Factors that influence physicians' and medical students' confidence in counseling patients about physical activity

Are the physical activity habits of healthcare professionals associated with their physical activity promotion and counselling?: A systematic review

OBJECTIVE

Healthcare professionals (HCPs) play an important role in conducting brief physical activity counselling during consultations, representing one of the population's most cost-effective interventions for its promotion. Despite this, their clinical practice often falls short in addressing physical activity with the necessary depth and frequency. This study aimed to synthesise the literature concerning the association between the physical activity habits of HCPs and their attitudes toward physical activity promotion and counselling.

METHODS

The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Its protocol was registered in PROSPERO under ID: CRD42023408302. In March 2023, a comprehensive search was conducted using key terms related to physical activity levels and HCPs counselling practices across the Web of Science, Scopus, PubMed, SPORTDiscus, APA PsycInfo, and CINAHL databases. Registered HCPs classified under the International Standard Classification of Occupations (ISCO) were included. The Newcastle-Ottawa Scale was used for assessing articles quality.

RESULTS

The search yielded 6618 articles, with 51 meeting the inclusion criteria after filtering and cross-referencing. Predominantly cross-sectional studies were included, mainly involving HCPs responding to questionnaires regarding their physical activity habits and promotion and counselling practices. Heterogeneous results were found.

CONCLUSION

High-quality studies mainly concluded that higher physical activity levels among HCPs were associated with more physical activity promotion and counselling practices. These findings are an important contribution to the relevance of the physical activity practice by HCPs and highlighting the importance of promoting its counselling in clinical practice.

Physical activity advice given by French general practitioners for low back pain and the role of digital e-health applications: a qualitative study

BACKGROUND

Low back pain is the fourth most common reason for consulting a general practitioner (GP) among people aged 40-50 years. Beyond the overall benefits of physical activity (PA) on health (psychological, cardiovascular, etc.), PA for low back pain seems to improve the prognosis in terms of pain, disability, and quality of life. The French National Health Insurance developed media campaigns to promote physical activity with low back pain and a smartphone application (app). Despite the known benefits and campaigns, GPs do not routinely provide advice about physical activity during low back pain consultations. To promote giving physical activity advice for low back pain, there is a need to understand how GPs currently provide this advice and whether technology could help. This study aims to explore the content of physical activity advice for low back pain that GPs provide in France, and their opinion about healthcare smartphone app provided electronically via the internet (e-health apps) as a support for this advice.

METHODS

This qualitative study was conducted with semi-structured individual interviews among French GPs. The verbatim was double coded using a coding tree. Thematic analysis was performed using an inductive approach.

RESULTS

Sixteen GPs from Maine et Loire, Sarthe, and Mayenne were included. The thematic analysis identified the following themes: GPs use a global patient-centred approach to physical activity advice for low back pain. The main goal is to enable patients to participate in their care. Advice was almost always general with little information about duration and frequency. The importance of patient-appropriate and easily achievable activities was emphasised. GPs referred patients to physiotherapists to reinforce regular physical activity, maintain motivation and improve patient adherence through supervision and follow-up. GPs knew little about e-health apps but felt they could be useful with young patients. The main barriers to their use included poor internet connection, lack of technical knowledge and no supervision meaning patients could injure themselves.

CONCLUSIONS

This is one of the first studies to assess the contents of physical activity advice GPs provide for low back pain. Further research is needed into the implementation of e-health apps for low back pain management.

TRIAL REGISTRATION

Not applicable.

Prevalence and associated factors of overweight and obesity among medical students from the Western Balkans (South-East Europe Region)

Being overweight and obese is associated with an elevated risk of developing noncommunicable diseases, which are the leading causes of mortality worldwide. It is a warning that global prevalence of overweight among university students ranges from 20 to 40%, which presents a significant public health problem. To date, there was no research conducted on medical students regarding the prevalence and associated factors of overweight and obesity in the countries of the Western Balkans (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, and Serbia). The aim of this study was to determine the prevalence and potential demographic, socioeconomic, and health-related behavioral factors associated with overweight and obesity of medical students from Western Balkans. A cross-sectional study was conducted, surveying 2452 students from 14 medical faculties from 5 countries in the region. The prevalence of overweight was 12% and obesity was 2.3% among medical students from Western Balkans. Male gender and smoking status are significant positive predictors of overweight and obesity. Daily level of physical activity up to 1 h per day, going to preventive check-ups once a year or as a part of annual dormitory check-ups are associated with lower odds of being overweight and obese. By creating adequate public health educational programs, students can be influenced to acquire proper health-related lifestyle habits, which would lead to reducing the prevalence of overweight and obesity among the student population, as well as risk of developing noncommunicable diseases and improving the overall health of the population.

Exercise and associated features with low-level exercise among doctors

BACKGROUND

Physical activity had been reported among doctors-in-training, with very few focusing on attending doctors. This study aimed to evaluate the physical activity, particularly exercise, of Thai doctors and features associated with low-level exercise.

MATERIALS AND METHODS

Thai doctors who participated in the hospital's CSR service, which was conducted between Feb 14, 2022, to Oct 31, 2022, were verbally informed along with an information sheet about this parallel study. The doctors who consented to participate provided their personal data on diets, work hours, illnesses, health surveillance, stress, state of well-being, and exercise. To investigate the association with clinical features, the exercise level was categorized as low-level (≤ 2 days/week) or high-level (≥ 3 days/week).

RESULTS

The median age of 1187 doctors was 45.0 years. Slightly over half were female (55.4%) or worked ≤ 40 hours/week (55.3%). The presence of illnesses was found in 55.9%, irregular health surveillance in 29.0%, no/low fiber diet in 19.2%, overweight/obesity in 28.0%, and moderate/severe stress in 25.9%. Among the doctors who provided exercise data, 29.8% had a high-level of exercise and 49.0% had a low-level. Independent features associated with low-level exercise were no/low fiber diet (aOR = 3.01), irregular health surveillance (aOR = 2.41), age ≤ 60 years (aOR = 1.82), female gender (aOR = 1.79), and work > 40 hours/week (aOR =  1.76).

