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Physical activity of Estonian family doctors and their counseling for a healthy lifestyle
– Reported, January 18, 2012
Physicians on the electronic list were contacted by e-mail and sent a questionnaire. The first part assessed physical activity by the International Physical Activity Questionnaire (IPAQ) short form. Self-reported physical activity during one week was calculated as total physical activity in minutes per week (MET min/week). The second part of the questionnaire included questions about the counselling of patients with chronic disease concerning their physical activity and a healthy lifestyle. The study focused on female FDs because 95% of the FDs in Estonia are women and to avoid bias related to gender.
198 female FDs completed the questionnaire. 92% reported that they exercised over the past 7 days to a moderate or high level of physical activity. Analysis revealed no statistically significant relationship between the level of physical activity and general characteristics (age, living area, body mass index [BMI], time spent sitting). FDs reported that patients with heart problems, diabetes, and obesity seek their advice on physical activity more often than patients with depression. Over 94% of the FDs claimed that they counsel their patients with chronic diseases about exercising. According to the FDs’ reports, the most important topic in counselling patients for a healthy lifestyle was physical activity.
This study showed that female FDs are physically active. The level of physical activity is not related to their age, BMI, living area, or time spent sitting. Also, FDs reported that promotion of physical activity is part of their everyday work.
Physical activity offers major health benefits and counselling for it should be integrated into the medical consultation. Based on the literature, the personal health behaviour of the physician (including physical activity) is associated with his/her approach to counselling patients. Our hypothesis is that family doctors (FD) in Estonia are physically active and their recommendation to counsel patients with chronic diseases to use physical activity is high. The study was also interested in how FDs value physical activity among other important determinants of a healthy lifestyle, e.g. nutrition, non-consumption of alcohol, and non-smoking.
Methods
Physicians on the electronic list were contacted by e-mail and sent a questionnaire. The first part assessed physical activity by the International Physical Activity Questionnaire (IPAQ) short form. Self-reported physical activity during one week was calculated as total physical activity in minutes per week (MET min/week). The second part of the questionnaire included questions about the counselling of patients with chronic disease concerning their physical activity and a healthy lifestyle. The study focused on female FDs because 95% of the FDs in Estonia are women and to avoid bias related to gender.
Results
198 female FDs completed the questionnaire. 92% reported that they exercised over the past 7 days to a moderate or high level of physical activity. Analysis revealed no statistically significant relationship between the level of physical activity and general characteristics (age, living area, body mass index [BMI], time spent sitting). FDs reported that patients with heart problems, diabetes, and obesity seek their advice on physical activity more often than patients with depression. Over 94% of the FDs claimed that they counsel their patients with chronic diseases about exercising. According to the FDs’ reports, the most important topic in counselling patients for a healthy lifestyle was physical activity.
Conclusion
This study showed that female FDs are physically active. The level of physical activity is not related to their age, BMI, living area, or time spent sitting. Also, FDs reported that promotion of physical activity is part of their everyday work.
A number of recent studies have shown that regular physical activity is beneficial for patients with different health problems, e.g. cardiovascular, musculoskeletal, obesity, and emotional disorders . As well as physical activity, the care of patients with chronic diseases must also address other factors concerning a healthy lifestyle, e.g. diet, non-smoking, and non-consumption of alcohol. Promotion of physical activity and counselling about a healthy lifestyle among patients is one of the physician’s tasks. Family doctors (FD) are particularly well placed for health promotion: early enquiry about patients’ lifestyles, provision of information, and counselling concerning risk factors . Giving advice and educating patients about health-related risk factors are considered professional responsibility by physicians themselves and also expected by patients . According to the literature, primary care doctors are more active in health promotion than other professionals and women physicians are more likely to counsel regarding prevention than men . Rogers et al reported that the physician’s personal experience of his/her own physical activity also improved counselling for physical activity. Doctors who exercised regularly were also more effective in helping patients to practise regular physical exercise . Previous studies concerning the physical activity of physicians have given controversial results. However, with very few exceptions most studies have shown that physicians are physically more active compared to the general population. Physical activity seems to be associated with gender . No studies have assessed physical activity of physicians in Estonia.
Our hypothesis is that FDs in Estonia are physically active and therefore their drive to counsel patients with chronic diseases to use physical activity is also high. We wished to know how FDs rate physical activity compared to other important determinants of a healthy lifestyle, e.g. nutrition, non-consumption of alcohol, and non-smoking.
Female FDs claim to be physically active, a low level of physical activity being reported by < 10% of them. According to the Estonian Health Interview Survey 2006 involving 6434 Estonian residents aged 15-84 years, ~70% of the respondents had undertaken moderate physical activity during the past 4 weeks . Our result that Estonian FDs are physically more active compared to the general population, is in line with most of the previously conducted studies . The postal survey among FDs from 11 European countries, including Estonia, found that 35% of the FDs from Estonia exercised regularly . In comparison, 43% of general practitioners were physically inactive in the PHIT GP Survey among general practitioners in Ireland that used IPAQ . Heterogeneity in assessment tools makes difficult to compare the exercise habits of physicians. However, our result that physicians are physically active is comparable to the results of other studies .
