Prescribing exercise increases physical activity

From Medscape, reporting on an RCT in the December 12th Online First issue of the BMJ: prescribing exercise may increase a woman’s physical activity (PA) and Quality of Life (QoL).

The goal was to assess the effectiveness of an exercise prescription over 2 years with relatively inactive women.  The women in this study were at one of 17 PCP’s in New Zealand, 40-74 y.o. and relatively inactive (not doing the recommended 30 min of moderate intensity PA on 5+ days of the week).  Randomly assigned, the control group had usual care for 2 years, and the intervention group received a “brief physical activity intervention led by a nurse, with a 6-month follow-up visit and monthly telephone support for 9 months.  Outcomes were PA levels at baseline, 12, and 24 months, SF-36 for QoL, weight, waist measurement, BP, fasting serum lipid concentrations, Hem-A, glucose, insulin, and physical fitness.  The intervention group had better scores on the physical functioning and mental health parts of the SF-36 but the role physical scores were lower, and all the clinical measures were not significantly different.  Additionally, the intervention group had more falls and injuries.  Limitations included no blinding, improved level of PA in the control, sample size too small to detect significance in changes of clinical measures, self-report measure as the main outcome (also how adverse events were measured), and possible recall bias.

Why does this interest me?  Because you can learn all your anatomy, all your neuro, all your scans/ screens/ special tests, and all your ther-ex and other treatments.  But if you can’t get your patient to adhere to a HEP (or even adhere to appointments or within your clinic visit), then all that is for nothing.  I don’t have the study available, but the advice of a health care provider has been shown to improve adherence.  Tell your patients not just what exercises to do or how many, but also why (does anyone use “prescription” pads to give their patients exercises, in addition to the standard ExercisePro-type handouts?).  I’ll have more posts on adherence in the future (I am doing research on older adults and adherence to exercise classes, and my case study will address adherence to exercise and PT for those with mental health/ substance abuse issues).


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