Physically Active for Life (PAL)

Sedentary behavior among middle-aged and older adults increases risk for such chronic diseases as colon cancer, coronary heart disease, hypertension and obesity. Regular physical activity substantially reduces the risk for these conditions, even when the activities are initiated later in life. Physicians can play a vital role in promoting increased physical activity; however, the prevalence of physician-based exercise counseling remains low.

Physically Active for Life is an office-based physical activity counseling intervention for adults aged 50 years and older. Integrating a patient-centered model of counseling with principals of the Transtheoretical Model of Change, social-cognitive theory, and health education theory, PAL encourages physicians to tailor their physical activity counseling message to the individual patient. Physicians counsel patients during a regularly scheduled appointment, provide them with an exercise prescription and patient manual, and schedule a follow-up appointment. After the follow-up visit, patients receive four monthly newsletters providing tips for increasing and/or maintaining physical activities.

A 1-hour training session on physical activity counseling is required. The intervention takes place over two physician office visits: the initial appointment and the follow-up appointment. At the initial visit, physicians counsel the patient for at least 5 minutes.

The intervention is targeted towards physicians and their adult, sedentary patients aged 50 years and older; the average age of patients was 65 years, 97% were White, and 65% were female.

This intervention is suitable for implementation in clinic and physician office settings.

Required resources include a 28-page PAL physician's manual, a 58-page PAL patient manual, a poster, and newsletter mailings.  Costs associated with the program's implementation are not provided.

Twenty-four community-based primary care practices were recruited and randomly assigned to either the physician counseling intervention or control group. Intervention physicians were trained to counsel their patients by integrating the principals of the Transtheoretical Model with a patient-centered counseling approach. At the initial appointment, patients' stage of motivational readiness for physical activity, physical activity preferences, and barriers to becoming physically active were assessed by providers. This information was used by the physician to guide his/her counseling approach. Physicians counseled their patients for about 5 minutes, gave them a written exercise prescription (using a preprinted form), and a physical activity manual. Patients were instructed to read the sections in the manual appropriate to their stage of motivational readiness for physical activity. At the follow-up visit, physicians provided additional counseling and a new exercise prescription. After the follow-up appointment with their physician, patients received four monthly newsletters and an additional copy of the patient manual. Patients were assessed at baseline, 6 weeks, and 8 months.

Results:

• At 6 weeks, patients in the intervention group were more likely to be in advanced stages of motivational readiness for physical activity compared with patients in the control group; 89% of intervention patients were in the Preparation or Action stage of change versus 74% in the control group.
• At 6 weeks, 49% of the intervention group had moved to Action versus 42% in the control group.
• No intervention effects were observed at 8 months.