Graduating Medical Students' Exercise Prescription Competence as Perceived by Deans and Directors of Medical Education in the United States: Implications for Healthy People 2010

Abstract

Objectives.

This study examined perceptions of deans and directors of medical education at 128 allopathic schools of medicine in the US about the importance of physical activity and exercise topics, and their perceptions about the competence of graduating medical students to perform six fundamental skills related to exercise prescription. Healthy People 2010 recommends that clinicians counsel all patients about regular physical activity. However, in previous studies physicians identified lack of training as a barrier to physical activity counseling, and they questioned their own ability to advise patients properly.

Methods.

Using the 17-item Exercise and Physical Activity Competence Questionnaire, data were collected from 72 of 128 medical schools, for a response rate of 56%.

Results.

While 58% of respondents indicated their typical graduate was competent in conducting a patient evaluation for the purpose of approving that patient to begin an exercise program, only 10% said their students could design an exercise prescription. Only 6% of respondents reported that their school provided a core course addressing the American College of Sports Medicine Guidelines for Exercise Testing and Prescription.

Conclusions.

Findings suggest a need for more undergraduate medical training in physical activity and exercise prescription.

References

Kampert

Blair

Barlow

Kohl

. Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women. Ann Epidemiol 1996; 6:452–7.

Blair

Kohl

3rd Paffenbarger

Jr Clark

Cooper

Gibbons

. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989; 262:2395–2401.

Berlin

Colditz

. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990; 132:612–28.

Hypertension Prevention Collaborative Research Group. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. JAMA 1989; 262:1801–7.

Blair

. Evidence for success of exercise in weight loss and control. Ann Intern Med 1993; 119:702–6.

Despres

Pouliot

Moorjani

Nadeau

Tremblay

Lupien

, Loss of abdominal fat and metabolic response to exercise training obese women. Am J Physiol 1991; 261:E159–67.

Manson

Nathan

Krotewski

Stampfer

Willett

Hennekens

. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992; 268:63–7.

Helmrich

Ragland

Leung

Paffenbarger

Jr . Physical activity and reduced occurrence of noninsulin dependent diabetes mellitus. N Engl J Med 1991; 325:147–52.

Smith

Gilligan

McAdam

Ensign

Smith

. Deterring bone loss by exercise intervention in pre-menopausal and postmenopausal women. Calcif Tissue Int 1989; 44:312–21.

10.

Chow

Harrison

Notarius

. Effect of two randomized exercise programs on bone mass of healthy postmenopausal women. BMJ 1987; 295:1441–4.

11.

Snow-Harter

Marcus

. Exercise, bone mineral density, and osteoporosis. Exerc Sport Sci Rev 1991; 19:351–88.

12.

Friedenreich

Rohan

. Physical activity and risk of breast cancer. Eur J Cancer Prev 1995; 4:145–51.

13.

Thune

Lund

. Physical activity and colorectal cancer in men and women. Br J Cancer 1996; 73:1134–40.

14.

Moses

Steptoe

Mathews

Edwards

. The effects of exercise training on mental well-being in the normal population: a controlled trial. J Psychosom Res 1989; 33:47–61.

15.

Ross

Hayes

. Exercise and psychologic well-being in the community. Am J Epidemiol 1988; 127:762–71.

16.

McAuley

Mihalko

Bane

. Exercise and self-esteem in middle-aged adults: multidimensional relationships and physical fitness and self-efficacy influences. J Behav Med 1997; 20:67–83.

17.

Laforge

Rossi

Prochaska

Velicer

Levesque

McHorney

. Stage of regular exercise and health-related quality of life. Prev Med 1999; 28:349–60.

18.

Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion. Cardiovascular Disease 1999 [cited 2000 Mar 28]. Available from: URL: http://www.cdc.gov/nccdphp/cardiov.htm

19.

Graves

Owings

. 1996 Summary: national hospital discharge survey. Advance data from vital and health statistics; no. 301. Hyattsville, (MD): National Center for Health Statistics; 1998.

20.

Harris

Flegal

Cowie

Eberhardt

Goldstein

Little

, Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults. The Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 1998; 21:518–24.

21.

Benson

Marano

. Current estimates from the National Health Interview Survey, 1995. Vital Health Statistics 10 1998;199.

22.

McGinnis

Foege

. Actual causes of death in the United States. JAMA 1993; 270:2207–12.

23.

Department of Health and Human Services (US). Physical Activity and Health: a report of the Surgeon General. Atlanta (GA): US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

24.

American College of Sports Medicine. Guidelines for exercise testing and prescription, 5th ed. Baltimore (MD): Williams & Wilkins; 1996.

25.

American Heart Association/American College of Sports Medicine. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med Sci Sports Exerc 1998; 26:33–4, 76.

26.

Monthly estimates of leisure-time physical inactivity-United States, 1994. MMWR Morb Mortal Wkly Rep 1997; 46:393–7.

27.

Dept of Health and Human Services (US). Healthy People 2010 homepage 1999 [cited 2000 Jan 12]. Available from: URL: http://www.health.gov/healthypeople/

28.

Wee

McCarthy

Davis

Phillips

. Physician counseling about exercise. JAMA 1999; 282:1583–8.

29.

Friedman

Brownson

Peterson

Wilkerson

. Physician advice to reduce chronic disease risk factors. Am J Prev Med 1994; 10:367–71.

30.

Madlon-Kay

Harper

Reif

. Health promotion counseling in residency training. J Gen Intern Med 1994; 9:465–7.

31.

Wechsler

Levine

Idelson

Rohman

Taylor

. The physician's role in health promotion: a survey of primary-care practitioners. N Engl J Med 1983; 308:97–100.

32.

McKenna

Naylor

McDowell

. Barriers to physical activity promotion by general practitioners and practice nurses. Br J Sports Med 1998; 32:242–7.

33.

Williford

Barfield

Lazenby

Olson

. A survey of physicians' attitudes and practices related to exercise promotion. Prev Med 1992; 21:630–6.

34.

American College of Preventive Medicine. 1998 National Prevention in Primary Care Study. Washington (DC): American College of Preventive Medicine; 1998.

35.

Pinto

Goldstein

DePue

Milan

. Acceptability and feasibility of physician-based activity counseling: the PAL project. Am J Prev Med 1998; 15:95–102.

36.

Blair

Applegate

Dunn

Ettinger

Haskell

King

, Activity Counseling Trial (ACT): rationale, design, and methods. Med Sci Sports Exerc 1998; 30:1097–1106.

37.

Long

Calfas

Wooten

Sallis

Patrick

Goldstein

, A multisite field test of the acceptability of physical activity counseling in primary care: project PACE. Am J Prev Med 1996; 12:73–81.

38.

Graber

Bellack

Musham

O'Neil

. Academic deans' views on curriculum content in medical schools. Acad Med 1997; 72:901–7.

39.

Rubin

Sobal

Moran

. Health promotion beliefs and practices of fourth-year medical students. Am J Prev Med 1990; 6:106–11.