CHICAGO - Two interventions for educating sedentary patients about physical activity were more effective than current recommended care standards in improving female patients' cardiorespiratory fitness, according to an article in the August 8 issue of The Journal of the American Medical Association (JAMA). The interventions did not have any significant effect on the cardiorespiratory fitness of men.

The Activity Counseling Trial (sponsored by the National Heart, Lung, and Blood Institute, Bethesda, Md.) studied 395 inactive women and 479 inactive men with stable health aged 35 to 75 years recruited from 11 primary care facilities. They were assigned to one of three groups and counseled, between 1995 to 1997, on the benefits of physical activity and then followed-up two years later to assess their cardiovascular fitness and degree of physical activity.

According to background information cited in the article, physical activity is important for health and many national healthcare organizations recommend that primary care physicians counsel patients on physical activity. Despite the recommendations, the authors state that "health care practitioners do not routinely counsel patients about

physical activity. ... [The] effectiveness of patient education and counseling in primary care on physical activity and fitness has been inadequately tested."

The three groups consisted of: an advice group (n=292) which included physician advice and written educational materials (recommended care); an assistance group (n=293) which included the components received by the advice group plus interactive mail and behavioral counseling at physician visits; or a counseling group (n=289) which included the components of the advice and assistance groups plus regular telephone counseling and behavioral classes. Cardiorespiratory fitness (measured by oxygen uptake during a treadmill exercise test) and self-reported physical activity measurements were analyzed before and after the intervention.

All three groups were given physical activity goals based on current national recommendations of five or more days a week of 30 minutes of moderate-intensity physical activity (such as brisk walking) or three or more days a week of 30 minutes of vigorous-intensity physical activity (such as running).

At six months and 24 months, there were no appreciable differences in the self-reported physical activity of the participants in any of the groups; however, "For women, the assistance and the counseling interventions were similar in significantly increasing cardiorespiratory fitness [compared to the advice group]," the authors state. "For men, neither the assistance nor counseling intervention improved cardiorespiratory fitness or total physical activity significantly above the level achieved by the advice group."

"The ACT assistance and counseling interventions demonstrated discernable success with women but not with men. It would seem advisable to use these, or similar, interventions for inactive women patients interested in increasing their physical activity, while delivering physician advice and educational materials to men, which is the current recommended care," the authors conclude.

(JAMA. 2001; 286:677-687; available post-embargo at jama.com)

Editors Note: This research was supported by grants from the National Heart, Lung, and Blood Institute. For the financial disclosure of principal investigator Steven Blair, please see the JAMA article.

EDITORIAL: THE CHALLENGE OF INFLUENCING BEHAVIORAL CHANGE

In an accompanying editorial, Christina C. Wee, M.D., M.P.H., of Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, comments on the results of the ACT study, stating that, "Unfortunately, the ACT does not directly address a central question-whether physical activity counseling by clinicians in primary care settings increases pysical activity or improves cardiorespiratory fitness levels." Dr. Wee states that the study "... still leaves clinicians facing the dilemma of whether and in what manner to counsel their patients regarding increasing physical activity."

Dr. Wee states that the study does address whether high-intensity counseling about physical activity improves fitness levels when compared with more modest counseling and that the study shows an association between physicians' engaging in intensive counseling about physical activity and improvements in physical fitness. "Because the ACT findings that intensive physical activity counseling improved cardiorespiratory fitness in women compared with the provision of advice alone, skeptics may be less likely to argue against the efficacy of high-intensity counseling, at least among women," the author states.

"Sedentary lifestyle and low physical fitness are health risks as important as type 2 diabetes mellitus and other conventional cardiovascular risk factors," the author states.

"How intensive counseling efforts need to be and whether such efforts will be cost-effective, however, remain important unanswered questions."

JAMA. 2001: 286; 717-719; available post-embargo at jama.com)

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