Prompting Primary Providers to Increase Community Exercise Referrals for Older Adults: A Randomized Trial

OBJECTIVES: To determine whether a clinic-based physical activity promotion intervention can lead to more community-based exercise referrals by providers and higher exercise motivation in patients. DESIGN: Cluster randomized, controlled trial. SETTING: Seattle Veterans Affairs General Internal Medicine Clinic. PARTICIPANTS: Thirty-one physicians and nurse practitioners were randomized to a physical activity counseling intervention or control condition (counseling about tobacco cessation). Three hundred thirty-six patients aged 50 and older and visiting a study provider were enrolled. INTERVENTION: Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were "contemplative" about regular exercise. MEASUREMENTS: Process measures of health behavior assessment and provider advice, exercise stage-of-change, proportion of participants reporting regular physical activity. RESULTS: At baseline, 172 intervention patients and 164 controls were similar with respect to sex, age, comorbidity score, and exercise motivation level. Forty-five percent of all intervention patients and 35% of controls reported receiving exercise advice (P=.07). Intervention patients who were contemplative about exercise were even more likely to receive exercise advice than contemplative controls (59% vs 38%; P=.02). After 4 months, 35% of all intervention patients reported regular exercise, compared with 28% of controls (P=.06). CONCLUSION: Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise. Patients may be more likely to start regular exercise as a result of this advice.