The physician’s level of physical activity (low, moderate, or high) was not related to the analysed contributing factors. Thus, we cannot claim that physical activity depends on the age, place of residence, BMI, or time spent on sitting by the physician.
FDs who were studied were physically active and promoted physical activity among patients through counselling. 94% of our population claimed that they counselled their patients about exercise. Earlier studies have reported lower levels of counselling of patients . Since the percentage of physicians counselling patients was so high, we were not able to differentiate high vs. low counsellors. Our high level of counselling could be influenced by our sample; women physicians are more likely to counsel regarding prevention than men , and primary care doctors are more active in health promotion than other professionals .
We found that patients are also active in asking advice about physical activity. Patients with heart problems, diabetes, and obesity seek medical advice on physical activity more often than patients with depression. This could be related to the poor motivation of depressed patients to take exercise . Based on our earlier study, both the level of previous physical activity of depressed patients and their motivation to exercise regularly were low . Even when patients’ reluctance to start regular physical activity was high, exercising and using physical activity was shown to improve their mood . Obviously, FDs should pay more attention to the lifestyle of depressed patients since such patients appear too passive to seek independently advice from FDs.
There are other factors besides physical activity that determine a healthy lifestyle. We found that the most important factor contributing to health in the process of counselling patients with chronic disease was physical activity followed by non-smoking, healthy nutrition, and non-consumption of alcohol. According to a study conducted among primary care physicians in the UK, the most important issue in promoting good health in patients was non-smoking followed by regular exercising . However, for a quarter of the physicians (26%) in the present study, reporting the most important factor contributing to health in counselling for a healthy lifestyle proved difficult. To some extent this is understandable because none of the factors – healthy nutrition, physical activity, non-smoking, or non-consumption of alcohol – alone is definitely the most significant in any given situation. As counselling depends on the patient, his/her risks, health problems, and lifestyle, it is essential to be flexible and patient-centred. Thus physical activity should always be prescribed on an individual basis . According to Ampt et al , the amount of information given by the physician should be proportional to patient risk. Hence, it is more important to discuss a healthy lifestyle and motivate patients according to his/her problems. Physicians should focus more on how to integrate physical activity into regular daily activities, for example, walking.
In modifying lifestyle or habits, it is essential that both partners communicate actively in order to share information with one another and co-operate to help solve the problem . The patient’s level of motivation is possibly one of the most important factors influencing counselling and changing lifestyle. The physician’s knowledge can also influence counselling . A physician’s behaviour is affected by his/her general attitude to the importance of preventive care , and those who regard exercise as a highly important health contributing factor are more likely to counsel for exercise . Consequently, one of our aims was to bring physical activity into focus among physicians by using the questionnaire as a tool.
The strength of the study is the use of the IPAQ, which is designed to assess self-reported physical activity and standardize measurements of physical activity in different independent studies. Thus our results are comparable to findings from similar physical activity studies based on the above widely used questionnaire.
The study also has some limitations, one being limitation is the sample. Although, the sample was quite small and the response rate was low, it involved ~25% of the FDs working in Estonia. It consisted only of female FDs, as 95% of the FDs in Estonia are women . According to the literature, physical activity is influenced by gender . We also found that the level of physical activity of the men was higher than of the women (mean MET of the men 3743 vs. 2871 of the women). Therefore, we excluded the few men from the sample and only reported on the women. Also the mean age of the study group is comparable to the mean age of Estonian FDs . Thus, we think the sample is representative of family doctors in Estonia.
Another limitation is the possible risk of overestimation or underestimation where physical activity is self-reported. The self-reported total physical activity scores alone do not yield a complete pattern of physical activity. On the other hand, the questionnaire is the most widely used method in epidemiological studies, while laboratory methods are more expensive and mainly employed for validation purposes . Hence it is evident that validated self-reported questionnaires like the IPAQ are suitable for everyday practice .
Conclusions
The most important finding of the study is that the women physicians reported being physically active. Another major finding is that promotion of health and especially the encouraging of physical activity among patients is part of the physicians’ everyday work. According to the physicians’ reports, patients with chronic health problems seek advice on physical activity. It appeared that only patients with depression were more passive in this respect. Therefore, more attention should be paid to the counselling of depressed patients.
Credit: Kadri Suija,Ülle Pechter,Jaak Maaroos,Ruth Kalda, Anneli Rätsep,Marje Oona and Heidi-Ingrid Maaroos.
More Information at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909965/?tool=pubmed
– WF Team