Patients Follow Activity Advice

When physicians and other health care practitioners recommend moving more, patients listen. Not only do they listen, patients actually increase levels of physical activity, according to a new study sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The study, the Activity Counseling Trial (ACT), shows that just 3 hours of advice over a 2-year period can significantly increase fitness levels in previously inactive women. Men achieved more modest fitness gains.

The ACT randomized 479 men and 395 women to one of three groups, “advice,” “assistance,” and “counseling,” for 2 years, then measured cardiovascular fitness by treadmill test and physical activity levels through structured interviews with participants. All study subjects were previously inactive and more than two-thirds were overweight.

Members of the advice group received current recommended care, which includes 2 to 4 minutes of doctor advice per visit and printed educational materials. Doctors are asked to advise their patients to get 30 minutes of moderate-intensity physical activity (equivalent to brisk walking) on 5 days a week, or 30 minutes of vigorous activity (equivalent to running) on 3 days a week.

In addition to the same advice and materials, the patients in the assistance group received a 30- to 40-minute behavioral counseling session with a health educator. In this session, patients watched a motivational videotape, set goals, discussed personal health benefits of physical activity, and developed an individualized workout plan. Assistance group members also received one follow-up phone call from the health educator; a monthly newsletter with a reply card for reporting weekly activity, goals, and barriers; an electronic step-counter; and a calendar for recording activity.

Patients randomized to the counseling group received the same care as those in the assistance group plus personalized counseling calls from a health educator. Additionally, they could attend weekly classes taught by health educators about developing skills for staying active. Communication time between patient and health care professional totaled about 9 hours over 2 years in the counseling group. This is compared with 3 hours for assistance group members and a mere 18 minutes for advice group members.

Results of the trial reveal that after 2 years, women in the assistance and counseling groups achieved equal gains in fitness levels. Both groups showed a 5 percent improvement in oxygen uptakes. Women in the advice group showed no change in fitness levels. In addition, all ACT participants reported increases in physical activity levels after 2 years.

“The surprise was that the two more intensive interventions worked equally well,” said Dr. Denise Simon-Morton, leader of the NHLBI Prevention Scientific Research Group and NHLBI Project Officer for ACT. “We had thought it would take the more intensive counseling interventions to boost physical fitness. This is a positive message. With fitness, a little help yields an important improvement.”

Another interesting finding is that study results differed between genders. There were no significant differences in the modest fitness gains for men enrolled in the advice, assistance, and counseling groups. For men, 9 hours of advice over 2 years seemed to be no more effective than 18 minutes. This led study authors to conclude that the recommended care of providing physician advice and printed materials may work to help men become more physically active; however, behavioral counseling and skill-building tools may particularly benefit women.

The study appears in the August 8, 2001 issue of JAMA. s