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The Effectiveness of a General-Practice-Based Physical Activity Intervention on Patient Physical Activity Status

Published online by Cambridge University Press:  06 October 2014

Peita Graham-Clarke  and
Brian Oldenburg
Peita Graham-Clarke*
Affiliation:
University of Sydney
Brian Oldenburg
Affiliation:
Queensland University of Technology
*
PHRDC Research Scholar, Department of Public Health, Building A27, University of Sydney NSW 2006, Australia
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Abstract

Physical inactivity is a risk factor for a number of chronic diseases, including cardiovascular disease. Interventions designed to reduce the prevalence of physical inactivity have focused primarily on either adoption of physical activity or noncompliance and relapse, and no interventions have been reported which cover adoption, compliance, maintenance, and relapse, particularly within the clinical setting. The Fresh Start program, a multiple risk factor intervention program for the reduction of cardiovascular disease risk factors in general practice patients, was developed to cover all aspects of the adoption and maintenance of habitual physical activity, using Prochaska and DiClemente's Transtheoretical model. The evaluation of the program on cardiovascular disease risk factors and behaviours provided the opportunity to evaluate the impact of a staged program on patient physical activity behaviour. The program was evaluated in a randomised controlled trial in Sydney's Western, South-western, and Wentworth regions with 80 volunteer general practitioners and 758 volunteer patients between January 1991 and January 1993. Self-reported physical activity data were used as the basis for estimating energy expenditure due to leisure-time physical activity. The results failed to show any differences between groups over time, as a function of patients' baseline stages of change, and as a function of baseline activity levels. There were some indications, however, that the least active would respond to doctor-based advice to increase their physical activity, and that doctor advice would lead to a progression in intention to change in approximately 20% of patients. Limitations of the study, the program, and physical activity intervention in the clinical setting are discussed.

Type
Research Article
Information
Behaviour Change , Volume 11 , Issue 3 , September 1994 , pp. 132 - 144
Copyright
Copyright © The Author(s) 1994