CONCLUSIONS

Only 30% of Thai doctors had a high level of exercise. The significant independent factors for low-level exercise were younger age, female, working load, irregular health surveillance, and no/ low fiber diet.

Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review

BACKGROUND

Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries.

METHODS

An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied.

CONCLUSIONS

Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.

Impact of Experiential Learning of Nutrition Therapy on Medical Students

Despite the recognition that nutrition is a critical component of health and disease, many medical schools struggle to incorporate nutrition education into their dense curriculum. We designed this study to determine whether a brief, experiential learning project would be an effective option for teaching this content. Medical students voluntarily enrolled in the study, agreeing to (1) attempt a 2-week "medically prescribed" diet and (2) participate in small group lunch discussions related to their diet experience. Data on student perception of nutrition in medicine was collected through validated surveys. Custom surveys were designed to capture student confidence in using nutrition counseling, while qualitative analysis of lunch discussions revealed themes of experiential learning. Participants reported an overall positive sentiment and named the most impactful learning component as actively attempting the diet. Student participants showed a variety of adherence to their assigned diet, yet as a cohort demonstrated increased confidence over their non-participant peers in the use of nutrition counseling in a clinical setting. In addition, diet participants demonstrated an increased perception of the importance of physician efficacy and the physician-patient relationship in the broader landscape of nutrition in patient care (compared to the control group). This study demonstrates the educational value of a short, immersive, extracurricular opportunity in bolstering an already demanding undergraduate medical education curriculum.

From COVID to Couch Potato: The Importance of Physical Activity Promotion and Education

For many, the lockdowns of the COVID-19 pandemic resulted in drastic behavior changes. While the immediate uncertainty and fear surrounding the initial lockdown has subsided, there are still significant changes to our daily lives and work that may have lasting impact on our health and well-being. One such change is the increase in physical inactivity and sedentarism, a result of decreased group activities, organized events, work and school from home mandates, and physical distancing. Physical inactivity represents one of the strongest modifiable risk factors for poor health outcomes and a preventable cause of early morbidity and mortality from many common chronic diseases. Overall, health care providers are inconsistent and often ineffective at screening and counseling patients on the benefits of regular physical activity. Additionally, there is very little structured curricula for medical learners to address physical inactivity and other lifestyle factors that contribute to the health of our patients. As we adjust to new social practices and behaviors as a result of the COVID-19 pandemic, it is critical that we emphasize the need for education, screening, evidence-based interventions, advocacy, and effective role modeling on the importance of physical activity for our patients, communities, and our own well-being.

Motives and Barriers for Regular Physical Activity among Medical Students from the Western Balkans (South-East Europe Region)

Regular physical activity (PA) has multiple beneficial effects on students' health, effectively reducing the risk of various non-communicable diseases. Various factors play a role in an individual's motivation to engage in and maintain regular PA. So far, no research dealing with the motives and barriers for regular PA among medical students has been conducted in the countries of the Western Balkans. The aim of this study was to identify the motives and barriers related to regular PA and compare them with different demographic, socioeconomic, and individual lifestyle factors among Western Balkans medical students. The research was conducted in a form of a cross-sectional study. It included 2452 medical students from 14 faculties in five countries (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, and Serbia). The most commonly reported motive of medical students for regular PA is to feel better, followed by stress reduction, to look better, the desire to lose weight, and to control chronic disease. PA improvement motives are more frequently associated with the female gender, more advanced years of study, a normal weight, above average household income, and a non-smoking status. Faculty obligations are the most common barrier for regular PA among medical students, followed by other barriers, such as financial situation, current life situation, and health conditions. Barriers are more frequently reported by male students who are overweight or obese, who have a below average income, and are smokers. It is necessary for public health authorities to examine and take into account the perceived motives and barriers when forming activities and policies that aim at increasing the level of PA, in order to enhance the health of the student population.

UK Doctors Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study

Despite strategies to enable Health Care Professionals (HCPs) to give physical activity (PA) advice to patients, this appears to be rarely done in consultations. The aims of the present study were to gain an understanding of doctors' awareness of current PA guidelines and to explore their opinions on barriers and solutions. A qualitative approach using semi-structured interviews was adopted. This study included 15 doctors currently working in the UK's National Health Service (NHS). A thematic analysis approach was used to analyse the transcripts. Four themes and twelve sub-themes were deciphered. Intrinsic factors limiting the delivery of PA advice included a lack of knowledge of PA guidelines and PA being an afterthought. Barriers to delivering PA guidance included a lack of PA education, time pressures, and patient engagement. Solutions included staff training, incorporating PA into undergraduate training, and encouraging staff to be physically active. Methods to optimise PA guidance included individualised PA advice, local exercise services and schemes, utilising online and visual resources, and motivational interviewing. This study provides an updated insight into doctors' opinions on barriers and solutions to discussing PA with patients. It is clear that further work is needed to ensure greater awareness of PA guidelines amongst clinicians.

Prevalence and Associated Factors of Physical Activity among Medical Students from the Western Balkans

The student population includes young adults who need nutrition and regular physical activity (PA) for mental, cognitive, and physical development. It is estimated that, globally, only 25–40% of the university student population is involved in regular PA. To date, no research has been conducted in the Western Balkans to address the PA of medical students. The aim of this study was to investigate the prevalence and factors influencing PA among medical students from the Western Balkans. A cross-sectional study included 2452 students from 14 medical faculties in five countries (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia and Serbia). There were significantly more students who engaged than those who did not engage in some type of regular (daily) PA. Gender, overweight or obesity, and household income are significantly associated with students’ PA. Students who are more often involved in regular daily PA and have higher daily PA levels are more likely to be males whose household income is above average. In order to improve the health of the student population, the public health authorities need to continuously investigate the PA of students and introduce appropriate activities to increase their level of PA.

Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland

The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30−39 years and 40−49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.

GPs' perspectives regarding their sedentary behaviour and physical activity: a qualitative interview study

Background

General practice is a highly sedentary occupation, with many GPs spending more than 10.5 hours sitting each workday. This excessive sedentary behaviour and lack of physical activity (PA) is potentially detrimental to the health of GPs, as well as their ability to counsel patients regarding sedentary behaviour and PA. There is a lack of prior research examining the perspectives of GPs regarding their sedentary behaviour and PA.

Aim

To explore GPs’ perspectives regarding their sedentary behaviour and PA.

Design & setting

A qualitative interview study of GPs in Northern Ireland.

Method

Semi-structured interviews were conducted with a purposive sample of 13 GPs who had previously taken part in a study to objectively measure their levels of sedentary behaviour and PA. Interview transcripts were analysed using deductive thematic analysis. The Theoretical Domains Framework (TDF) was used to facilitate identification of barriers and enablers affecting the ability of GPs to increase their PA.

Results

Key themes were categorised within six theoretical domains (environmental context and resources, social professional role and identity, goals, social influences, knowledge, and intentions) with sub-themes within each domain.

Conclusion

Most GPs are unhappy with their current levels of sedentary behaviour and PA, and are concerned with how this is affecting their health. Numerous barriers and facilitators were identified affecting the ability of GPs to increase their PA, including working environment, and personal and professional responsibilities, among others. Addressing these could improve the health of GPs and their ability to counsel patients regarding sedentary behaviour and PA.

Exploration of sedentary behaviour among general practitioners: A cross-sectional study

BACKGROUND

Sedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality.

AIM

To explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs).

DESIGN & SETTING

Sequential, cross-sectional design (initial online sedentary behaviour questionnaire, subsequent thigh-worn accelerometer sub-study) of GPs and GPSTs in Northern Ireland.

METHOD

Self-reported questionnaire data were aggregated and compared with device-measured accelerometry data.

RESULTS

Data from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 (SD =2.97) hours) than those in secondary care (7.9 (SD =3.43) hours) (MD 2.43 hours; P<0.001). An active workstation (eg, sit-stand desk), was used by 5.6% of participants in general practice, while 86.0% of those without one would consider using one in future. Active workstation users self-reported lower workday sedentary time (7.88 (SD =3.2) hours) than non-users (10.47 (SD =2.88) hours) (MD -2.58 hours, P=0.001). Accelerometer sub-study participants underestimated their workday sedentary time by 0.17 hours (95% CI -1.86, 2.20; P=0.865), and non-workday sedentary time by 2.67 hours (95% CI 0.99, 4.35; P=0.003). Most GPs (80.7%) reported increased workday sitting time compared to prior to the COVID-19 pandemic, while 87.0% would prefer less workday sitting time.

CONCLUSION

GPs have high levels of workday sedentary time, which may be detrimental to their health. It is imperative to develop methods to address sedentary behaviour among GPs on workdays, both for their own health and the health of their patients.

The Importance of Health Values Among Health Care Providers

Medical professionals' healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers' knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Sedentary behaviour among general practitioners: a systematic review

Background

Sedentary behaviour is when someone is awake, in a sitting, lying or reclining posture and is an independent risk factor for multiple causes of morbidity and mortality. A dose-response relationship has been demonstrated, whereby increasing sedentary time corresponds with increasing mortality rate. This study aimed to identify current levels of sedentary behaviour among General Practitioners (GPs), by examining and synthesising how sedentary behaviour has been measured in the primary care literature.

Methods

A systematic review was conducted to identify studies relating to levels of sedentary behaviour among GPs. Searches were performed using Medline®, Embase®, PscycINFO, Web of Science and the Cochrane Library, from inception of databases until January 2020, with a subsequent search of grey literature. Articles were assessed for quality and bias, with extraction of relevant data.

Results

The search criteria returned 1707 studies. Thirty four full texts were reviewed and 2 studies included in the final review. Both were cross-sectional surveys using self-reported estimation of sedentary time within the International Physical Activity Questionnaire (IPAQ). Keohane et al. examined GP trainees and GP trainers in Ireland. 60% reported spending in excess of 7 h sitting each day, 24% between 4 and 7 h, and 16% less than or equal to 4 h. Suija et al. examined female GPs in Estonia. The mean reported daily sitting time was 6 h and 36 min, with 56% sitting for over 6 h per day. Both studies were of satisfactory methodological quality but had a high risk of bias.

Conclusion

There is a paucity of research examining current levels of sedentary behaviour among GPs. Objective data is needed to determine GPs’ current levels of sedentary behaviour, particularly in light of the increase in remote consulting as a result of the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01359-8.

Registered dietitians' beliefs and behaviours related to counselling patients on physical activity and sedentary behaviour from a theory of planned behaviour perspective

Background

Registered dietitians working in team-based primary care settings (e.g., family health teams [FHTs]) are positioned to counsel on physical activity and sedentary behaviour when providing nutrition-related services to promote health and prevent disease. This qualitative study explored FHT registered dietitians’ beliefs and behaviours related to counselling patients on physical activity and sedentary behaviour.

Methods

Twenty registered dietitians in FHTs in Ontario, Canada were interviewed in person. Theory of planned behaviour guided the development of this cross-sectional, descriptive study. Thematic analysis was used to identify themes within each of the following theoretical constructs (topics): registered dietitians’ behaviour (practice), behavioural intention, attitude, subjective norm, and perceived behavioural control related to physical activity and sedentary behaviour counselling.

