Prevalence of Health-Care Providers Asking Older Adults About Their Physical Activity Levels --- United States, 1998

Regular physical activity reduces the risk for heart disease, diabetes, and high blood pressure; helps in the control of weight; and maintains muscles, joints, and bone strength (1). Physical activity also might afford additional benefits for adults aged >50 years by increasing coordination and balance (2), preventing falls, and maintaining independence (1). Despite these findings, the prevalence of inactivity increases with age (3), and approximately one third of older U.S. adults are not active during their leisure time (4). The national health objectives for 2010 include recommendations to increase the proportion of adults who engage in regular, preferably daily, moderate physical activity for >30 minutes per day and vigorous physical activity >3 days per week for >20 minutes per occasion (5). To evaluate whether health-care providers ask about physical activity among older adults, CDC analyzed data from the 1998 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicate that approximately half of older adults who attended a routine check-up during the previous year reported being asked about physical activity by their health-care providers. To help older adults make lifestyle changes, health-care providers should ask older adults during routine check-ups about their physical activity levels.

NHIS is a stratified, multistage probability sample survey that collects data on health conditions and disability among the U.S. civilian, noninstitutionalized population. For 1998, the overall household response rate was 90.0%, and the overall family response rate was 88.2%; the overall response rate for adults was 73.9% (6). Data were analyzed from the 1998 adult sample of the 12,629 respondents aged >50 years; SUDAAN (version 7.5 for Windows) was used to account for the complex sampling. Respondents were excluded who 1) had not seen a health-care provider for a routine check-up during the previous year (n=4,081), 2) reported a physical disability that could restrict participation in leisure-time physical activity (n=1,974), or 3) were missing data on demographic variables (n=420). The final sample comprised 6,154 persons.

Respondents were asked whether their health-care provider had asked during their most recent check-up about the amount of physical activity or exercise in which they engaged. Respondents also were asked about their participation in leisure-time physical activities (e.g., exercise, sports, and physically active hobbies); respondents were asked how often they engaged for at least 10 minutes in vigorous activities that caused heavy sweating or large increases in breathing or heart rate and light or moderate activities that caused only light sweating or slight or moderate increases in breathing or heart rate. Those who reported activity were asked how long they did that activity per occasion. Respondents were categorized as either meeting or not meeting physical activity recommendations according to both frequency and duration of their activities. Recommended physical activity was defined as moderate-intensity physical activity (>5 times per week for >30 minutes per occasion) or vigorous-intensity physical activity (>3 times per week for >20 minutes per occasion) (3). Multivariate logistic regression was used to determine whether being asked was associated with specific characteristics of older adults or their physical activity levels. The prevalence of recommended physical activity among older adults who were asked about physical activity was compared with those who were not asked.

A total of 52% of respondents reported that their health-care providers had asked about their level of physical activity or exercise (Table 1). Women were significantly less likely than men to be asked (adjusted odds ratio [OR]=0.8; 95% confidence interval [CI]=0.7--0.9). The likelihood of being asked declined with age and increased with level of education. Persons who were obese (OR=1.2; CI=1.1--1.4) were more likely to be asked than persons with normal weight.

The prevalence of older adults who met recommended levels of physical activity was higher among those asked (36%) than among those not asked (23%) (Table 2). This pattern was consistent for both men and women and across each of the three sex-specific age categories examined. After accounting for age, sex, race/ethnicity, education, marital status, body mass index, and region of residence, those who were asked about physical activity were 1.7 times (CI=1.5--2.0) more likely to engage in recommended levels of physical activity than those who were not asked.

Reported by: D Galuska, PhD, M Serdula, MD, D Brown, PhD, National Center for Chronic Disease Prevention and Health Promotion; J Kruger, PhD, EIS Officer, CDC.

Editorial Note:

Although health-care providers generally have positive attitudes toward preventive care practices, this study indicated that only 52% of older adults reported being asked during routine check-ups about physical activity or exercise. This finding is consistent with a 1999 study indicating that <50% of older adults reported that their health-care provider had ever recommended exercise (7). Common barriers to discussing physical activity with older adults in the health care setting include lack of time, lack of reimbursement for physician counseling, and lack of evidence-based protocols and resources (2). However, at least one study that addressed barriers related to time, physical activity assessment, and counseling protocols indicated that provider-based counseling for physical activity produced moderate short-term increases in physical activity among sedentary adults (8).

Regular physical activity among older adults provides substantial health benefits, including reduced risk for heart disease, diabetes, high blood pressure, obesity, and fall-related injuries (1,2). These findings and the 2010 national health objectives supported development of a national action plan, the National Blueprint: Increasing Physical Activity Among Adults Aged 50 and Older, which identifies the health-care setting as one of several important delivery channels for encouraging all older adults to increase physical activity (2). Older adults with symptoms or risk factors for cardiovascular disease or those who are sedentary and plan to start a program of vigorous physical activity are advised to consult with their health-care providers before beginning an activity program (9).

The findings in this report are subject to at least four limitations. First, NHIS does not collect information on the amount or quality of physical activity information provided by health-care providers. Second, data were self-reported, making them subject to error, including respondent overreporting of socially desirable behaviors (e.g., engagement in physical activities). Third, data are cross-sectional, and a causal relation between health-care providers' inquiries and their patients' physical activity levels cannot be inferred. Fourth, NHIS measures only leisure-time physical activity; estimates based on this measure do not account for other contributors to overall physical activity (e.g., occupational tasks, housework, and childcare).

Health-care providers should increase efforts to promote physical activity among older adults. The U.S. Preventive Services Task Force recommends that this promotion include assessing patients' current activity levels and providing information on physical activity and disease prevention to help patients make lifestyle changes (10). The health-care setting affords opportunities for providing counseling and information on physical activity resources. This analysis demonstrates that this setting is underused, possibly due in part to provider-based counseling resulting only in moderate short-term increases in physical activity among patients (9). The National Blueprint documents strategies that could lead to more substantial increases in patients' physical activity through the health-care setting (2). These include increased health-care provider training, the development of materials and toolkits, and identification of community resources. Increased coordination between health-care providers and community programs (e.g., community centers, senior centers, and community-based health and wellness programs) to facilitate referrals and information sharing might encourage greater and longer-term increases in physical activity behavior change.

References

1. CDC. Physical activity and health: a report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, 1996.
2. Robert Wood Johnson Foundation. National blueprint: increasing physical activity among adults age 50 and older. Princeton, New Jersey: The Robert Wood Johnson Foundation, 2001.
3. Schoenborn CA, Barnes PM. Leisure-time physical activity among adults: United States, 1997--1998. Advanced data from vital and health statistics, no. 325. Hyattsville, Maryland: National Center for Health Statistics, 2002.
4. CDC. Physical activity trends---United States 1990--1998. MMWR 2001;50:166--9.
5. U.S. Department of Health and Human Services. Healthy people 2010 (conference ed., 2 vols). Washington, DC: U.S. Department of Health and Human Services, 2000.
6. U.S. Department of Health and Human Services. 1998 National Health Interview Survey: public use data release. Hyattsville, Maryland: U.S. Department of Health and Human Services, 2000.
7. Damush TM. Prevalence and correlates of physician recommendations to exercise among older adults. J Gerontol A Biol Sci Med Sci 1999;54:4423--7.
8. Calfas KJ, Long BJ, Sallis JF, Wooten W, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med 1996;25:225--33.
9. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription, 5th ed. Media, Pennsylvania: Williams & Wilkins, 1995.
10. U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Baltimore, Maryland: Williams & Wilkins, 1996.

Table 1


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Table 2


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