‘Sedentary behaviour counselling’: the next step in lifestyle counselling in primary care; pilot findings from the Rapid Assessment Disuse Index (RADI) study

Abstract

Background Accumulating evidence emphasises a relationship between prolonged sitting and increased risk for cardiometabolic disorders and premature death irrespective of the protective effects of physical activity. Primary care physicians have the potential to play a key role in modifying patients’ sedentary behaviour alongside physical activity. Methods A pilot study examining sedentary behaviour and physical activity counselling in a primary care clinic. A total of 157 patients completed a detailed survey related to lifestyle counselling received from their primary care physician. We analysed these responses to describe counselling practices within the 5A framework, and to examine correlates (ie, patients’ demographics, sedentary behaviour and physical activity and clinical variables) related to receiving counselling. Results A total of 10% received general advice to decrease sitting time, in comparison with 53% receiving general physical activity counselling. None, however, received a written plan pertaining to sedentary behaviour whereas 14% received a written physical activity prescription. Only 2% were provided with specific strategies for sedentary behaviour change in comparison with 10% for physical activity change. Multivariable analysis revealed that patients who were obese were more likely to receive counselling to decrease sitting (OR=7.0; 95% CI 1.4 to 35.2). In comparison, higher odds for receiving physical activity counselling were associated with being younger, aged 40–59 years (OR=2.4; 95% CI 1.1 to 5.4); and being a non-smoker (OR=6.1; 95% CI 1.3 to 28.4). Conclusions This study is the first to assess sedentary behaviour counselling practices in primary care and such practices appear to be infrequent. Future research should attempt to establish a ‘knowledge base’ to inform development of sedentary behaviour interventions, which should be followed by testing feasibility, efficacy, and subsequent effectiveness of these programmes in a clinical setting.

Sedentary behaviour and physical inactivity assessment in primary care: the Rapid Assessment Disuse Index (RADI) study

“…Inclusion and exclusion criteria for this study as well as participants’ sociodemographics have been described previously. 16 Briefly, patients were excluded if they: did not consent to participate; had physical disabilities that restricted lower limb function; were cognitively impaired; had a medical procedure in the past year that restricted their usual physical function and/or activity; were pregnant; or replied positively to one or more of the Physical Activity Readiness (PAR-Q) screening test questions, such as indicating feeling chest pain when physically active. 17 Thus, a total of 179 patients were eligible and interested in the study and completed a questionnaire on a computer interface at baseline.…”

Prescribing Physical Activity Through Primary Care: Does Activity Intensity Matter?

“…[21][22][23][24][25][26][27] Moreover, previous reports highlight the importance of interrupting prolonged periods of sedentary time to reduce cardiometabolic disease risk. 28 It has been suggested that promoting reductions in sedentary time may be a more achievable behavior to change through counseling in the primary care setting given that, compared with exercise behaviors, it requires smaller lifestyle changes to accomplish and may be more feasible to integrate into clinical practice than traditional exercise prescription.…”

“…28 It has been suggested that promoting reductions in sedentary time may be a more achievable behavior to change through counseling in the primary care setting given that, compared with exercise behaviors, it requires smaller lifestyle changes to accomplish and may be more feasible to integrate into clinical practice than traditional exercise prescription. 26 However, recent research has suggested that few attempts have been made to translate this evidence into clinical practice. 26…”

“…Previously it has been shown that more patients receive exercise counseling from their physician than counseling focused on reducing sedentary behavior. 26 Moreover, recent research has demonstrated that counseling for sedentary behaviors through the primary care setting is more likely to occur for obese patients, whereas exercise counseling is more likely to be conducted for younger patients, nonsmokers, and patients with dyslipidemia. 26 Results from the current study support the feasibility of counseling to change sedentary behaviors through the primary care setting.…”

“…26 Moreover, recent research has demonstrated that counseling for sedentary behaviors through the primary care setting is more likely to occur for obese patients, whereas exercise counseling is more likely to be conducted for younger patients, nonsmokers, and patients with dyslipidemia. 26 Results from the current study support the feasibility of counseling to change sedentary behaviors through the primary care setting. In addition to the physiological difference between exercise and sedentary activity, health practitioners may also consider the complex nature of human behavior when attempting to manage cardiometabolic risk with lifestyle modification.…”