From ATPM & ACPM

Physical Activity Counseling in the Adult Primary Care Setting: Position Statement of the American College of Preventive Medicine

The American College of Preventive Medicine (ACPM or the College) is dedicated to providing position statements on issues for which one or more entities has previously conducted an evidence review and developed guidelines or recommendations. This position statement addresses the role of the primary care provider in counseling healthy adult patients on the benefits of regular physical activity for the purpose of primary disease prevention and health promotion. The term “physical activity,” as used within this statement, is defined as both exertion during routine daily activities and exercise for the sake of enhancing fitness. Although a significant amount of research has been conducted on this issue, the implications for clinical practice remain uncertain. The College, through expert opinion, puts forth this statement to lend guidance and clarity to current practice in light of the available data. It will be updated periodically as new scientific evidence accrues.

In 2002, the U.S. Preventive Services Task Force (USPSTF) determined that there is insufficient evidence to recommend for or against behavioral counseling to promote physical activity in the primary care setting.¹ This differs from the 1996 USPSTF recommendation that clinicians should counsel patients to incorporate regular physical activity into their daily routine.² This recommendation change was based on a new review of the evidence and a new USPSTF methodology that changed the standards for evidence on the effectiveness of behavior change.

Whereas the USPSTF provides a review of the evidence, professional organizations are encouraged to formulate their own recommendations independently.3, 4 The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the American College of Sports Medicine, and the American Heart Association have addressed physical activity counseling of some type in the primary care setting.5, 6, 7, 8, 9, 10 The U.S. Department of Health and Human Services also encourages physical activity counseling within its Healthy People 2010 objectives.¹¹

The American College of Preventive Medicine is in agreement with these organizations and believes that despite varying research results to date, several factors have emerged that speak to the importance of developing recommendations for physical activity counseling in the primary care setting. The College believes that an emphasis on counseling healthy adults for the purpose of primary disease prevention is vital for at least three reasons.

• 1

  Trends in the obesity epidemic show an urgent need to address weight maintenance in normal weight and overweight adults. The significance of the obesity epidemic may require the promotion of physical activity by any expedient means available.

• 2

  The health benefits of regular physical activity extend beyond weight loss and weight control. Prior research shows that body mass index and level of physical activity are independent predictors of all-cause mortality.¹² In addition, being obese and physically fit is better in terms of overall health than being obese and unfit—with the best health status occurring in normal weight, fit individuals.12, 13, 14, 15, 16, 17

• 3

  Certain behavioral interventions have been shown to be effective in the primary care setting. Interventions using the stages of change approach and the 5A’s (assess, advise, agree, assist, arrange) have been successful in other areas such as tobacco cessation, and could be applied to physical activity interventions.18, 19 However, a more recent review of lifestyle interventions in primary care suggests that a modified approach may be necessary for successful stages of change based physical activity interventions.²⁰ Other interventions such as writing exercise prescriptions, establishing office support systems, and improving patient follow-up procedures have been shown to positively affect counseling and preventive services.18, 21, 22, 23, 24, 25, 26

In addition, the 2002 National Ambulatory Medical Care Survey shows 316 physician office visits per 100 persons (age adjusted) with 45% to 50% occurring in the primary care specialties.²⁷ Thus, the impact of using effective physical activity counseling interventions in this setting has enormous potential for population-level behavior change.

In light of these factors, the American College of Preventive Medicine puts forth its official position statement.