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References

REFERENCES

Ainsworth, B.E., Haskell, W.L., Leon, A.S., Jacobs, D.R. Jr, Montoye, H.J., Sallis, J.F., & Paffenbarger, R.S. (1993). Compendium of physical activities: Classification of energy costs of human physical activities. Medicine and Science in Sports and Exercise, 25, 71–80.CrossRefGoogle ScholarPubMed
Bauman, A., Owen, N., & Rushworth, R. (1990). Recent trends and socio-demographic determinants of exercise participation in Australia. Community Health Studies, 14, 19–26.CrossRefGoogle ScholarPubMed
Berlin, J., & Colditz, G. (1990). A meta-analysis of physical activity in the prevention of coronary heart disease. American Journal of Epidemiology, 132, 612–628.CrossRefGoogle ScholarPubMed
Blair, S.N. (1984). How to assess exercise habits and physical fitness. In Matarazzo, J.D., Weiss, S.M., Herd, J.A., Miller, N.E., Weiss, S.M. (Eds.), Behavioral health: A handbook of health enhancement and disease prevention (pp. 424–447). New York: John Wiley & Sons.Google Scholar
Blair, S., Kohl, H., Gordon, N., & Paffenbarger, R. (1992). How much physical activity is good for health? Annual Review of Public Health, 13, 99–126.CrossRefGoogle ScholarPubMed
Blair, S., Kohl, H.W., Paffenbarger, R., Clark, D., Cooper, K., & Gibbons, L. (1989). Physical activity and all-cause mortality: A prospective study of healthy men and women. Journal of the American Medical Association, 2622, 395–401.Google Scholar
Blair, S.N., Powell, K.E., Bazzarre, T.L., Early, J.L., Epstein, L.H., Green, L.W., Harris, S.S., Haskell, W.L., King, A.C., Koplan, J., Marcus, B., Paffenbarger, R.S., & Yeager, K.K. (1993). Workshop V: Physical inactivity. AHA Prevention Conference III Behavior Change and Compliance: Keys to improving cardiovascular health, Monterey, CA. Circulation, 88, 1402–1405.CrossRefGoogle Scholar
Booth, M.L., Macaskill, P., Owen, N., Oldenburg, B., Marcus, B.H., & Bauman, A. (1993). Population prevalence and correlates of stages of change in physical activity, Health Education Quarterly, 20, 431–440.CrossRefGoogle ScholarPubMed
Brownell, K.D., & Stunkard, A.J. (1980). Exercise in the development and control of obesity. In Stunkard, A.J. (Ed.), Obesity. Philadelphia, PA: W.B. Saunders.Google Scholar
Clinical Reporting Systems. (1990). Clinical report system data base management. Castle Hill, NSW: Clinical Reporting Systems Pty Ltd.Google Scholar
Commonwealth Department of the Arts, Sport, the Environment and the Territories (DASET). (1992). Pilot survey of the fitness of Australians. Canberra: Australian Government Publishing Service.Google Scholar
DiClemente, C.C., Prochaska, J.O., Fairhurst, S., Velicer, W.F., Velasquez, M., & Rossi, J.S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295–304.CrossRefGoogle ScholarPubMed
Family Heart Study Group. (1994). Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: Principal results of British Family Heart study. British Medical Journal, 308, 313–20.CrossRefGoogle Scholar
Gloag, D. (1992). Exercise, fitness and health. British Medical Journal, 305, 377–378.CrossRefGoogle ScholarPubMed
Godin, G., & Shephard, R.J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Sciences, 10, 141–146.Google ScholarPubMed
Gordon, N., & Cooper, K. (1988). Controlling cholesterol levels through exercise. Comprehensive Therapy, 14, 52–57.Google ScholarPubMed
Graham-Clarke, P., Oldenburg, B., Shaw, J., & Walker, S. (1994). CVD Risk reduction in general practice: Outcomes of a program designed for cardiovascular risk modification in the primary care setting. Manuscript submitted for publication.Google Scholar
Hagberg, J. (1990). Exercise, fitness and hypertension. In Bouchard, C., Shepherd, R., Stephens, T., Sutton, J., McPherson, B. (Eds.), Exercise, fitness and health: A consensus of current knowledge (pp. 455–466). Champaign, IL: Human Kinetics.Google Scholar
Imperial Cancer Research Fund OXCHECK Study Group. (1994). Effectiveness of health checks conducted by nurses in primary care: Results of the OXCHECK study after one year. British Medical Journal, 308, 308–312.CrossRefGoogle Scholar
Johns, M.B., Hovell, M.F., Ganiats, T., Peddecord, K.M., & Agras, W.S. (1987). Primary care and health promotion: A model for preventive medicine. American Journal of Preventive Medicine, 3, 346–357.CrossRefGoogle Scholar
