Addition of counseling to physician advice improves women's fitness

המידע באדיבות www.medicontext.co.il
Last Updated: 2001-08-07 16:00:29 EDT (Reuters Health)

NEW YORK (Reuters Health) – Regardless of its intensity, a program of education and counseling about physical activity is more effective than physician advice and written materials in improving women's cardiorespiratory fitness, according to a study conducted at 11 primary care clinics in the United States. For men, more intensive educational efforts seemed to be unproductive.

A team led by Dr. Denise G. Simons-Morton of the National Heart, Lung, and Blood Institute, Bethesda, Maryland, encouraged 874 adults to reach one of two goals: to exercise moderately 30 minutes a day, at least 5 days a week, through activities such as brisk walking; or to exercise vigorously–by running, for instance–for 30 minutes a day, at least 3 days per week.

A control group of patients received standard exercise advice and educational materials from their doctors. A second group received advice plus an initial counseling session with a health educator, followed by regular correspondence with the educator through the mail. The third group received all of this assistance plus periodic phone calls and weekly classes with a health educator.

At the end of the 2-year study, 26% of the women and 30% of the men met the recommendations about the frequency, duration and intensity of physical activity, the research team reports in The Journal of the American Medical Association for August 8.

For women, the two counseling programs were equally effective and were superior to usual care in improving cardiorespiratory endurance during the 2-year study. Among women in these groups, maximal oxygen uptake during exercise was about 5% higher than that of women in the advice-only group. This difference could translate into a modestly lower risk of death, the investigators notes.

Among men, neither counseling program significantly improved cardiorespiratory fitness above the level achieved by the advice-only group.

"The difference in physical fitness afforded by higher-intensity…counseling was small, even among women," Dr. Christina C. Wee of Harvard Medical School in Boston points out in an editorial. "Furthermore, the lack of substantive difference in physical fitness between the [two counseling groups] demonstrates that, above a certain threshold, added counseling likely provides negligible additional benefit.

Dr. Wee suggests that "where this threshold lies and whether high-intensity counseling is feasible and cost-effective in primary care settings are important questions that need to be examined in future studies."

JAMA 2001;286:677-687, 717-719.

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