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PCPs can overcome barriers, help increase physical activity among patients

Despite multiple barriers faced by both patients and physicians, PCPs can help patients normalize physical activity among their patients by using a multilevel approach and an increased awareness of community support structures, according to a review published in the American Journal of Medicine.

“About half (49.6%) of U.S. adults met the most recent (2008) [CDC] Physical Activity Guidelines of at least 150 minutes weekly of moderate- or vigorous-intensity aerobic physical activity,” Mona AuYoung, PhD, MS, MPH, of the Ann Arbor VA Center for Clinical Management Research, in Michigan, and colleagues wrote. “Even fewer adults met the recommendations for strength training activities on 2 or more days of the week (23.6% in 2012), and fewer still fulfilled both recommendations (20.3% in 2012).”

The review, based on a 2014 symposium hosted by the Society of Behavioral Medicine and the American College of Sports Medicine, details the barriers faced by PCPs and patients alike in increasing physical activity. According to the authors, only one-third of patients report receiving counseling on physical activity from their PCPs.

Physicians barriers identified in the review include lack of provider time, especially when trying to address multiple other, sometimes complex, health issues, particularly among patients who are elderly or diabetic; lack of provider skills, as some physicians do not have the training to counsel patients about physical activity; cost and lack of reimbursement, as CMS offers coverage for obesity counseling only if provided by high-level providers; lack of provider reach to at-risk patients; and lack of routine patient screening for physical activity in primary care patients.

Patient barriers to physical activity include limited time, fatigue, family obligations and other competing priorities, according to the review.

However, interventions at multiple levels of the socioecological framework can help overcome many of these barriers, specifically the issues of provider time and training, the authors wrote. PCPs and primary care teams can serve as a “hub” for physical activity counseling, while resources at other levels, including policy, organizations and community, can help patients make physical activity part of their routine.

According to the authors, resources that can help PCPs and patients in promoting and adopting increased physical activity include primary care practice organizations, where physical activity screening can start conversations about its importance; primary care teams, which can reduce the individual burden on physicians who have limited time; patient self-monitoring, using wearable technology or smartphone apps, which help them assess their current level of activity and set future goals; support systems, involving families, friends and coworkers; local community organizations, including walk-a-thons, weight-loss challenges, local parks and schools that promote physical activity; worksites, as many employers provide physical activity resources; national health care organizations; and various local and national policies, such as Let’s Move!, a national campaign established by First Lady Michelle Obama and the Partnership for a Healthier America.

“The PCP plays a central role in this multilevel approach to physical activity counseling, from helping patients to understand the importance of physical activity to connecting them with various resources for physical activity,” AuYoung and colleagues wrote. “Using the range of supports for physical activity available at each of these socioecological levels can help to increase physical activity counseling in primary care, increase physical activity by patients and sustain these positive behaviors.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.