Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial

• Published in: BMJ Vol. 326; no. 7393; pp. 793 - 796
• Main Authors: Elley, C Raina, Kerse, Ngaire, Arroll, Bruce, Robinson, Elizabeth
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 12.04.2003; British Medical Association; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Publishing Group
• Edition: International edition
• Subjects: Adult; Aged; Bias; Biological and medical sciences; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Clinical trials; Cluster Analysis; Control groups; Coronary artery disease; Counseling - standards; Data collection; Diastolic blood pressure; Effectiveness; Energy expenditure; Evaluation; Exercise; Exercise therapy; Expenditures; Family Practice - standards; Female; General practice; Health Behavior; Health Services Research; Heart; Heart diseases; Humans; Intervention; Leisure; Male; Medical sciences; Middle Aged; Miscellaneous; New Zealand; Patient compliance; Patients; Physical activity; Physical Fitness; Physical training; Primary Care; Primary health care; Prognosis; Psychoeducational intervention; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Questionnaires; Recreation; Researchers; Rural Health; Studies; Treatment Outcome; Urban Health; Variables; New Zealand; Oceania; Physical exercise; Human; Randomization; Efficiency; General practitioner; Medical prescription; Clinical trial; Epidemiology; Long term; Public health; Quality of life
• ISSN: 0959-8138; 0959-8146; 1756-1833; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.326.7393.793

Abstract Objective: To assess the long term effectiveness of the “green prescription” programme, a clinician based initiative in general practice that provides counselling on physical activity. Design: Cluster randomised controlled trial. Practices were randomised before systematic screening and recruitment of patients. Setting: 42 rural and urban general practices in one region of New Zealand. Subjects: All sedentary 40–79 year old patients visiting their general practitioner during the study's recruitment period. Intervention: General practitioners were prompted by the patient to give oral and written advice on physical activity during usual consultations. Exercise specialists continued support by telephone and post. Control patients received usual care. Main outcome measures: Change in physical activity, quality of life (as measured by the “short form 36” (SF-36) questionnaire), cardiovascular risk (Framingham and D'Agostino equations), and blood pressure over a 12 month period. Results: 74% (117/159) of general practitioners and 66% (878/1322) of screened eligible patients participated in the study. The follow up rate was 85% (750/878). Mean total energy expenditure increased by 9.4 kcal/kg/week (P=0.001) and leisure exercise by 2.7 kcal/kg/week (P=0.02) or 34 minutes/week more in the intervention group than in the control group (P=0.04). The proportion of the intervention group undertaking 2.5 hours/week of leisure exercise increased by 9.72% (P=0.003) more than in the control group (number needed to treat=10.3). SF-36 measures of self rated “general health,” “role physical,” “vitality,” and “bodily pain” improved significantly more in the intervention group (P<0.05). A trend towards decreasing blood pressure became apparent but no significant difference in four year risk of coronary heart disease. Conclusion: Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months. What is already known on this topic Counselling patients in general practice on exercise has resulted in gains in physical fitness and activity, but no health benefits have been found What this study adds Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months without evidence of adverse effects The intervention may reduce blood pressure by an average of 1–2 mm Hg over 12 months No changes in the risk of coronary heart disease were observed The intervention is sustainable in usual general practice Prompting practice staff to deliver the intervention may have increased its effectiveness