Primary care physicians have an important role to play in encouraging older adults to get fit, according to a study published in the American Journal of Preventive Medicine (Vol. 24, No. 4: 316-322).

“Being active at any age can help improve quality of life, decrease risk of disease, and probably most important for the elderly, help improve balance and reduce falls,” said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

The American Cancer Society recommends getting regular physical activity as part of a healthy lifestyle.

Yet a substantial number of older Americans don’t get regular physical activity. According to a 2000 report by the Robert Wood Johnson Foundation, approximately 34% of Americans over 50 are sedentary and less than half of older adults have been advised on exercise by their doctors.

In the new study, researchers in Canada found that a detailed prescription for exercise can help elderly patients become more active, and more fit.

Robert J. Petrella, MD, PhD, and colleagues from the University of Western Ontario, studied 284 people over age 65 who did not have a regular exercise program. At the beginning of the study in 1998, all the participants were given a treadmill fitness test to measure their aerobic capacity (the amount of oxygen flowing through the blood; higher oxygen levels indicate greater physical fitness).

The participants were then divided into two groups. The first group was given a “Step Test Exercise Prescription” or STEP. These patients were given another fitness test (stepping up and down two small steps 20 times) and instructions from the doctor about aerobic capacity, heart rate, and what kind of exercise they should be doing. The doctors also taught the patients how to measure their heart rate, and discussed how frequently they should exercise, how long each session should be, and how intensely they should exercise.

In the second group (the control group), the patients were given the doctor’s usual counseling on exercise and told about the benefits of regular activity. Both groups were given a list of nearby facilities available for physical activity, and both groups kept a log of their weekly exercise.

Six months later, the participants were given another fitness test. Those in the STEP group saw their fitness levels increase by 11%, while those in the control group had a 4% increase in fitness. After a year, the STEP group improved by 17%, while the control group improved by just 3%. The STEP participants also had reduced their blood pressure and lost weight over the course of the year.

The researchers attribute the results to the specificity of the recommendations given to the STEP group, and to the influence of the physicians.

“Primary care physicians represent a large pool of professionals who have credibility with their patients,” they write.

Doyle agrees. “I think there’s no question that for many segments of the population, their health care provider is the most trusted source of information. I think it’s critical for physicians to be talking to their patients about things like nutrition, physical activity, weight control, and tobacco cessation, for instance.”

But the nature of the health care system can make this type of counseling difficult to provide, said Gregg Walker, director of health care initiatives for ACS.

Doctors have a limited amount of time to spend with each patient, and most of that time is spent dealing with the specific complaints of the patient. Many physicians may not have the extra minutes needed to provide the kind of intensive instruction STEP requires. (The STEP counseling took about 12 minutes on average, while the standard counseling took half as long.) And typically, physicians aren’t reimbursed by insurance companies for these types of initiatives.

The researchers acknowledge the obstacles to this type of intensive counseling, but they note that regular office visits can “provide an ideal opportunity to introduce exercise advice to a large group of patients at risk.”