Doctor Training for Physical Activity Promotion

Recruiting at 1 trial location

Overseen By Kathryn Schmitz, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Not from PHN or UPMC

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

48 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this voluntary research study is to determine the impact of an ECHO intervention on the likelihood that rural primary care providers (PCP) will refer their physically inactive patients to be more active.

Will I have to stop taking my current medications?

The trial information does not specify whether participants must stop taking their current medications.

What data supports the effectiveness of the ECHO training treatment for physical activity promotion?

Research shows that training programs for doctors can improve their confidence and frequency in advising patients about physical activity, although it may not always lead to increased activity levels in patients. Programs like the Clinical Champions Physical Activity Training Program have been evaluated for their impact on increasing brief physical activity advice given by healthcare professionals. ^{1 2 3 4 5}

Is the Doctor Training for Physical Activity Promotion generally safe for humans?

Research on physical activity interventions, including those for high-risk and elderly populations, shows that serious adverse events are rare. Most reported issues are minor, like muscle injuries, and can be minimized by starting with low-intensity exercises and gradually increasing intensity. ^{6 7 8 9 10}

How does the treatment 'Doctor Training for Physical Activity Promotion' differ from other treatments for promoting physical activity?

This treatment is unique because it focuses on training doctors to effectively counsel patients on physical activity, addressing a gap in medical education where such training is often lacking. Unlike other treatments that might directly target patients, this approach empowers doctors with the skills to promote physical activity, potentially leading to better patient outcomes and addressing the global issue of physical inactivity. ^{2 11 12 13 14}

Research Team

Kathryn Schmitz, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for rural primary care providers or adjunct faculty from PHN and FCM clinics who can understand and provide informed consent. It's not open to those outside these networks.

Inclusion Criteria

Must be able to provide and understand informed consent

Primary care providers or adjunct faculty from Primary Health Network (PHN) and Penn State Health Family and Community Medicine (FCM) rural clinics

Exclusion Criteria

Primary care providers or adjunct faculty NOT from PHN or FCM rural clinics

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Active Intervention

PCP participants receive the ECHO46 intervention via real-time, interactive videoconferencing through Zoom sessions held once weekly for 4 weeks

4 weeks

4 sessions (virtual)

Delayed Intervention

PCP participants will be offered the intervention in year 5

Year 5

Follow-up

Participants are monitored for the likelihood of patient referral to a community-level, telephone-based physical activity counseling service

5 years

Treatment Details

Interventions

• ECHO training

Trial Overview The study tests whether an ECHO intervention increases the likelihood that rural PCPs will encourage patients to be more physically active. Some participants receive training immediately, while others are offered it in year five.

Participant Groups

Group I: Delayed Intervention Active Control 1 Intervention

PCP participants will be offered the intervention in year 5.

Group II: Active Intervention Active Control 1 Intervention

PCP participants in the practice cohort or the intervention group will receive the ECHO46 intervention via real-time, interactive videoconferencing through Zoom sessions held once weekly for 4 weeks (4 sessions total) at regularly scheduled times convenient to providers. Session topics will focus on training PCP participants to assess, advise, and refer patients to be more physically active, as well as provide evidence-based strategies they can use to supplement and sustain their communication efforts.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

Milton S. Hershey Medical Center

Lead Sponsor

Trials

515

Recruited

2,873,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

An educational intervention consisting of two workshops significantly improved self-efficacy and counseling frequency among 21 internal medicine residents compared to 27 control residents.

Despite the improvement in physicians' confidence and counseling behaviors, there was no significant increase in physical activity levels reported by patients, indicating that further strategies are needed to address barriers to exercise in chronically ill patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changing physician practice of physical activity counseling. Eckstrom, E., Hickam, DH., Lessler, DS., et al.[2023]

In a 1.5-year study involving 274 male veterans with cardiovascular disease risk factors, only one serious adverse event (atrial fibrillation) occurred, indicating that a progressive walking program can be safely recommended for high-risk individuals.

While minor musculoskeletal issues were common, over half of the reported adverse events were unrelated to the exercise program, highlighting the need for strategies to help individuals with chronic illnesses safely resume physical activity after any health setbacks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events among high-risk participants in a home-based walking study: a descriptive study. Goodrich, DE., Larkin, AR., Lowery, JC., et al.[2022]

In a randomized controlled trial involving 209 elderly participants (average age 80), a home-based exercise program was found to be generally safe, with 151 adverse events reported, affecting 47% of participants.

Despite the program's safety, 14% of the adverse events were serious, highlighting that high levels of pre-existing morbidity in this population can pose challenges to maintaining consistent exercise participation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in mobility-limited and chronically ill elderly adults participating in an exercise intervention study supported by general practitioner practices. Hinrichs, T., Bücker, B., Wilm, S., et al.[2015]

In a review of over 5,500 participants from 11 physical activity interventions, no serious study-related adverse events were reported, indicating a high level of safety in these exercise programs.

While minor musculoskeletal injuries were noted, the studies emphasized a 'start low and go slow' approach, suggesting that moderate-intensity physical activity is safe and effective for sedentary, chronically ill, or older populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium. Ory, M., Resnick, B., Jordan, PJ., et al.[2022]

The EXPERT tool was developed to assist clinicians in prescribing exercise for patients with various cardiovascular diseases and risk factors, providing tailored recommendations based on specific conditions and individual patient factors.

This digital system offers exercise training recommendations and safety advice for 10 cardiovascular diseases and several chronic conditions, potentially improving the implementation of exercise rehabilitation in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Hansen, D., Dendale, P., Coninx, K., et al.[2018]

Researchers in resistance training studies often lack clear guidance and motivation for thorough adverse event (AE) reporting, which can lead to inconsistent practices.

There is a need for exercise-specific guidelines for AE reporting, as current standards are perceived as not applicable to exercise trials, highlighting the importance of tailored strategies to improve reporting consistency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Researchers' perspectives on adverse event reporting in resistance training trials: a qualitative study. El-Kotob, R., Pagcanlungan, JR., Craven, BC., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Mixed Methods Process Evaluation of a National Peer-Led Training Program to Increase Brief Advice on Physical Activity Given By Health Care Professionals. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Are family medicine residents trained to counsel patients on physical activity? The Canadian experience and a call to action. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Changing physician practice of physical activity counseling. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Evaluating the effectiveness of physician counseling to promote physical activity in Mexico: an effectiveness-implementation hybrid study. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Impact of a National Peer-Led Training Program to Increase Brief Physical Activity Advice Given to Patients by Health Care Professionals. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Adverse events among high-risk participants in a home-based walking study: a descriptive study. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Adverse events in mobility-limited and chronically ill elderly adults participating in an exercise intervention study supported by general practitioner practices. [2015]

8. England pubmed.ncbi.nlm.nih.gov

Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium. [2022]

9. England pubmed.ncbi.nlm.nih.gov

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. [2018]

10. Canada pubmed.ncbi.nlm.nih.gov

Researchers' perspectives on adverse event reporting in resistance training trials: a qualitative study. [2022]

11. England pubmed.ncbi.nlm.nih.gov

Realising the potential for an Olympic legacy; teaching medical students about sport and exercise medicine and exercise prescribing. [2015]

12. England pubmed.ncbi.nlm.nih.gov

Developing a training programme in physical activity counselling for undergraduate medical curricula: a nationwide Delphi study. [2020]

13. United States pubmed.ncbi.nlm.nih.gov

Talking to patients about aerobic exercise for disease prevention: an educational exercise for medical students. [2019]

14. United States pubmed.ncbi.nlm.nih.gov

Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for Healthy People 2010. [2022]