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Christina C. Wee, MD, MPH; Ellen P. McCarthy, PhD; Roger B. Davis, ScD; Russell S. Phillips, MD

JAMA. 1999;282:1583-1588.

Context  The increase in sedentary lifestyle may contribute to the rise in obesity nationally. Although guidelines suggest that physicians counsel all patients about exercise, physicians counsel only a minority of their patients. Whether patient factors influence physician counseling is not well established.

Objectives  To examine and to identify factors associated with exercise counseling by US physicians.

Design and Setting  National population-based supplemental (Year 2000) survey to the 1995 National Health Interview Survey.

Participants  Of the 17,317 respondents to the Year 2000 supplemental survey, 9711 adults had seen a physician in the previous year, and 9299 responded when asked about physician counseling on exercise.

Main Outcome Measure  Physician counseling to begin or to continue to exercise.

Results  Of 9299 respondents, 34% reported being counseled about exercise at their last visit. After adjustment for other sociodemographic and clinical factors, women were slightly more likely to be counseled, with an adjusted odds ratio (AOR) of 1.15 (95% confidence interval [CI], 1.02-1.29). Physicians counseled older patients (>30 years) more often than younger patients; those aged 40 to 49 years were counseled most often (AOR, 1.71 [95% CI, 1.34-2.20]). Patients with incomes above $50,000, those with higher levels of physical activity, college graduates, and patients who were overweight to obese (body mass index: 25 to 30 kg/m²) were more likely to be counseled, as were patients with cardiac disease (AOR, 1.81 [95% CI, 1.52-2.14]) and diabetes (AOR, 1.87 [95% CI, 1.46-2.38]). Counseling did not vary by physician specialty or patient race.

Conclusion  The rate of physician counseling about exercise is low nationally. Physicians appear to counsel as secondary prevention and are less likely to counsel patients at risk for obesity. The failure to counsel younger, disease-free adults and those from lower socioeconomic groups may represent important missed opportunities for primary prevention.

Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

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