Counseling by health professionals boosts patients' physical fitness

Just three hours of advice and counseling by doctors and other healthcare professionals over two years can boost sedentary adults' physical fitness, according to a new study sponsored by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

The study compared three types of education and counseling, which differed in intensity. Results showed that doctors' advice and behavioral counseling worked better than advice alone in increasing sedentary women's physical fitness. However, the added help had no increased effect on sedentary men's physical fitness.

"The study shows that doctors and their medical staff can help their patients, especially women, increase their physical fitness and that such an effort doesn't take much time," said NHLBI Director Claude Lenfant. "For women, such counseling could make a crucial difference, because national surveys show they are less likely to be physically active than men."

Advice, assistance and counseling

The study involved 874 men and women, ages 35 to 75, who were inactive at the start of the trial and had no clinical cardiovascular disease. Forty-five percent of participants were women and 55% were men. About 33% were minorities.

Approximately 85% of the participants had one or more cardiovascular risk factors in addition to physical inactivity. The most common risk factor was overweight or obesity: About 72% of women and 75% of men were overweight or obese. Additionally, about 33% of participants had high blood pressure, about 20% had high blood cholesterol, about 10% had diabetes and about 10% smoked cigarettes.

Participants were randomly assigned to one of three groups, which received "advice," "assistance," or "counseling." Participants in the first group were given two to four minutes of advice from the doctor about physical activity and were referred to an on-site health educator for more information, which included educational materials on the topic. The assistance group received the same recommendations, plus behavioral counseling by a health educator, one follow-up telephone contact, a monthly interactive newsletter, and an electronic step-counter and calendar. The counseling group was given everything the other two groups received, plus regular counseling by telephone from a health educator and weekly classes on behavioral skills to help them adopt and maintain their physical activity.

Over two years, the interventions amounted to an average of three contacts (or 18 minutes of interaction) for both men and women in the advice group, 22 contacts (or almost three hours of interaction) for both men and women in the assistance group, and 44 contacts (or nine hours of interaction) for women and 38 contacts (or 5.5 hours) for men in the counseling group.

Cardiovascular fitness was measured by oxygen uptake during a maximal treadmill test, and physical activity levels were determined by a recall questionnaire.

Researchers assessed changes in physical activity and cardiorespiratory fitness for each group and compared the results. The comparisons were done separately for men and women, because investigators felt they might respond differently to the interventions.

After two years, when compared with women in the advice group, women in the counseling group had 80 ml/minute higher oxygen uptake, and women in the assistance group had 74 ml/minute higher oxygen uptake - both equaling about a 5% improvement. The interventions worked equally well in their effect on reported physical activity.

"The surprise was that the two more intensive interventions worked equally well," said Denise Simons-Morton, leader of the NHLBI Prevention Scientific Research Group. "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." PR