Lobelo Felipe, de Quevedo Isabel Garcia
Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Lifestyle Med. 2016 Jan;10(1):36-52. doi: 10.1177/1559827613520120. Epub 2014 Jan 21.
Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs' personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs' PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs' personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs' PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 ( < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs' PA role-modeling and how it influences patients' PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.
缺乏身体活动是全球第四大主要死因。医疗保健提供者（HCPs）应在为患者提供咨询并适当地指导他们进行身体活动（PA）方面发挥关键作用。先前的报告表明，积极参与身体活动的HCPs更有可能为患者提供更好、更可信且更具激励性的预防性咨询。本综述总结了关于HCPs个人身体活动习惯与其相关身体活动咨询实践之间关联的现有证据。基于相关研究，通过滚雪球搜索策略，在筛选的196项研究中，共确定了1979年至2012年间发表的47篇相关文章。其中，23篇描述了HCPs的身体活动习惯和/或他们的咨询实践，24篇分析性研究评估了HCPs个人身体活动习惯与其身体活动咨询实践之间的关联。大多数研究来自美国（n = 33），9项研究纳入了非医生（护士、药剂师和其他HCPs）。身体活动水平大多通过自我报告，咨询通常通过临床实践中的自我报告频率或感知自我效能来评估。大多数（24项中的19项）分析性研究报告称，HCPs的身体活动习惯与咨询频率之间存在显著正相关，在6项允许直接比较的研究中，优势比在1.4至5.7之间（P <.05）。本综述发现了一致的证据支持这样的观点，即积极参与身体活动的医生和其他HCPs更有可能为患者提供身体活动咨询，并且确实可以成为强大的身体活动榜样。这一证据似乎足以证明进行随机试验是合理的，以确定在HCPs中增加促进身体活动的干预措施是否也会导致初级保健环境中HCPs向患者提供身体活动预防性咨询和转诊的频率及质量得到改善。未来的研究还应旨在客观量化HCPs身体活动榜样作用的效果及其对患者身体活动水平的影响。在中低收入国家需要更多证据，因为80%因缺乏身体活动及相关非传染性疾病导致的死亡已经在这些国家发生。
