Portland, Ore.

Researchers cite lack of long-term, well-designed studies to make recommendation

Advice from primary care clinicians about the importance of physical exercise would seem to play a role in getting people to exercise. Yet a review of the research on this subject for the U.S. Preventive Services Task Force found the evidence to be mixed, leading the task force to conclude that there is insufficient evidence to recommend that clinicians should routinely counsel their patients about physical activity, according to an article in today's Annals of Internal Medicine.

The research supporting this task force conclusion was based on a report from a team led by Karen Eden, Ph.D., from the Evidence-based Practice Center at Oregon Health & Science University under contract to the Agency for Healthcare Research and Quality.

The study sought to advise the task force, an independent panel of private-sector experts in prevention and primary care, on the efficacy of clinician counseling on physical activity. Physical activity is critical to maintaining good health, and reducing the risk of disease and early death. The benefits of physical activity are seen at even modest levels of activity, such as walking or bicycling 30 minutes per day on most days of the week. Benefits increase with increasing levels of activity.

The task force notes that certain types of combined counseling interventions from providers do appear promising, such as goal setting by patients, written exercise prescriptions, individually tailored physical activity regimens, and mail or telephone follow-up by trained staff, especially if these are linked to community-based physical activity and fitness programs where group support can provide reinforcement to behavior changes.

The task force previously recommended that clinicians counsel their patients to engage in physical activity because the benefits of such activity are well-documented. But the task force noted that the evidence was unclear about how effective counseling was at changing the behavior of patients. In updating its recommendation, the task force focused on whether the newer studies contained better evidence * more consistent results and lasting effects on levels of physical activity. The lack of data has led the task force to issue its revised recommendation.

"This report endorses the widely known and important benefits of physical exercise," stressed Eden. "We simply have not found consistent evidence that because a doctor encourages it, patients will exercise. More research is needed to clarify whether it's effective for clinicians to counsel patients to increase their physical activity."

The USPSTF recommendation is available at:
http://www.ahrq.gov/clinic/3rduspstf/physactivity/

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