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ORIGINAL ARTICLE
Year : 2021  |  Volume : 21  |  Issue : 3  |  Page : 115-126

Personal physical activity and physical activity counseling habits among primary care physicians of Prince Sultan Military Medical City, Riyadh city, Saudi Arabia, 2018


Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Date of Submission27-Jun-2021
Date of Acceptance07-Nov-2021
Date of Web Publication13-Dec-2021

Correspondence Address:
Ayman Afifi
Makkah Al Mukarramah Rd, As Sulimaniyah, Riyadh 12233
Saudi Arabia
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DOI: 10.4103/sjsm.sjsm_18_21

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  Abstract 


Objective: Physical activity (PA) practice is effective in the primary and secondary prevention of many chronic diseases. Primary care physicians are well placed to be a role model and to promote their patients regarding PA practice. Therefore, the objective of this study was to prove the positive relationship between being physically active physician and providing a proper counseling about PA practice.
Methodology: This was a cross-sectional study targeting primary care physicians of Prince Sultan Military Medical City (PSMMC), Riyadh city, Saudi Arabia, 2018. The researcher designed a self-administered questionnaire for data collection from the target population, undertaken validation process, and it was then analyzed using SPSS software.
Results: A total of 214 primary care physicians participated in our study. 56.5% were male, and 43.5% were female. The prevalence of physically active physicians who practice PA as recommended by most of PA recommendations (Canadian Society for Exercise Physiology, American Heart Association, American Diabetes Association, American College of Sports Medicine, etc.) was 37.9%, while 62.1% were physically inactive. The prevalence of physicians who recommend PA according to these recommendations was 78%. Significant association was found between physician's PA practice and providing effective PA counseling (P = 0.008) and showing confidence to counsel all patients about PA as a part of preventive care provided by primary care physicians (P = 0.038). 72.9% of the participants reported that lack of time is the major barrier to counseling patients about PA.
Conclusion: The prevalence of physically active primary care physicians was 37.9%. 78% of them practice an effective PA according to the current recommendations. Significant association was found between physician's PA practice and providing an effective PA counseling (P = 0.008) and showing confidence to counsel all patients about PA as a part of preventive care provided by them (P = 0.038). Lack of time was the major barrier to counsel patients about PA.

Keywords: Counseling, exercise, general practitioners, physical activity, primary care physician


How to cite this article:
Muharib NS, Afifi A, Hakami MH. Personal physical activity and physical activity counseling habits among primary care physicians of Prince Sultan Military Medical City, Riyadh city, Saudi Arabia, 2018. Saudi J Sports Med 2021;21:115-26

How to cite this URL:
Muharib NS, Afifi A, Hakami MH. Personal physical activity and physical activity counseling habits among primary care physicians of Prince Sultan Military Medical City, Riyadh city, Saudi Arabia, 2018. Saudi J Sports Med [serial online] 2021 [cited 2022 Jan 22];21:115-26. Available from: https://www.sjosm.org/text.asp?2021/21/3/115/332391






  Introduction Top


A healthy lifestyle is an important aspect in maintaining and improving personal health. Regular physical activity (PA) is considered one of the healthy lifestyle aspects that shows to be effective in primary and secondary prevention of many chronic diseases (cardiovascular diseases, diabetes mellitus, hypertension, obesity, depression, and others).[1] The term PA is defined as movements of the body parts produced by the skeletal muscles contraction, and that substantially increases energy production and expenditure.[2] Depending on previous studies done about the importance and effectiveness of PA practice on personal health, many health organizations, including the American Diabetes Association (ADA), Canadian Society for Exercise Physiology (CSEP), American College of Sports Medicine (ACSM), and American Heart Association (AHA) developed recommendations to the public about PA practice. Most of them recommend for an adult to practice 30 min of moderate-intensity PA 5 days per week OR 20–25 min of high-intensity PA 3 days per week. Further, it is acceptable to practice combination of moderate- to high-intensity PA for 150 min/week or more. However, some differences exist between these recommendations.

Recommendation of healthy lifestyles should be administered to the patients to improve their health and to provide them with the best preventive care. Family physicians are well positioned to counsel and provide health advice to their patients. First, they are considered respected source of health-related information. Second, they are able to provide a continuous care to their patient, with continuous counseling follow-up.[3] Many studies found that physicians who are applying their knowledge about healthy lifestyles, such as regular PA practice, in their own personal life are better and more confident than other physicians in counseling and providing advices to their patients in that specific healthy practice.[3]

Level of physician's PA remains low despite their knowledge about the importance of PA to the overall health. Study done in the United States (US) revealed that 62% of primary care physicians are physically active,[2] while in Saudi Arabia (SA), it was found to be as low as 23.5% among primary healthcare physicians in Riyadh city[4] and up to 42% among primary healthcare physicians in Asser region.[5] Practicing regular PA among primary care physicians eventually will improve their PA counseling habits.