Results

All participants counselled patients on physical activity, using some motivational interviewing strategies, and most counselled on sedentary behaviour. Many participants intended to continue their current physical activity counselling practices and increase sedentary behaviour counselling. Some participants had a positive attitude about the effectiveness of counselling on physical activity and sedentary behaviour, but their belief about effectiveness was dependent on factors such as time frame for behaviour change. Many participants felt that other health care professionals expected them to counsel on physical activity and they believed that other registered dietitians counsel on physical activity and sedentary behaviour. Facilitators to counselling included FHT dynamics and time with patients. In terms of barriers, almost all participants were confident in basic PA counselling only and contended that only this is within their scope of practice. Many participants posited that exercise prescription is outside their scope of practice. Other barriers included registered dietitians’ lack of knowledge and not having a physical activity expert on the team.

Conclusions

The results suggest that strategies are warranted to improve FHT registered dietitians’ knowledge, attitude, and counselling skills related to physical activity and sedentary behaviour. This study provides a strong foundation to develop a theory-based, quantitative measure to assess physical activity and sedentary behaviour counselling practices and determinants among registered dietitians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-020-00392-1.

Patient and Provider Communication Regarding Exercise during Pregnancy in a Rural Setting

Women in rural settings are at increased risk for adverse pregnancy outcomes. One potential way to improve pregnancy outcomes in rural settings is through physical activity promotion. However, given the disparities in prenatal care, women in rural areas may not receive information from their health care provider regarding physical activity during pregnancy. Therefore, the purpose of this study was to examine patient and provider communication in a rural setting (both patients' and providers' perspectives) regarding physical activity during pregnancy. A mixed methods study was performed among patients and providers in an obstetrical practice in a rural setting. During early pregnancy, patients were asked questions about their current physical activity levels and intentions for physical activity during their pregnancy. During late pregnancy, patients completed a survey regarding communication from their obstetric provider about exercise during pregnancy. Providers responsible for the patients' prenatal care were surveyed regarding communication with patients about physical activity. Seventy-one pregnant women and five providers participated. 58.2% of patients reported their provider did not discuss physical activity during pregnancy with them at all. Meanwhile, all providers (100%) reported discussing physical activity with all of their patients. Similarly, only 21.8% of patients reported their provider discussed the benefits of exercise during pregnancy, while 100% of providers reported telling their patients about the benefits of exercise during pregnancy. Our study suggests ineffective patient-provider communication regarding physical activity during pregnancy in a rural setting. Improved communication strategies could reduce disparities in health outcomes among pregnant women in rural settings.

Effect of modified physiology laboratory sessions on the awareness and knowledge of obesity of health-related university students

BACKGROUND:

Obesity is a global health problem of immense magnitude. Increased awareness and knowledge about obesity in health-care providers are essential to addressing this global issue. The aim of the present study was to assess the baseline knowledge on obesity of university students in health-related programs and evaluate the effectiveness of modified physiology laboratory (MPL) sessions in enhancing the awareness of obesity of these students by repeated exposure to physiological differences between normal weight (NW) and overweight or obese (OW/OB) individuals.

MATERIALS AND METHODS:

It was a quasi-experimental study in which three regular physiology laboratory exercises were modified (MPL) to address different aspects of obesity. A total of 319 students (181 male and 138 female) from health-related colleges taking the physiology course during academic session 2011–2012 were included in the study. A questionnaire on obesity served as a measure of prior knowledge and improvement of evolution of student knowledge. The questionnaire was administered thrice: Beginning of the first MPL session (pretest), at the end of the second session of the first MPL (posttest-1), and the end of second session of the final MPL (posttest-2). Correct knowledge (CK), perceived knowledge (PK), and accuracy of knowledge (KA) were evaluated. Students gathered and analyzed physiological data in these sessions to explore the differences between NW and OW/OB subjects.

RESULTS:

The students' level of PK on obesity was high, but KA was low in pretest. The three knowledge indices improved significantly (P <0.001) from pretest (PK = 77.2%; KA = 52.8%; CK = 40.5%) to posttest 1 (PK = 93.5%; KA = 70.1%; CK = 65.9%). However, from posttest 1 to posttest 2, only small but significant increments were observed in CK (10.5%) and KA (8.7%).

CONCLUSION:

The awareness and knowledge on obesity of health-related undergraduate university students at baseline were low, but significantly improved after MPLs. The students' knowledge did not only increase but also improved in accuracy. This increase in awareness and knowledge of obesity is expected to directly impact on the students' lifestyles and boost their confidence to counsel others on obesity.

Nutrition and physical activity counselling by general practitioners in Lithuania, 2000-2014

BACKGROUND

Primary health care plays a crucial role in providing recommendations on a healthy diet and physical activity to assist patients in weight management. The study aimed to evaluate health behaviour counselling provided by general practitioners (GPs) for adults with overweight and obesity in Lithuania between 2000 and 2014.

METHODS

Eight biennial postal surveys to independent nationally representative random samples of Lithuanians aged 20-64 were conducted. Response rates varied from 41.1 to 74%, with a decreasing trend over time. The data of 5867 participants who visited a GP at least once during the last year and had BMI of ≥25.0 kg/m² were analysed. Respondents were asked about GP advice on nutrition and physical activity and changes in their health behaviour during the last year.

RESULTS

The proportion of persons with overweight who reported GP advice on nutrition increased from 23.6% in 2000 to 37.5% in 2010 and advice on physical activity from 11.9 to 17.2% respectively; however, later both proportions decreased slightly. The likelihood of reporting was higher in respondents with higher BMI, more chronic conditions and frequent contact with a GP. Respondents who were living in cities, older and highly educated women were all more likely to report being advised on physical activity. Men and women who received advice from a GP more often reported changes in health behaviour as compared with non-advised individuals.

CONCLUSIONS

Despite increasing trends, the rate of GP advice on nutrition and physical activity reported by patients with overweight and obesity remains low in Lithuania. GP advice appears to have a significant impact on attempts by patients to change behaviour related to weight control. Therefore, there is an obvious need to make additional efforts to increase the frequency of GP counselling and to identify and address barriers to advising patients with overweight.

