELOPMENT CONFERENCEType: JOURNAL ARTICLEType: REVIEWLanguage: Eng
BACKGROUND: The benefits of physical activity in reducing morbidity and mortality are well-established, but the effect of physical inactivity on direct medical costs is less clear. OBJECTIVE: To describe the direct medical expenditures associated with physical inactivity. DESIGN: Cross-sectional stratified analysis of the 1987 National Medical Expenditures Survey that included US civilian men and nonpregnant women aged 15 and older who were not in institutions in 1987. Main outcome measure was direct medical costs. RESULTS: For those 15 and older without physical limitations, the average annual direct medical costs were $1,019 for those who were regularly physically active and $1,349 for those who reported being inactive. The costs were lower for active persons among smokers ($1,079 vs $1,448) and nonsmokers ($953 vs $1,234) and were consistent across age-groups and by sex. Medical care use (hospitalizations, physician visits, and medications) was also lower for physically active people than for inactive people. CONCLUSl0N: The mean net annual benefit of physical activity was $330 per person in 1987 dollars. Our results suggest that increasing participation in regular moderate physical activity among the more than 88 million inactive Americans over the age of 15 might reduce annual national medical costs by as much as $29.2 billion in 1987 dollars- $76.6 billion in 2000 dollars.
We examined the relation of physicians' clinical specialty, personal health habits, and health-related beliefs to their practices in counseling about smoking, weight, exercise, and alcohol. We surveyed a random sample of members of a county medical society in selected specialties. Physicians with better personal health habits and more positive attitudes toward counseling counsel a broader range of patients and counsel more aggressively. Surgeons counsel less than nonsurgeons, even after controlling for differences in health-related attitudes and personal habits.
(JAMA 1984;252:2846-2848)
Aging of the population, increasing prevalence of chronic and disabling illnesses with multiple social and behavioral risk factors, concern about quality of care, and escalating costs of medical care require fundamental changes in the way that academic health centers discharge their mission. This article describes a newly developed "Mission Statement" for academic health centers that wish to contribute positively to the health of the populations that they serve. A shift toward addressing the needs of the public may produce increasing institutional strength, long-run stability, and enhanced productivity, as well as higher quality, more cost-effective care for patients. Seventeen centers in the Health of the Public Program are currently conducting activities that implement the described mission elements. The goals and objectives described herein create a foundation for change, with more balanced institutional goals, and could turn an emerging confrontation between academe and its public into an opportunity for both.
(JAMA. 1992;267:2497-2502)
Context
Physical activity is important for health, yet few studies have examined
the effectiveness of physical activity patient counseling in primary care.Objective
To compare the effects of 2 physical activity counseling interventions
with current recommended care and with each other in a primary care setting.Design
The Activity Counseling Trial, a randomized controlled trial with recruitment
in 1995-1997, with 24 months of follow-up.Setting
Eleven primary care facilities affiliated with 3 US clinical research
centers.Participants
Volunteer sample of 395 female and 479 male inactive primary care 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 received 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 behavioral classes.Main Outcome Measures
Cardiorespiratory fitness, measured by maximal oxygen uptake
(O2max), and self-reported total physical activity, measured 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 and
77.6% had completed cardiorespiratory fitness measurements. For women at 24
months, O2max was significantly higher in the assistance
group than in the advice group (mean difference, 80.7 mL/min; 99.2% confidence
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), with no
difference between the counseling and assistance groups and no significant
differences in reported total physical activity. For men, there were no significant
between-group differences in cardiorespiratory fitness or total physical activity.Conclusions
Two patient counseling interventions differing in type and number of
contacts were equally effective in women in improving cardiorespiratory fitness
over 2 years compared with recommended care. In men, neither of the 2 counseling
interventions was more effective than recommended care.
Figures in this Article
Physical activity is important for health,1
and many national organizations recommend that physicians and other health
care practitioners counsel patients on physical activity.2- 8
The US adult averages about 3 medical office visits annually,9
and patients report that they want information about physical activity from
physicians.10 Health care practitioners do
not routinely counsel patients about physical activity,11
although they are more likely to counsel patients at high risk for or with
a known disease.12- 17
Studies of physical activity interventions in primary care have been short
term or have lacked control groups,18- 20
and effectiveness of patient education and counseling in primary care on physical
activity and fitness has been inadequately tested.
