Physical activity is one of the strongest predictors of health and well-being throughout the life course and remains a major protective factor against morbidity and mortality in late life. Nonetheless, older adults are among the most sedentary in the American population, with those 65 and older being the least likely to engage in any leisure-time physical activity and the least likely to meet the Centers for Disease Control and Prevention recommendations for physical activity.
Physicians can play a major role in encouraging older patients to be more physically active. In recognition of the importance of behavioral counseling for patients at high risk, Healthy People 2010 sets a goal of having most physician visits include lifestyle-related behavioral counseling for individuals with chronic diseases. However, little is known about the actual frequency and quality of discussions about exercise and other health-promoting behaviors during older patient–physician medical visits.
A recent article in the Journal of Aging and Physical Activity (JAPA) examines the discussion of exercise during follow-up medical visits and investigates the following questions:
- How often do physicians and their older patients discuss exercise?
- Who initiates these discussions?
- How does the presence of an accompanying person at the medical visit influence the likelihood of discussion about exercise?
- What is the quality of physician and patient questioning, informing, and support about exercise?
- What older patient and physician sociodemographic factors influence the discussion of exercise in follow-up medical encounters?
Researchers reported the following findings:
- Exercise was discussed in approximately 13% of all visits.
- The topic of exercise was equally likely to be initiated by patients as by physicians, but the quality of physician informing was better when the physician raised the topic than when the patient did.
- Individuals accompanying the patient into the exam room never initiated discussion of exercise. Exercise was significantly more likely to be discussed in two-person visits than in three-person visits.
- Exercise was significantly more likely to be discussed in encounters with female physicians (21.6%) than in encounters with male physicians (8.8%), however the quality of the discussions of exercise did not differ according to sex of the physician.
- Exercise was more likely to be discussed with patients who had more than a high school education than with those who had less education.
- Exercise was more likely to be discussed in visits with patients who had higher overall scores on the physical-health subscales of the SF-36.
The authors of this study say that the findings are useful for several reasons. First, given the inferior quality of physician responsiveness to patient-raised discussions versus physician-raised discussions, interventions should address this area as a potential for improvement in older-patient-centered communication. Second, providers should be alerted to the potential for bias regarding education and discussions of exercise to address and avoid it in practice. Third, in this data set, when an older patient was accompanied to the medical visit, exercise was significantly less likely to be discussed, even after controlling for the effects of the older patient’s health status. Finally, given the data that patients with lower physical health scores tend to have fewer discussions about exercise, providers should recognize that this topic is not discussed with patients who may need it the most.