Developing a training programme in physical activity counselling for undergraduate medical curricula: a nationwide Delphi study

OBJECTIVES

To identify the essential content and approaches for developing a training programme in physical activity (PA) counselling for undergraduate medical curricula.

DESIGN

A three-round Delphi survey was conducted to investigate four key topics: (1) contents of PA counselling in medical education; (2) teaching and learning methods; (3) medical school collaboration and (4) educational policy implementation. Round 1 collected opinions from the participants. Round 2 focused on scoring the opinions. Round 3 summarised the expert opinions. A mean score of 4 or above identified as an important item.

SETTING

All 23 medical schools in Thailand.

PARTICIPANTS

Academic staff who were experts or in charge of medical schools in the fields of PA, health promotion or medical education.

RESULTS

A total of 20 representatives from 18 of the 23 Thai medical schools participated in the study (for a response rate of 78.2%). The top three most important indicators of knowledge were (1) the definition and types of PA (4.75±0.55), (2) the FITT principle (frequency, intensity, time and type) (4.75±0.55) and (3) the benefits of PA (4.65±0.67). The most important component of the training involved general communication skills (4.55±0.60). An extracurricular module (4.05±0.76) was preferable to an intracurricular module (3.95±0.94). Collaborations with medical education centres and teaching hospitals (4.45±0.78) and supporting policies to increase medical students' PA (4.40±0.73) were considered to be important.

CONCLUSION

Knowledge and counselling skills are important for PA counselling. Building collaborations between medical education and health institutions, as well as implementing effective educational policies, are key approaches to the integration of PA counselling into medical education. Future research should focus on investigating the effects of training in PA counselling on the learning outcomes of medical students and the clinical outcomes of patients.

Influence of weight etiology information and trainee characteristics on Physician-trainees' clinical and interpersonal communication

OBJECTIVE

This analysis explores the effects of relaying information about the genetic and behavioral causes of obesity (vs. control) on physician trainees' verbal communication behavior with a virtual patient with obesity. Moderation by physician trainees' gender and BMI was also assessed.

METHODS

119 physician trainees' verbal responses were recorded and coded using a close-ended content analytic approach.

RESULTS

Physician trainees in the behavioral and genetic information conditions were more likely to discuss weight (behavioral: AOR = 5.40; genetic: AOR = 6.58,) and provide lifestyle counseling (behavioral: AOR = 10.92; genetic: AOR = 3.50). Those in the behavioral condition were more likely to make assumptions about the patient's lifestyle behavior (AOR = 5.53) and use stigmatizing language (AOR = 4.69). Heavier physician trainees in the genetic condition had shorter interactions (β = -0.53, p <  0.01).

CONCLUSION

Emphasizing the genetic causes of overweight offers a potential avenue for encouraging clinical communication with patients with obesity, without also increasing prejudice and bias. Additional efforts may be needed to reap the benefits of genetic information for providers with higher weight.

PRACTICE IMPLICATIONS

For providers, considering genetic factors underlying patient body weight and obesity risk may serve to reduce stigmatizing communication with patients.

Influence of Osteopathic Medical Students' Personal Health on Attitudes Toward Counseling Obese Pediatric Patients

Context

Research has shown that physicians with positive health and lifestyle behaviors have more positive attitudes toward effective counseling, but little is known about how personal health behaviors of medical students influence their attitudes regarding pediatric obesity counseling before entering practice.

Objective

To determine whether the personal health status and habits of osteopathic medical students influence their attitudes toward counseling obese pediatric patients regarding lifestyle behaviors.

Methods

A cross-sectional survey was distributed electronically to first- through fourth-year osteopathic medical students. The survey assessed students' personal lifestyle habits and their top anticipated barriers to providing pediatric weight counseling.

Results

A total of 200 participants completed the survey. National physical activity recommendations were met by 81 participants (40.5%). These 81 participants had significantly more positive attitudes toward pediatric physical activity counseling than participants who did not meet the recommendations (H=-35.06, P=.001) or those who only met resistance training recommendations (H=40.63, P=.021). Participants with obesity had significantly lower pediatric weight management counseling scores than overweight participants (H=40.77, P=.028). Thirty-one participants (15.5%) consumed a healthy amount of both vegetables and fruit. These 31 participants had significantly higher dietary mean item counseling scores than those who did not (H=-30.40, P=.048). Participants identified the barriers "Time" (137 [68.5%]) and "Difficult for patients to change behavior" (99 [49.5%]) most frequently. Clinical participants identified "Poor or lacking reimbursement" (21 [28.0%]) more frequently than preclinical participants (12 [9.6]).

Conclusion

Medical students who exhibited healthier lifestyle habits were more likely to positively view pediatric obesity management counseling.

Perception and Management of Obesity Among Pakistani Doctors

Background The incidence of obesity has been on the rise worldwide. In Pakistan alone, one in four adults is overweight/obese and thus at risk of developing a number of comorbidities such as cardiovascular disease and diabetes. This research aimed to examine how doctors perceived and managed their obese patients. Methods A standardized questionnaire was filled by 100 doctors working in Pakistan, either by hand or online. The study was conducted from November 2017 to January 2018. Results It was found that only 8% of doctors had completed a training course on obesity. Doctors discussed the links between obesity and diabetes (88%) most often whilst neglecting cancer (30%) and dementia (17%). Only 60% of doctors calculated body mass index (BMI) for adult obese patients, with general practitioners (GPs) being the most confident in discussing their weight issues (p=0.001). In terms of childhood obesity, 54% of doctors were confident in putting in place a weight management program. Doctors who checked their weight more than four times a year were found to calculate the BMI of children and adult patients more often (p=0.000 and p=0.044). Comparably, doctors of normal weight were more confident in managing the complications of adult obesity (p=0.015). Conclusion Training courses regarding obesity should be provided to doctors not only to increase their knowledge but also to increase their confidence levels in managing such patients. Further research needs to be carried out in order to understand the patients' perception of obesity management.