The Activity Counseling Trial (ACT) was sponsored by the National Heart,
Lung, and Blood Institute to test patient education and counseling approaches
for physical activity in the primary care setting.21- 23
The objective was to determine the effects of 2 patient education and counseling
interventions compared with current recommended care, and with each other,
on cardiorespiratory fitness and physical activity in inactive adult patients.
The results of this study and our review of the literature lead to the following conclusions: 1. Medical education in the United States currently places litle emphasis on the medical aspects of exercise. 2. There is a growing need for physicians to learn about the health benefits of exercise and the guidelines for exercise prescription. 3. Undergraduate medical students should be required to take at least one short course in exercise medicine. 4. Physicians should include exercise counseling and prescription as major components of their promotion of preventive, self-help medicine. 5. The medical profession should take a greater leadership role in providing the public with valid information about cardiorespiratory fitness and sports medicine.
Presently developing attitudes of future physicians towards preventive medicine will likely provide either a major impetus for or barriers to the inclusion of preventive medicine content in medical school curricula and in other formats of physician education. In turn, attitudes about preventive care and its role in medical practice will continue to have a large influence on how much disease prevention and health promotion emphasis physicians provide in their practices. Consequently, it becomes important to study how medical students' attitudes evolve during the process of medical education. Furthermore, to the extent that we can better understand how desired attitudes can be developed and nurtured, the practice of preventive medicine may become more purposeful. Beginning and third-year medical students were surveyed with a 100-item questionnaire designed to assess their attitudes regarding: the relative importance of 20 specific preventive services to the practice of medicine and the adequacy of preclinical coursework for preparing them to offer preventive care in medical practice. The confidence of third year students' in the ability of primary care physicians to provide these specific services was also assessed. Preventive care service areas about which third-year students expressed high confidence in the ability of physicians to provide were: immunizations, health screening physicals, blood pressure control, cancer detection education, family planning, health counseling/education, and sexually transmitted disease prevention. Services that students had low confidence in the ability of physicians to provide were: smoking cessation, nutrition counseling/education and weight reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
One hundred sixty-eight physicians responded to a survey to determine their attitudes and practices related to exercise and the development of exercise prescriptions. The mean age was 45.5 +/- 10.8 years, with the majority being male (86.7%).
The survey found that 48% of the physicians required an exercise history as part of their initial examination and 91% encouraged their patients to participate in regular exercise programs. Seventy percent of the physicians did not develop exercise prescriptions and only 23% were familiar with the American College of Sports Medicine guidelines related to the development of exercise prescriptions. Only a small number of physicians (3%) had ever taken a college-level course related to exercise physiology and the development of exercise programs. The majority (78%) felt that there was a definite need in medical school for a course related to the medical aspects of exercise.
Results of this investigation indicate that while physicians support exercise for health promotion and rehabilitation, greater emphasis needs to be placed on physician involvement in promoting and/or prescribing exercise.
Aging of the population, increasing prevalence of chronic and disabling illnesses with multiple social and behavioral risk factors, concern about quality of care, and escalating costs of medical care require fundamental changes in the way that academic health centers discharge their mission. This article describes a newly developed "Mission Statement" for academic health centers that wish to contribute positively to the health of the populations that they serve. A shift toward addressing the needs of the public may produce increasing institutional strength, long-run stability, and enhanced productivity, as well as higher quality, more cost-effective care for patients. Seventeen centers in the Health of the Public Program are currently conducting activities that implement the described mission elements. The goals and objectives described herein create a foundation for change, with more balanced institutional goals, and could turn an emerging confrontation between academe and its public into an opportunity for both.
Regular exercise has been associated with numerous health benefits. In response, the promotion of regular exercise for patients has become a recommended component of preventive health care. The extent to which primary care physicians encourage their patients to exercise and the factors associated with exercise promotion are not well elucidated. We surveyed the attitudes and practices of 63 family physicians and 63 internists regarding exercise promotion to patients. We evaluated the associations between demography, cognition, belief, and behavior with exercise promotion. Several factors were associated with physicians' recommending exercise to their patients. A logistic regression model suggests that physicians who have a follow-up plan, who have been in practice over 10 years, who exercise themselves, and who estimate that more than 10% of their patients exercise encourage exercise in greater than or equal to 50% of their patients.
