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Effects of Physical Activity Counseling in Primary Care
The Activity Counseling Trial: A Randomized Controlled Trial
The Writing Group for the Activity Counseling Trial Research Group
JAMA. 2001;286:677-687.
Context Physical activity is important for health, yet few studies have examined the effectiveness of physical activity patient counseling in primary care.
Objective To compare the effects of 2 physical activity counseling interventions with current recommended care and with each other in a primary care setting.
Design The Activity Counseling Trial, a randomized controlled trial with recruitment in 1995-1997, with 24 months of follow-up.
Setting Eleven primary care facilities affiliated with 3 US clinical research centers.
Participants Volunteer sample of 395 female and 479 male inactive primary care patients aged 35 to 75 years without clinical cardiovascular disease.
Interventions Participants were randomly assigned to 1 of 3 groups: advice (n = 292), which included physician advice and written educational materials (recommended care); assistance (n = 293), which included all the components received by the advice group plus interactive mail and behavioral counseling at physician visits; or counseling (n = 289), which included the assistance and advice group components plus regular telephone counseling and behavioral classes.
Main Outcome Measures Cardiorespiratory fitness, measured by maximal oxygen uptake ( O2max), and self-reported total physical activity, measured by a 7-day Physical Activity Recall, compared among the 3 groups and analyzed separately for men and women at 24 months.
Results At 24 months, 91.4% of the sample had completed physical activity and 77.6% had completed cardiorespiratory fitness measurements. For women at 24 months, O2max was significantly higher in the assistance group than in the advice group (mean difference, 80.7 mL/min; 99.2% confidence interval [CI], 8.1-153.2 mL/min) and in the counseling group than in the advice group (mean difference, 73.9 mL/min; 99.2% CI, 0.9-147.0 mL/min), with no difference between the counseling and assistance groups and no significant differences in reported total physical activity. For men, there were no significant between-group differences in cardiorespiratory fitness or total physical activity.
Conclusions Two patient counseling interventions differing in type and number of contacts were equally effective in women in improving cardiorespiratory fitness over 2 years compared with recommended care. In men, neither of the 2 counseling interventions was more effective than recommended care.
Affiliations of Investigators and Staff of the Activity Counseling Trial (ACT)
Clinical Centers: Cooper Institute for Aerobics Research/University of Texas Southwestern (UTSW) Medical Center, Dallas: Steven Blair (principal investigator), Andrea Dunn, Larry Gibbons, Benjamin Levine (principal investigator, UTSW Medical Center), Peter Snell (UTSW Medical Center), James Sallis (San Diego State University, San Diego, Calif), Bess Marcus (Brown University, Providence, RI), Melissa Garcia, Amy Strasner (UTSW Medical Center), Sheila Reynolds, Michelle Edwards, Nancy Pierce, Ruth Carpenter, Laura Fast, Christopher Cole (UTSW Medical Center), Jerome Differding, James Kampert, Alan Levitt, Jay Revi, Joe Simpson, Kelly Wilks. ACT Health Professionals: Henry Armstrong, Leonard Berry, Durado Brooks, Laura Defina, Melanie Green, Tom Hampton, Edith Hawkins, Kathleen McAllister, Bristol Ming, Mark Nelson, Jack Shelton, Paul Sokal, Peter Stack, Kathy Zeller.
Stanford University School of Medicine, Palo Alto, Calif: Abby King (principal investigator), William Haskell, Cheryl Albright, Leslie Pruitt, Lisa Palmer, Wayne Phillips, Ami Laws, Karen Bolen, Marcia Stefanick, Irene Etter-McNee, Kelley Callahan, Marina Nicolae, Alisa Kamigaki, Steven Park, Julie Peltz, Lynne Alexander. ACT Health Professionals: Alfonso Banuelos, Walter Bortz, John Boggs, Jeff Croke, Korina DeBruyne, Tracy Fearnside, Paul Ford, Ward Hagar, Ann Hargadon, Joseph Hopkins, Kent Imai, Jay Jernick, Henry Jones, Pat Kearns, Thomas Kelsey, Ami Laws, Sam LeBaron, Gary Lee, Richard Lee, Donald MacKay, Nancy Morioka-Douglas, Gary Pasternak, Dave Thom, Seth Weissman, Eva Weinlander.
University of Tennessee, Memphis: Mary O'Toole (principal investigator), William B. Applegate (consultant), Robert C. Klesges (University of Memphis), Stephen T. Miller, Karen C. Johnson, Joyce Banton, Mace Coday, Jay Lee Taylor, James E. Bailey, Candy Berry, Tara Clark, Vivian Driscoll, Jan Elam, Martha Garriott, Beate Griffin, Veroncia Horton, Jerold Loftin. ACT Health Professionals: Martin V. Acree, Hayes J. Brantley, Felix L. Caldwell, Ramie Cox, Stanley Dowell, John W. Fowler, Nancy Fuller, Hany Habashy, Marion Hildenbrand, Karen Johnson, Stephen T. Miller, Thomas O. Motley, J. O. Patterson, Karen A. Purdy, Joseph A. Sullivan, Ralph C. Taylor, Bill C. Weber.
Project Office: National Heart, Lung, and Blood Institute, Bethesda Md: Denise Simons-Morton (project officer), P. Scott Allender, Jeffrey Cutler, Eva Obarzanek, Joanna Shih, John Taylor (contracting officer), Carolyn Voorhees.
Coordinating Center: Wake Forest University School of Medicine: Timothy Morgan (principal investigator), Roger Anderson, Stuart Cohen, Mark Espeland, Walter Ettinger, Elizabeth Mayer-Davis, Michael Miller, Jack Rejeski, Paul Ribisl, Mary Ann Sevick, Brent Shelton, Mara Vitolins, Robert Amoroso, Timothy Craven, Kathy Dotson, Rebecca Fussell, Darrin Harris, Patricia Hogan, Kurt Lohman, Susan Margiti, Susan Moxley, Stephanie Reece, Carol Wasilauskas.
Central Laboratory: Penn Medical Laboratories, Washington, DC: David Robbins and Marilyn Cadorette.
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