Leon, A.S., Connett, J., Jacobs, D.R. Jr, & Rauramad, R. (1987). Leisure-time physical activity levels and the risk of coronary heart disease and death. Journal of the American Medical Association, 253, 2388–95.CrossRefGoogle Scholar
Lewis, B.S., & Lynch, W.D. (1993). The effect of physician advice on exercise behavior. Preventive Medicine, 22, 110–121.CrossRefGoogle ScholarPubMed
Marcus, B.H., Banspach, S.W., Lefebvre, R.C., Rossi, J.S., Carleton, R.A., & Abrams, D.B. (1992). Using the stages of change model to increase the adoption of physical activity among community participants. American Journal of Health Promotion, 6, 424–429.CrossRefGoogle ScholarPubMed
Marcus, B.H., Rossi, J.S., Selby, V.C., Niaura, R.S., & Abrams, D.B. (1992). The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychology, 11, 386–395.CrossRefGoogle Scholar
Nutbeam, D., Wise, M., Bauman, A., Harris, E., & Leeder, S. (1993). Goals and targets for Australia's health in the year 2000 and beyond. Report to the Commonwealth Department of Health, Housing and Community Services. Canberra: Australian Government Publishing Service.Google Scholar
Oldenburg, B., Graham-Clarke, P., Shaw, J., & Walker, S. (in press). Modification of health behavior and lifestyle mediated by physicians. In Orth-Gomer, K., & Schneidermann, N. (Eds.), Behavioral medicine approaches to cardiovascular disease prevention. Hillsdale, NJ: Lawrence Erlbaum & Associates.Google Scholar
Oldenburg, B., Owen, N., Graham-Clarke, P., & Gomel, M. (1992). Lifestyle change and cardiovascular disease. Principles and practice. Australian Family Physician, 21, 1289–1296.Google ScholarPubMed
Owen, N., & Bauman, A. (1992). The descriptive epidemiology of physical inactivity in adult Australians. International Journal of Epidemiology, 21, 305–310.CrossRefGoogle ScholarPubMed
Owen, N., Sedgwick, A.W., & Davies, M. (1988). Validity of a simplified measure of participation in physical activity. Medical Journal of Australia, 148, 600.CrossRefGoogle Scholar
Powell, K., Thompson, P., Caperson, C., & Kendrick, J. (1987). Physical activity and the incidence of coronary heart disease. Annual Review of Public Health, 8, 253–287.CrossRefGoogle ScholarPubMed
Prochaska, J.O., & DiClemente, C.C. (1983). Stages and processes of self-change in smoking: Towards an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.CrossRefGoogle Scholar
Prochaska, J.O., Velicer, W.F., DiClemente, C.C., & Fava, J. (1988). Measuring processes of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56, 520–528.CrossRefGoogle Scholar
Richmond, R., Austin, A., & Webster, I. (1986). Three-year evaluation of a program by general practitioners to help patients stop smoking. British Medical Journal, 292, 803–806.CrossRefGoogle Scholar
Risk Factor Prevalence Study Management Committee. (1990). Risk Factor Prevalence Survey No 3, 1989. Canberra: National Heart Foundation of Australia and Australian Institute of Health.Google Scholar
SAS Institute. (1987). SAS guide for personal computers, version six. Cary, NC: SAS Institute.Google Scholar
Sallis, J.F., Haskell, W.L., Wood, P.D., Fortmann, S.P., Rogers, T., Blair, S.N., & Paffenbarger, R.S. Jr. (1985). Physical activity assessment and methodology in the Five-City Project. American Journal of Epidemiology, 121, 91–106.CrossRefGoogle ScholarPubMed
Sanson-Fisher, R., Webb, G., & Reid, A.L.A. (1986). The role of the medical practitioner as an agent for disease prevention. In Better Health Commission, Looking forward to better health Volume 3 (pp. 201–212). Canberra: Australian Government Publishing Service.Google Scholar
Shaper, A., & Wannamethee, G., (1991). Physical activity and ischaemic heart disease in middle-aged British men. British Heart Journal, 66, 384–395.CrossRefGoogle ScholarPubMed
Ward, A., & Morgan, W.P. (1984). Adherence patterns of healthy men and women enrolled in an adult exercise program. Journal of Cardiac Rehabilitation, 4, 143–152.Google Scholar
Williford, H.N., Barfield, B.R., Lazenby, R.B., & Olson, M.S. (1992). A survey of physicians' attitudes and practices related to exercise promotion. Preventive Medicine, 21, 630–636.CrossRefGoogle ScholarPubMed
Wilson, D., Wakefield, M., Steven, I., Rohrsheim, R.A., Esterman, A.J., & Graham, N.M.H. (1990). Sick of Smoking: Evaluation of a targetted minimal smoking cessation intervention in general practice. Medical Journal of Australia 152, 518–521.CrossRefGoogle ScholarPubMed