An inventory of the knowledge and skills appropriate for the instruction of medical students in the disciplines of disease prevention and health promotion was developed by a steering committee of medical practitioners and teachers, with the input of over 70 colleagues. The inventory, which is intended as a guide for curriculum planners, defines the fundamentals of subject areas appropriate for the general education of all physicians, including the skills and knowledge related to delivery of personal disease prevention/health promotion services, quantitative methods, health services organization and delivery, and community dimensions of medical practice, as well as attitudes and philosophy.
Little is known about medical student beliefs about health promotion issues or about their prevention practices with patients. We administered a questionnaire about health promotion beliefs and practices to fourth-year medical students in a required course, "Preventive Medicine in Clinical Practice," at the University of Maryland School of Medicine. During a three-year period we surveyed 343 students. A majority of students believed that most of 23 health behaviors were of some importance to health promotion, and their responses were similar to those of practicing physicians in prior studies. Most students reported that they assessed preventive practices in their patients but did not feel well prepared to counsel patients about health issues. Students reported they were currently unsuccessful in modifying patient health behaviors and expressed limited optimism about future success in helping patients change health promotion behaviors with further training and support. There were no differences between students entering primary care specialties and other students. Information about medical student health promotion and disease prevention beliefs and practices can be applied in curriculum development.
A national sample of family practice physicians reported on the treatments and referrals they provide for each of three behavioral health risks--cigarette smoking, obesity, and insufficient exercise--and on obstacles to effective office-based health promotion. Most respondents reported regular health education and advice, but infrequent systematic treatment or referral for the substantial proportions of their patients who smoke cigarettes (40%), are obese (40%), or get too little exercise (70%). Results confirm past impressions that primary-care physicians (a) are somewhat reluctant to treat such problems, (b) overutilize relatively ineffective risk education strategies, and (c) underutilize potentially more effective behavioral or psychological treatments, either in their practices or via referral to outside programs and specialists. Physicians' pessimism about their patients' abilities to change health lifestyles, a lack of confidence in their own and outside treatments, and perceived patient rejection of referral for lifestyle change treatment, appear the major contributors to this underutilization along with the known financial and organizational obstacles to office-based health promotion and a lack of time and training for these activities. Suggestions for improving primary-care training and supports for health-promotion services are offered.
We examined the relation of physicians' clinical specialty, personal health habits, and health-related beliefs to their practices in counseling about smoking, weight, exercise, and alcohol. We surveyed a random sample of members of a county medical society in selected specialties. Physicians with better personal health habits and more positive attitudes toward counseling counsel a broader range of patients and counsel more aggressively. Surgeons counsel less than nonsurgeons, even after controlling for differences in health-related attitudes and personal habits.
To determine which of 33 topics academic deans identify as worthy of greater emphasis in medical curricula. Also, to assess the barriers to needed curricular changes.
In March 1996 a questionnaire was developed and mailed to the academic deans of all U.S. schools affiliated with the Association of American Medical Colleges (n = 126) and all schools associated with the American Association of Colleges of Osteopathy (n = 17). There were 46 questions in a five-point Likert-type format (1 = not at all, 5 = to a great extent) and one open-ended question. The deans were queried as to what extent each of 33 topics (1) was included in medical students' required learning experiences (current emphasis) and (2) should be included in medical students' required learning experiences (ideal emphasis). The deans were also asked to what extent they believed 12 different factors would be barriers to needed curriculum changes in their programs. Primary data analysis focused on simple comparisons of response means and frequencies.
Two separate mailings resulted in the return of 100 questionnaires (70%): 85 from the allopathic schools (67%) and 15 from the osteopathic schools (88%). "Effective patient-provider relationships/communication," "outpatient/ambulatory care," and "health promotion/disease prevention" had the three highest mean ratings for ideal emphasis by the allopathic school deans. "Primary care," "professional values," and "use of electronic information systems" also had high mean rankings for ideal emphasis. "Primary care," "outpatient/ambulatory care," and "health promotion/disease prevention" had the three highest mean ratings for ideal emphasis by the osteopathic school deans.
