Physical activity counseling in medical school education: a systematic review

Abstract

BackgroundDespite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools.MethodsThe authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling.ResultsConsiderable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors.ConclusionsCurrent results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.

A Physical Activity Learning Module Improves Medical Students’ Skills and Confidence for Advising Patients about Physical Activity

“…Green Prescription Initiative in New Zealand), understanding of specific benefits of exercise such as the safety of exercise in clinical populations and the awareness of the other health professionals who can assist in providing further PA advice. These findings are consistent with the results of recent studies and findings from a recent systematic review on PA counselling in medical school education (Dacey et al, 2014;Jones, Brooks & Wylie, 2013). The authors of the present study previously reported that New Zealand medical students had a good understanding of the links between exercise and health and positive attitudes towards PA advising in general practice (Mandic et al, 2017) and those outcomes were not changed considerably after the intervention in the present study.…”

“…The effective medical education programmes incorporated experiential learning, theoretically based frameworks, and students' personal PA habits (Dacey et al, 2014). The heterogeneity of the PA-related curriculum and weak study design of previous studies (Dacey et al, 2014) warrant further examination of the effects of the inclusion of curricula on PA advising in medical education. The current study examined the effects of an introductory learning module on PA on knowledge, skills, and attitudes toward PA advising in third-year medical students in New Zealand.…”

“…Since physicians' confidence in PA-advising skills was significantly influenced by prior training (Rogers et al, 2002), it is essential to provide opportunities for medical students to develop effective skills in PA advising as a part of their undergraduate training. A recent systematic review of PA counselling in medical education curriculums reported positive changes in students' attitude towards PA, their PA counselling knowledge and skills, and their self-efficacy to provide PA advice (Dacey, Kennedy, Polak & Phillips, 2014). The effective medical education programmes incorporated experiential learning, theoretically based frameworks, and students' personal PA habits (Dacey et al, 2014).…”

“…A recent systematic review of PA counselling in medical education curriculums reported positive changes in students' attitude towards PA, their PA counselling knowledge and skills, and their self-efficacy to provide PA advice (Dacey, Kennedy, Polak & Phillips, 2014). The effective medical education programmes incorporated experiential learning, theoretically based frameworks, and students' personal PA habits (Dacey et al, 2014). The heterogeneity of the PA-related curriculum and weak study design of previous studies (Dacey et al, 2014) warrant further examination of the effects of the inclusion of curricula on PA advising in medical education.…”

Communication to promote physical activity in family case study in community medicine for under graduate medical students

“…Seventy one percent felt "physical activity" should be part of the regular curriculum. 9 Doctors are a respected source of health-related information and are well positioned to provide physical activity counselling to patients. Anand T et al, refers doctors as the potential agents to increase the levels of physical activity in large population and thus produce important health gains.…”