NEW YORK (Reuters Health) - Medical experts recommend that healthy Americans perform at least 30 minutes of moderate exercise on most days of the week, but no one is quite sure how to dislodge sedentary people from their couches. New research shows that advice from doctors and other health professionals can make a difference.

In a two-year study of sedentary adults, researchers found that exercise education programs--and even just a little guidance from a doctor--help get inactive people moving. For women, more intensive education efforts seem to work particularly well.

Among nearly 900 healthy adults aged 35 to 75, exercise advice and education boosted the number who met the minimum recommendations for exercise. Up to 30% of men and 26% of women met the requirement two years after starting the study, up from 1% to 2% at the outset.

But the overall success varied between men and women, with women faring better with a more intensive intervention, while men generally did as well with a doctor's advice as with a more involved program.

A team led by Dr. Denise G. Simons-Morton of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, reports the results in the August 8th issue of The Journal of the American Medical Association.

Only about 20% of US adults engage in regular physical activity for a half-hour on most days of the week. Guidelines advise doctors to ask patients about their exercise habits and, if needed, offer advice on how to increase their activity levels. But whether such advice helps and whether stronger interventions might work better is unknown.

Simons-Morton and her colleagues looked at these questions by testing three types of exercise interventions, all based in 11 primary care practices in the US. One group of patients received standard exercise advice and educational materials from their doctors. A second group received the advice and materials plus ``assistance'' in the form of an initial counseling session with a health educator, followed by regular correspondence with the educator through the mail. The third group--the ``counseling'' group--received all of this advice, materials, and assistance plus periodic phone calls from health educators and weekly classes on maintaining physical activity.

The investigators found that, for women, the two more intensive programs were more effective in improving their cardiovascular endurance over two years, based on treadmill exercise tests. The women's maximal oxygen uptake during exercise--a measure of cardiovascular health--was about 5% higher than that of women in the advice group. This difference, the researchers suggest, could translate into a modestly lower risk of death.

But the situation was different for men, for whom there were no significant differences in fitness among groups. Regardless of group, the men's treadmill performance improved early on in the study, but had declined closer to pre-study levels by the two-year mark.

Men and women in all three groups increased their activity levels during the study.

According to Simons-Morton and her colleagues, these results suggest that women might benefit from more rigorous efforts to promote exercise.

``It would seem advisable to use these, or similar, interventions for inactive women patients interested in increasing their physical activity, while delivering physician advice and educational materials to men, which is the current recommended care,'' the authors write.

But it is doubtful that doctors are following current recommendations, let alone launching more intensive efforts to promote exercise, according to an accompanying editorial.

Despite ``undisputed'' evidence of the health benefits of exercise, ``US physicians advise only a minority of their patients about physical activity,'' writes Dr. Christina C. Wee of Harvard Medical School in Boston, Massachusetts.

And, while the current study adds to what is known about the effectiveness of exercise counseling, Wee notes that it does not answer the question of how doctors can best counsel patients on exercise. She advises everyone to remember that exercise need not be vigorous nor involve a gym membership.

``Lifestyle activities, such as climbing stairs, walking, and gardening over the course of the day, can have similar physical fitness benefits and may be more feasible,'' Wee writes.

In the current study, all participants were encouraged to reach one of two goals: to exercise moderately 30 minutes a day, at least five days a week, through activities such as brisk walking; or to exercise vigorously--by running, for instance--for 30 minutes a day, at least three days per week.

SOURCE: The Journal of the American Medical Association 2001;286:677-687,

Reference Source 89

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