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Medical experts recommend that healthy
Americans perform at least 30 minutes of moderate exercise
on most days of the week, but no one is quite sure how to
dislodge sedentary people from their couches. New research
shows that advice from doctors and other health professionals
can make a difference.
In a two-year study of sedentary adults,
researchers found that exercise education programs -- and
even just a little guidance from a doctor -- help
get inactive people moving. For women, more intensive
education efforts seem to work particularly well.
Among nearly 900 healthy adults aged
35 to 75, exercise advice and education boosted the number
who met the minimum recommendations for exercise. Up to 30%
of men and 26% of women met the requirement two years after
starting the study.
But the overall success varied between
men and women, with women
faring better with a more intensive intervention,
while men generally did
as well with a doctor's advice as with a more involved
program.
Only about 20% of US adults engage in
regular physical activity for a half-hour on most days of
the week.
Guidelines advise doctors to ask patients
about their exercise habits and, if needed, offer advice on
how to increase their activity levels. But whether such advice
helps and whether stronger interventions might work better
is unknown.
Simons-Morton and her colleagues looked
at these questions by testing three types of exercise interventions,
all based in 11 primary care practices in the US. One group
of patients received standard exercise advice and educational
materials from their doctors.
A second group received the advice and
materials plus "assistance" in the form of an initial
counseling session with a health educator, followed by regular
correspondence with the educator through the mail.
The third group -- the "counseling"
group -- received all of this advice, materials, and assistance
plus periodic phone calls from health educators and weekly
classes on maintaining physical activity.
The investigators found that, for women,
the two more intensive programs
were more effective in improving their cardiovascular endurance
over two years, based on treadmill exercise tests. The women's
maximal oxygen uptake during exercise -- a measure of cardiovascular
health -- was about 5% higher than that of women in the advice
group.
But the situation was different for men,
for whom there were no significant differences in fitness
among groups. Regardless of group, the men's
treadmill performance improved early on in the study, but
had declined closer to pre-study levels by the
two-year mark.
These results suggest that women might
benefit from more rigorous efforts to promote exercise. 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.
But it is doubtful
that doctors are following current recommendations,
let alone launching more intensive efforts to promote exercise.
Despite "undisputed" evidence
of the health benefits of exercise, US physicians advise only
a minority of their patients about physical activity.
JAMA
August 8, 2001;286:677-687, 717-719
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