Prompting Primary Providers to Increase Community Exercise Referrals for Older Adults: A Randomized Trial

Abstract

To determine whether a clinic-based physical activity promotion intervention can lead to more community-based exercise referrals by providers and higher exercise motivation in patients. Cluster randomized, controlled trial. Seattle Veterans Affairs General Internal Medicine Clinic. Thirty-one physicians and nurse practitioners were randomized to a physical activity counseling intervention or control condition (counseling about tobacco cessation). Three hundred thirty-six patients aged 50 and older and visiting a study provider were enrolled. Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were "contemplative" about regular exercise. Process measures of health behavior assessment and provider advice, exercise stage-of-change, proportion of participants reporting regular physical activity. At baseline, 172 intervention patients and 164 controls were similar with respect to sex, age, comorbidity score, and exercise motivation level. Forty-five percent of all intervention patients and 35% of controls reported receiving exercise advice (P=.07). Intervention patients who were contemplative about exercise were even more likely to receive exercise advice than contemplative controls (59% vs 38%; P=.02). After 4 months, 35% of all intervention patients reported regular exercise, compared with 28% of controls (P=.06). Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise. Patients may be more likely to start regular exercise as a result of this advice.