Changes in health care delivery and an increasing generalist orientation are influencing academic deans' perspectives on needed curriculum changes, and there appears to be considerable support for medical school curricula that will foster a broader, more humanistic role for physicians.
This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions.
Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics.
Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effect on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates.
Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.
We conducted a prospective controlled trial to determine whether an educational intervention could improve resident physician self-efficacy and counseling behaviors for physical activity and increase their patients' reported activity levels. Forty-eight internal medicine residents who practiced at a Department of Veterans Affairs hospital received either two workshops on physical activity counseling or no intervention. All residents completed questionnaires before and 3 months after the workshops. The 21 intervention physicians reported increased self-efficacy for counseling and increased frequency of counseling compared with the 27 control physicians. Approximately 10 patients of each resident were included in the study and surveyed before and 6 months after the intervention. Of 560 patients, 465 (83%) returned both questionnaires. Following the intervention, there were no significant differences between patients of intervention and control physicians on any outcome measures. We conclude that educational interventions can improve physicians' reported self-efficacy of physical activity counseling but may not increase patient physical activity levels. Alternative approaches that emphasize overcoming the substantial barriers to exercise in chronically ill outpatients clearly will be important for facilitating changes in physical activity.
Background:
Recommendations from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) advise all adults to accumulate at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week, but many U.S. adults engage in no 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 about exercise habits, counseled about exercise, and prescribed exercise; and the factors that were associated with their counseling and prescription habits.
Design:
Survey of 326 internists, family practitioners, and internal medicine and family practice residents.
Results:
One hundred seventy-five physicians completed the questionnaire (54% response rate). Two thirds of physicians reported asking more than half of their patients about exercise, 43% counseled more than half of their patients about exercise, but only 14% prescribed exercise for more than half of their patients. Only 12% of physicians were familiar with the new ACSM recommendations. Physicians aged 35 and over were more likely than physicians less than 35 year old to ask about (82% versus 60%), counsel about (58% versus 37%), and prescribe (30% versus 8%) exercise. Family practitioners were more likely to ask about (85% versus 62%) and counsel about (59% versus 39%) exercise than internists. Physicians who felt they had adequate exercise knowledge were more likely to ask about (72% versus 49%) and counsel about (48% versus 29%) exercise than those who felt their knowledge was inadequate. Finally, physicians who felt that they were successful in changing behavior were more likely to ask about and counsel about exercise. The most important barriers to exercise counseling were not having enough time and needing more practice in effective counseling techniques.
Conclusion:
Many primary care physicians are not asking about, counseling about, or prescribing exercise for their patients. Since primary care physicians are in the best position to provide individualized exercise prescriptions for their patients, future research should focus on training physicians in effective counseling techniques that can be done as brief interventions.
Although physical activity is important for the prevention and management of a variety of common chronic diseases, the prevalence and patient and visit characteristics associated with provision of physical activity advice by community family physicians is not well understood.
In a cross-sectional multi-method study of 138 family physicians in northeast Ohio, exercise advice was measured by direct observation and patient report of consecutive patient visits to 138 practicing family physicians. The association of exercise advice with patient and visit characteristics, assessed by direct observation, medical record review, patient exit questionnaire, and billing data, was determined by logistic regression analysis.
In 4,215 visits by patients older than 2 years of age, exercise counseling was observed during 927 visits (22.3%), but reported by only 13% of patients returning questionnaires. The mean time spent counseling about exercise was 0.78 minutes, with a range of 0.33 to 6.00 minutes (SD = 0.67). Exercise advice was more common during longer visits, visits for well care, and visits by patients who were older, male, and had chronic illnesses for which lack of physical activity is a risk factor.
Exercise counseling is relatively common during outpatient visits to family physicians, and is more commonly given to patients with risk factors. Multiple patient visits over time present opportunities to integrate exercise counseling among the competing demands of primary care practice.
It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey.
A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues.
Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor.
Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.
NIH consensus development panel on physical activity and cardiovascular health
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