Efficacy of GP referral of insufficiently active patients for expert physical activity counseling: protocol for a pragmatic randomized trial (The NewCOACH trial)

Abstract

BackgroundPhysical inactivity is fourth in the list of risk factors for global mortality. General practitioners are well placed to offer physical activity counseling but insufficient time is a barrier. Although referral to an exercise specialist is an alternative, in Australia, these allied health professionals are only publicly funded to provide face-to-face counseling to patients who have an existing chronic illness. Accordingly, this trial aims to determine the efficacy of GP referral of insufficiently active patients (regardless of their chronic disease status) for physical activity counseling (either face-to-face or predominately via telephone) by exercise specialists, based on patients’ objectively assessed physical activity levels, compared with usual care. If the trial is efficacious, the equivalence and cost-effectiveness of face-to-face counseling versus telephone counseling will be assessed.MethodsThis three arm pragmatic randomized trial will involve the recruitment of 261 patients from primary care clinics in metropolitan and regional areas of New South Wales, Australia. Insufficiently active (less than 7000 steps/day) consenting adult patients will be randomly assigned to: 1) five face-to-face counseling sessions, 2) one face-to-face counseling session followed by four telephone calls, or 3) a generic mailed physical activity brochure (usual care). The interventions will operationalize social cognitive theory via a behavior change counseling framework. Participants will complete a survey and seven days of pedometry at baseline, and at three and 12 months post-randomization. The primary analyses will be based on intention-to-treat principles and will compare: (i) mean change in average daily step counts between baseline and 12 months for the combined intervention group (Group 1: face-to-face, and Group 2: telephone) and usual care (Group 3); (ii) step counts at 3 months post-randomization. Secondary outcomes include: self-reported physical activity, sedentary behavior, quality of life, and depression.DiscussionIf referral of primary care patients to exercise specialists increases physical activity, this process offers the prospect of systematically and sustainably reaching a large proportion of insufficiently active adults. If shown to be efficacious this trial provides evidence to expand public funding beyond those with a chronic disease and for delivery via telephone as well as face-to-face consultations.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000884909.

Physical activity coaching by Australian Exercise Physiologists is cost effective for patients referred from general practice

“…Participants were randomised to delivery either during five face‐to‐face (FTF) visits with an EP, or one visit followed by four sessions delivered by telephone, or to a control group who received a printed pamphlet to encourage increases in physical activity. Futher details of the methods have been published previously 6 …”

“…Futher details of the methods have been published previously. 6 Input costs are shown in Table 1. Cost analysis included time taken for the GP to make a referral.…”

Predictors of adherence to a physical activity counseling intervention delivered by exercise physiologists: secondary analysis of the NewCOACH trial data

“…This is a secondary analysis of data collected in a three-arm pragmatic randomized trial testing the effect of counseling by EPs on physical activity among insufficiently active primary care patients. As described elsewhere,15 203 insufficiently active (<7,000 steps/day) primary care patients were randomly allocated to 1) five face-to-face counseling sessions with an EP, 2) one face-to-face counseling session followed by four telephone calls with an EP, or 3) a generic mailed physical activity brochure (usual care). The counseling was delivered by EPs who had undertaken 5 hours of study-specific training covering the importance of behavior change theory (specifically, Bandura’s Social Cognitive Theory) and on how to operationalize theoretical constructs that have been shown to promote physical activity among adults (self-efficacy, outcome expectations, social support, perceived physical environment, and goal setting)16,17 using a patient-centered approach.…”

The Role of the Fitness Professional in the Clinical Setting

“…Exercise prescriptions also increased physical activity levels in New Zealand where the Green Prescription (GRx) has been widely implemented (8) (discussed in further detail in the following section). Australian researchers are embarking on a randomized controlled trial to evaluate the effectiveness of physician referral of inactive patients to qualified exercise professionals for either face-to-face or telephone counseling (17).…”