[Every step counts: what is the physical activity level of our patients? A pedometer study]

The prevalence of obesity is increaseing worldwide and thus enhancing the development of the chronic diseases. Physical activity represents not only an important modulator of the energy balance but physical exercise represents a key feature for chronic disease risk reduction independently from body weight. In this study we assessed physical activity by counting the steps with the help of a pedometer in 49 consecutive patients (33 women and 16 men) of the obesity- and hypertension clinic at the Medical Policlinic at the University Hospital in Zurich. 29 of the patients were obese (mean +/- SD BMI 35.3 +/- 5.5 kg/m(2)), eleven overweight (27.6 +/- 1.1 kg/m(2)) and eight of normal body weight (22.7 +/- 1.5 kg/m(2)) according to the WHO-classification. The mean +/- SD steps per week of the whole population was 67917 +/- 33856. Patients with a normal weight had more steps per week, but the difference did not reach significance as compared to the overweight or obese subjects. Only on Sunday the normal weighted patients had significantly more steps than the other groups. The data suggest that strategies to enhance physical activity on the weekend should be encouraged in all subjects, especially however in those with an increased body weight.

[Body weight and physical activity: how much is too little? How much is enough?--a study in recreational cyclists]

Body weight and body mass index (BMI) were studied in non professional cyclists. BMI increased from 22.2 +/- 2.3 kg/m2 (20 to 29 y) to 23.8 +/- 1.7 kg/m2 (55 to 77 y) (mean +/- SD). The mean increase per decade was 0.5 kg/m2, markedly less than in the general Swiss population (0.8 to 1.0 kg/m2). Overweight (BMI 25.1-29.9 kg/m2) prevalence increased from 7.4% (20 to 29 y) to 25.5% (55 to 77 y) and obesity (BMI +/- 30.0 kg/m2) was rare (0.2%, n = 1). The amount of sport correlated negatively with BMI change. A high amount of moderate to heavy physical activity (five hours weekly) was required to avoid an increase in BMI. This amount is to high for the general population. Thus, control of energy intake should be advised together with physical activity.

Patient education in asthma: a survey of physicians' knowledge of the principles and implementation of self management in practice

BACKGROUND

Therapeutic patient education, particularly when including written instructions in self-management, improves outcomes in asthma. The education of patients in self-management requires specific knowledge and skills, which are not generally taught in under- or postgraduate training programmes.

PURPOSE

To investigate physicians' knowledge of the principles and implementation of self-management in asthma care.

METHOD

A 14-item questionnaire was developed, piloted and subsequently sent to 1039 general physicians (general practitioners and internists) and pulmonologists registered as members of the Medical Society of Zurich.

RESULTS

368 (35%) of the physicians returned the questionnaire. 352 (96%) stated that they care for patients with asthma, 312 (87%) provided asthma education, 264 (75%) gave information about the mechanisms of illness, 272 (77%) provided instructions on how to use inhalers although only 212 (60%) checked inhaler technique. 170 (48%) instructed patients in home measurement of peak flow recordings (PEFR). 21% of general physicians and 52% of pulmonologists provided written action plans outlining what actions to take if PEFR or symptoms deteriorated. The majority of physicians were aware of positive benefits of patient education and over 80% stated that all asthmatic patients should be offered education. Only 32% felt that they should personally be educating the patients whilst two-thirds expressed a preference for the education to be provided by a specialist centre. 66% of the physicians expressed a desire to undertake further training in effective patient education.

CONCLUSION

Whilst most physicians in this study state to be aware of the benefits of patient education in asthma, only 24% actually provide their patients with asthma self-management plans. With a low response rate, our study is likely to be biased towards those physicians with a greater interest in asthma; hence actual use of self-management plans is likely be lower than in our sample.