Physical activity counseling in primary care and family medicine residency training: a systematic review

Sanhapan Thanamee,Titiporn Tuangratananon,Apichai Wattanapisit

doi:10.1186/s12909-018-1268-1

Abstract

BackgroundPhysical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs.MethodsThe authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review.ResultsBased on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling.ConclusionsThis systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.

Highlights

Physical inactivity is a global public health challenge
The findings provide a comprehensive understanding of the training for Physical activity (PA) counseling during primary care residency
The search terms and Medical Subject Headings (MeSH) terms were the combination of “exercise”, “physical activity”, “counseling”, “prescribe”, “prescription”, “family medicine”, “family physician”, “family practice”, “general practitioner”, “primary care physician”, “curriculum”, “education”, “residency”, “resident”, “teaching”, and “training” (Details of search strategies are in the Additional file 1)

Summary

Introduction

Physical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. According to the 2015 Global Burden of Disease Study, physical inactivity contributed to approximately 1.6 million deaths by increasing risk for several non-communicable diseases (NCDs) including; colon and rectum cancer, ischemic stroke, ischemic heart disease, and diabetes mellitus [3]. This “pandemic” of global physical inactivity contributes to a tremendous economic loss [4]. Physical activity (PA) promotion in healthcare delivery systems is an effective means by which to reduce physical inactivity and to ensure clinical benefit for patients [5]. Encounters between physicians and patients are an opportunity for lifestyle counseling [8], with PA counseling an excellent opportunity for advice and discussion between healthcare provider and individual patient [9]

Methods

Results

Discussion

Conclusion