How to make exercise counseling more effective: Lessons from rural America
Presenting counseling as a detailed prescription and periodically following up make a big difference
Intervention programs and tools have been developed to help health care providers overcome time, skill, and training barriers. These programs, available even to rural providers, have proven effective.49,50 (Go to www.paceproject.org/Home.html and click on “Projects” to learn about the PACE program.) However, application of such skills and tools may be more successful if training is incorporated into medical school curricula and residency training programs rather than through CME endeavors.49 This would require medical institutions and organizations to prioritize the direct link between healthy lifestyle behaviors and disease prevention and the vital role physicians play in underscoring this link.
Finally, health care policy makers and systems must be persuaded to address the lack of organizational support and reimbursement that prevents physicians from counseling at-risk patients on unhealthy lifestyle behaviors. Responsible payers and providers should aggressively explore low-cost ways to promote physical activity and weight loss in primary care settings, to stem the tide of obesity-related chronic diseases. At the local level, physicians can team up to support policies that may enhance preventive counseling efforts2—increasing access to places for activity, encouraging physical activity programming in communities, schools, and organizations, and physical environment enhancements such as safe sidewalks, adequate lighting, and improved zoning.44,51,44,52
Acknowledgments
We thank the communities that are participating in the ongoing intervention study. For their assistance in data collection, we thank the Department of Health Management and Informatics, Behavioral Risk Research Unit at the University of Missouri, Columbia.
Funding/support
This study was funded through the National Institutes of Health grant NIDDK #5 R18 DK061706 and the Centers for Disease Control and Prevention contract U48/CCU710806 (Centers for Research and Demonstration of Health Promotion and Disease Prevention). Human subjects approval was obtained from the Saint Louis University Institutional Review Board.
Correspondence
Sarah L. Lovegreen, MPH, Prevention Research Center and Department of Community Health, Saint Louis University School of Public Health, 3545 Lafayette Ave., Salus Center, Suite 300, St. Louis, MO 63146; slove green@oasisnet.org.