Results from the Medical School Physical Activity Report Card (MSPARC) for a Thai Medical School: a mixed methods study

BACKGROUND

Data systems for surveillance and monitoring are essential to develop understanding of the levels of physical activity (PA) occurring at the population levels. To comprehensively understand PA in medical schools, a suitable surveillance tool might be useful to present and monitor key PA-related metrics. This study investigated PA-related metrics in a Thai medical school and summarised the findings using a newly developed tool-the Medical School Physical Activity Report Card (MSPARC).

METHODS

A mixed methods study was carried out at three campuses of a medical school in Southern Thailand. Data analysis included descriptive statistics and qualitative reviews. All 285 medical students from a medical school were the target population. The prevalence of PA (≥ 150 min/week of moderate- to vigorous-intensity PA) and sedentary behaviours (SB) (≥ 8 h/day of sedentary time) among medical students were analysed using data from a self-administered questionnaire. Usage patterns, quality, and accessibility of walkable neighbourhoods; bicycle facilities; and recreational areas were assessed. PA promotion programmes, education, and investment related to PA promotion were reviewed from the school documents.

RESULTS

Of 279 participants, 138 (49.5%) met PA recommendation, but 71.7% met criteria for SB. Male students were more active (61.8 vs. 42.4%) and less sedentary (65.7 vs. 75.1%) than female students. Bicycle facilities were rated as having the lowest quality and accessibility among PA-related facilities. Most PA promotion programmes were sports clubs and sport competitions. A total of 25 h of PA education was taught throughout the entire curriculum, which provided minimal PA counselling training. The school invested 2136.14 Baht/student/year (US $64.34) in PA promotion, or 2.4% of the annual tuition. The MSPARC presented the summary of the findings by using simple symbols, infographics, and short texts.

CONCLUSIONS

To increase PA and decrease SB among medical students, there is a need to improve the quality and accessibility of the built environment as well as the natural environment, so as to establish health promoting policies. PA counselling training is required to develop the medical students' essential skills and awareness for future practices. Monitoring and subsequent surveillance of PA in medical school are needed.

The Relationship between Levels of Physical Activity and Academic Achievement among Medical and Health Sciences Students at Cyberjaya University College of Medical Sciences

BACKGROUND

This study aimed to explore the prevalence of physical activity among medical and health sciences students at Cyberjaya University College of Medical Sciences (CUCMS) and to determine the relationship of their physical activity level with their academic achievement and self-determination level.

METHODS

An analytical cross-sectional study was conducted among 244 Medical and Health Sciences undergraduate students at CUCMS from January to April 2017 using self-administered short-form version of the International Physical Activity Questionnaire (IPAQ-SF) and the third version of the Behavioural Regulation in Exercise Questionnaire (BREQ-3). Multiple regression models were fitted using SPSS version 20 to examine the relationships between study variables.

RESULTS

Half of the male students (51.7%) were in the health-enhancing physical activity (HEPA) group, as compared to only 24.7% of females. The odds of having a good grade point average was twice as high among HEPA active students (odds ratio [OR] = 1.89, 95% CI [1.09, 3.27], P = 0.023) than among non-HEPA active students. Further, the odds of being HEPA active was higher for males (OR = 3.16, 95% CI [1.61, 6.14], P < 0.01) than for females and higher for overweight students than for normal weight students (OR = 2.58, 95% CI [1.24, 5.57], P = 0.017). The odds of being HEPA active was 1.79 times higher for each unit increase in the integrated regulation score (OR = 1.79, 95% CI [1.14, 2.91], P = 0.020).

CONCLUSION

The prevalence of physical inactivity was higher among females than males. This study also confirmed a significant association between physical activity level and academic achievement. HEPA active students performed better academically than those who were non-HEPA active.

Nutrition Education in Internal Medicine Residency Programs and Predictors of Residents' Dietary Counseling Practices

BACKGROUND

Although physicians are expected to provide dietary counseling for patients with cardiovascular (CV) risk factors such as hypertension, hyperlipidemia, diabetes, and obesity, nutrition education in graduate medical education remains limited. Few studies have recently examined nutrition education and dietary counseling practices in Internal Medicine (IM) residency training.

OBJECTIVES

To conduct a contemporary assessment of outpatient nutrition education in IM residency programs in the United States, identify predictors of residents' dietary counseling practices for CV risk factors, and identify barriers for educators in providing nutrition education and barriers for residents in counseling patients.

DESIGN

Cross-sectional anonymous surveys were completed by IM program directors (PDs) and residents throughout the United States. Linear regression was used to examine the association between the amount of nutrition education received and the number of instruction methods used by the residents and frequency of residents' dietary counseling for patients with CV risk factors.

KEY RESULTS

A total of 40 educators (PDs and ambulatory/primary care PDs) and 133 residents across the United States responded to the survey. About 61% of residents reported having very little or no training in nutrition. Nutrition education in residency, both the amount of education (β = 0.20, P = .05) and the number of instruction methods used (β = 0.26, P = .02), predicted frequency of residents' dietary counseling practices independent of nutrition education in medical school, which was also significantly associated with counseling (β = 0.20, P = .03). Residents' total fruit and vegetable intake likewise predicted frequency of counseling (β = 0.24, P < .001). Low perceived faculty expertise was a major barrier for educators and was associated with lower level of provided nutrition education (r = -.33, P = .04). Low resident and low perceived clinic preceptors' interests in nutrition were also associated with lower frequency of residents' dietary counseling (r = -.19, P = .04; r = -.18, P = .05).

CONCLUSIONS

The provision of nutrition education in IM residency programs and IM residents' dietary counseling for patients need to be systematically assessed nationally. This study's preliminary findings suggest that multimodal nutrition education in IM residency and better resident dietary habits are associated with higher frequency of dietary counseling for patients. Lack of faculty expertise and low faculty and resident interests in patient counseling need to be addressed perhaps by mandating nutrition education in graduate and continuing medical education.

Development of a physical activity monitoring tool for Thai medical schools: a protocol for a mixed methods study

INTRODUCTION

Physical activity (PA) is important in promoting health, as well as in the treatment and prevention of diseases. However, insufficient PA is still a global health problem and it is also a problem in medical schools. PA training in medical curricula is still sparse or non-existent. There is a need for a comprehensive understanding of the extent of PA in medical schools through several indicators, including people, places and policies. This study includes a survey of the PA prevalence in a medical school and development of a tool, the Medical School Physical Activity Report Card (MSPARC), which will contain concise and understandable infographics and information for exploring, monitoring and reporting information relating to PA prevalence.

METHODS AND ANALYSIS

This mixed methods study will run from January to September 2017. We will involve the School of Medicine, Walailak University, Thailand, and its medical students (n=285). Data collection will consist of both primary and secondary data, divided into four parts: general information, people, places and policies. We will investigate the PA metrics about (1) people: the prevalence of PA and sedentary behaviours; (2) place: the quality and accessibility of walkable neighbourhoods, bicycle facilities and recreational areas; and (3) policy: PA promotion programmes for medical students, education metrics and investments related to PA. The MSPARC will be developed using simple symbols, infographics and short texts to evaluate the PA metrics of the medical school.

ETHICS AND DISSEMINATION

This study has been approved by the Human Research Ethics Committee of Walailak University (protocol number: WUEC-16-005-01). Findings will be published in peer-reviewed journals and presented at national or international conferences. The MSPARC and full report will be disseminated to relevant stakeholders, policymakers, staff and clients.

Leisure time physical activity and quality of life in medical students: results from a multicentre study

BACKGROUND/AIM

We evaluated the association between leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between volume of PA and various domains of perception of QoL.

METHODS

Data were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, ≤540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week.

RESULTS

Forty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL for all measurements. For low levels of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains.

CONCLUSION

We observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical students.

Physical activity levels and counseling by health care providers in cancer survivors

Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's<0.05). A HCP's recommendation is associated with higher levels of leisure-time aerobic physical activity among cancer survivors and adults without cancer. The communication between cancer survivors and their HCPs may act as a 'window' of opportunity to increase physical activity levels among the U.S. cancer survivors.

Walking Cadence to Exercise at Moderate Intensity for Adults: A Systematic Review

Background. Most adults choose walking as a leisure activity. However, many do not reach the international physical activity guidelines for adults, which recommend moderate intensity aerobic activity for at least 150 minutes/week in bouts of 10 minutes. Purpose. This systematic review provides an update on the walking cadence required to reach moderate intensity in adults and older adults, identifies variables associated with reaching moderate intensity, and evaluates how walking cadence intensity should be measured, but the main purpose is to report the interventions that have been attempted to prescribe walking cadence to increase time spent at moderate intensity or other outcomes for adults and older adults. Methods. SportDISCUS, Scopus, and PubMed databases were searched. We identified 3,917 articles and 31 were retained for this systematic review. Only articles written in English were included. Results. In general, 100 steps/minute is prescribed for adults to achieve moderate intensity, but older adults may require a higher cadence. Currently, few studies have explored using walking cadence prescription as an intervention to increase physical activity levels. Conclusion. Prescribing walking cadence as a way to increase physical activity levels has potential as a practical and useful strategy, but more evidence is required to assess its ability to increase physical activity levels at moderate intensity.

Physical activity among medical students in Southern Thailand: a mixed methods study

OBJECTIVES

The study aimed to investigate the prevalence of physical activity (PA) and factors influencing PA behaviours among medical students in Southern Thailand.

DESIGN

The study implemented a mixed methods approach. The sequential design consisted of 2 phases: a survey followed by in-depth interviews.

SETTING

The study was conducted in the 3 campuses of a medical school in Southern Thailand. The preclinical students (years 1-3) studied general and basic science subjects at Nakhon Si Thammarat campus. The clinical students (years 4-6) received clinical training and hospital attachments at Trang or Phuket campuses. Total number of students was 285, with 46-48 students in each class. The study was conducted from September 2015 to February 2016.

PARTICIPANTS

Participants were medical students, 18 years old and above, from 3 campuses without disabilities or medical conditions which limited their ability to perform PA.

OUTCOME MEASURES

The prevalence of the recommended levels of PA was measured using Global Physical Activity Questionnaire (GPAQ). The association between the demographic data and the recommended PA levels were analysed by univariate and multivariate analysis. In-depth interviews and thematic analysis were completed to explore PA behaviours.

RESULTS

A total of 279 (response rate 97.9%) medical students participated in the study. Approximately half (49.5%) of the participants were physically active. The median total energy use was 540 metabolic equivalent-min/week (range 0-5640). Male and preclinical students were more likely to be physically active (p<0.05). Twenty-four in-depth interviews were conducted. Supportive factors included social support from friends and families. Study-related activities and overtime shift work were barriers.

CONCLUSIONS

More than half of the medical students have insufficient PA because of study-related activities and overtime shift work. Future studies should focus on finding ways to improve PA in clinical and female students in Thailand.

The prevalence of binge drinking among primary care residents

BACKGROUND

Over one quarter of American adults binge drink, resulting in significant alcohol-related morbidity and mortality. Although brief interventions can decrease patients' alcohol use, many physicians in training do not provide this service. This study examines the prevalence of binge drinking among primary care residents, and the association of resident drinking behaviors with addressing patients' hazardous alcohol use.

METHODS

Between July 2013 and August 2014, the authors surveyed all trainees in 6 primary care residency programs. The survey assessed self-reported frequency of binge drinking, confidence working with hazardous drinkers, and the performance of brief interventions when hazardous drinking was detected in patients.

RESULTS

221 of 246 residents completed the survey (response rate 89.8%). Half of residents (109/221) reported at least one episode of binge drinking in the prior year, and 18% (39/221) reported binge drinking at least once a month. In multivariable analysis, monthly binge drinking was associated with male gender (OR 2.5, 95% CI 1.1-5.4) and year of training (OR 0.25 for Year 3 vs. Year 1, 95% CI 0.07-0.90). Few residents felt confident they could help patients cut down or quit alcohol, regardless of personal binge drinking history (19% for those who binged monthly, 24% for those who binged 1-11 times a year, and 27% for those who never binged, p for trend = 0.31). Performance of brief interventions did not vary by personal binge drinking history.

CONCLUSIONS

Binge drinking is common among primary care residents. In addition to training residents to effectively intervene with hazardous drinkers, residency programs should address the high prevalence of binge drinking by their physicians in training.

Preceptor perceptions of fourth year student pharmacists' abilities regarding patient counseling on therapeutic lifestyle changes

OBJECTIVE

Advanced pharmacy practice experiences (APPEs) provide an opportunity for students to showcase health and wellness knowledge and skills attained during didactic education. The primary objective of this study was to assess preceptor perceptions of how well pharmacy year four (PY4) students are prepared to provide guideline-based and patient-specific therapeutic lifestyle change (TLC) counseling at onset of an APPE rotation. A secondary objective included assessment of differences in counseling abilities if the preceptor considered the student normal weight versus overweight or obese, or if they were a known smoker.

METHODS

A questionnaire containing Likert questions about perceptions regarding TLC counseling was distributed electronically in October 2014 to 708 PY4 preceptors from two pharmacy schools. Only preceptors who routinely provided TLC counseling were included in data analysis that were done using descriptive statistics. The project was approved by both universities' institutional review boards.

RESULTS

The survey was completed by 165 PY4 preceptors (response rate = 23.3%), and 67 met inclusion criteria. Regarding nutrition counseling, a greater percentage of preceptors agreed that students more adequately provided counseling per guidelines (79.1%) versus individual patient needs (62.6%). Preceptors perceived students of normal weight were more likely to provide adequate lifestyle-modification counseling to overweight/obese patients (81%) compared to students that were overweight/obese themselves (69%). Students of normal weight were perceived to be more likely to adequately counsel normal weight patients on lifestyle modifications (81%) compared to students that were overweight/obese (64%). Students who smoked were perceived to adequately counsel about not smoking, though, to a lesser degree than students who were non-smokers.

IMPLICATIONS

While students are perceived as adequately equipped to provide guideline-based recommendations, there is room for improvement in providing patient-specific counseling. Additionally, it is perceived that student health status related to weight impacts TLC counseling.

A parallel curriculum in lifestyle medicine

BACKGROUND

Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours such as diet, physical activity or weight control, despite the prediction by the World Health Organization that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. This gap in patient-clinician dialogue is perhaps the result of a lack of structured training in medical school surrounding the components of lifestyle medicine.

CONTEXT

Although Harvard Medical School does have a required course in nutrition, there are no requirements for the other components of lifestyle medicine, including physical activity, behaviour change and self-care.

INNOVATION

Since 2009 Harvard Medical School has addressed this absence in the curriculum by developing a student-led, faculty member-advised, parallel curriculum in lifestyle medicine. Medical student participants were invited to take part in anonymous questionnaires between 2009 and 2013, which gathered data about personal ability and attitude in counselling patients on lifestyle behaviours, as well as subjective data on the curriculum content and applications to effective medical practice. Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours IMPLICATION: Each year, students have pointed to a lack of lifestyle medicine knowledge because of a gap in the traditional curriculum surrounding topics such as physical activity, nutrition and behaviour-change strategies, and indicated that the inclusion of this knowledge and these skills was an important component of medical education. Although participation is currently voluntary, this is the first such curriculum of this type and addresses a critical gap in undergraduate medical education.

Steps for Improving Physical Activity Orientation Among Health-care Providers of Older Cardiovascular Patients

Attaining appropriate levels of physical activity can have many potential physiological and psychological benefits in older adults with cardiovascular disease. However, these individuals often report low levels of physical activity and high levels of sedentary behavior. Older adults encounter many potential "barriers" to physical activity, but numerous studies have demonstrated the ability to positively influence this important health behavior using well-established behavior change theories and models. The information provided in this review is directed at health-care providers who have the potential to impact physical activity behaviors during regular, often brief, clinical interactions. In addition to providing the latest physical activity recommendations, this update will provide a brief summary of some of the more widely used behavioral skills and strategies for promoting physical activity in older adults with cardiovascular disease.

A review of the use of the 5 A's model for weight loss counselling: differences between physician practice and patient demand

BACKGROUND

The 5 A's (Assess, Advise, Agree, Assist and Arrange) is a model that can be used by primary care physicians and practitioners to promote patient behaviour change. The 5 A's model is a viable intervention for encouraging weight management in response to the epidemic of obesity among patients.

AIM

To identify and summarize quantitative research related to the 5 A's patients want to receive from their physicians during weight loss discussions and how frequently physicians use each practice.

DESIGN AND SETTING

We conducted a systematic literature review of the MEDLINE/PubMed database using relevant keywords. Of 230 articles originally identified, 15 articles included quantitative research data from cross-sectional studies related to the aim of this review.

RESULTS

Based on the available evidence, the majority of patients want to discuss weight loss with their physicians, with the Assist and Arrange aspects of the 5 A's being most desired. However, physicians most frequently Advise and Assess, and rarely Agree, Assist or Arrange.

CONCLUSIONS

There are some significant limitations to the available evidence, including a limited number of studies addressing patient preference, inconsistent assessment of all aspects of the 5 A's, a lack of longitudinal designs and failure to take contextual factors such as patient and physician characteristics into account when interpreting study results. Future studies should address these limitations, document the outcomes that result from better physician training in lifestyle modification strategies and determine how to best routinely implement all aspects of the 5 A's for weight management in family practice settings.