PA has a positive impact on the personal health. Warburton et al. have mentioned in their study that there was a relationship between the PA and state of health, as health improvement will increase with PA.[1]

Physician's PA has been studied and compared to PA among general population. Study done by Stanford et al., to compare PA levels in physicians and medical students with the general adult population of the US, found that 78% of physicians and medical students included in the study meet US Department of Health and Human Services (DHHS) 2008 guidelines for PA, but only 64.5% of the general US adult population meet DHHS guidelines.[6] In 2015, study done in SA, alJouf region, by Banday et al., to know the prevalence of PA among primary care physicians, found that 65.2% of respondent primary care physicians were physically active and they advise their patients about PA better than inactive physicians.[7] At Prince Sultan Military Medical City (PSMMC), a study was done by Al Reshidi, in 2014, among resident physicians from different specialties to assess their PA level and to determine the main barriers to be physically active. It showed that 68.4% of the resident physicians had low level of PA and male physicians were found to be more physically active compared to female physicians. The most reported barriers of PA practicing among male physicians were: exercise facilities are limited at home (71.7%), weather is not suitable (69%), and the PA is not the first priority for 67.2%, while among females were: lack of time (69.3%), lack of suitable places to practice PA nearby (68%), and the PA is not the first priority (66.7%).[8]

Counseling about healthy lifestyle is a priority for primary care physicians, as it is part of the preventive care toward their patients. In Germany, study was done in 2015 among primary care physicians to study the knowledge, attitude, and implementation of PA counseling. It revealed that the majority (87%) of primary care physicians rated their own competence level in counseling about PA as high, while 52.3% rated their capability to motivate their patient as not good.[9] On the other hand, Bloy et al. published a research in 2016 about general practitioners (GPs) and PA counseling in Paris; they found that GPs do not have resources or tools to encourage their patient to practice PA. Moreover, PA counseling is not systematically addressed and was never the subject of specific consultation.[10]

Many researchers have addressed the barriers to counsel patient about PA and factors that may influence the primary care physicians to do a proper counseling about PA. In 2018, study was done on Canadian solid organ transplant (SOT) physicians to determine the proportion of physicians who are practicing counseling about PA and to identify the common barriers to include such counseling as a routine practice toward SOT recipient. The result was that about 97% of them were providing counseling about PA to their patient, but only about 18% of them were very confident in counseling about PA, while the main barriers to counsel their patient about PA were lack of time (56%) and lack of PA guidelines (53%).[11] Study was done in 2014, in the US, by Stanford et al., to determine the factors that influence PA counseling among physicians and medical students. They found that the physicians and medical students who had normal body mass index and those who met vigorous US DHHS guidelines were feeling more confident when they counsel their patient about PA.[12]

Physician's counseling habits about PA have been studied in relation to their personal PA. Recently, a study was published in 2016 and done by Pojednic et al.; they found that the physicians with an interest in sports understand the importance of PA counseling. Out of the participants, 74% regularly recommended PA, 66% talked about exercise with patients, and 49% included as a vital sign. Only 26% of physicians provided a written exercise prescription. As well as, physician's counseling was associated with personal familiarity with PA.[13] In addition, study done in 2008 by Lobelo et al. showed that there is compelling evidence that physician's personal physical exercise influences their attitude and practice toward PA counseling.[3] Frank et al. did a study about US woman physicians' personal PA and counseling habits about PA and mentioned that 96% of US women physicians in the study are physically active and 49% of them meet the ACSM recommendations.[14] In addition, Askew et al. have mentioned, in their study, which was done in 2000, that there was a positive correlation between PA of physicians and their counseling practice.[2] In 2010, a published study among Estonian family doctors was conducted to study the physicians PA and their counseling habits for healthy lifestyles. They found that 92% of the participants reported that they practiced PA over the past 7 days and moderate or high level of PA. 94% of them reported that they usually counsel their patients with chronic diseases about PA.[15] Published study in 2011 was done to study the attitudes of medical students, clinicians, and sports scientists toward PA counseling. It showed that most respondents (70%) met the National Australian PA (NAPA) Guidelines. GPs had significantly low compliance rates with NAPA Guidelines compared to other professionals. 68% of physicians reported that they discuss PA with their patients sometimes.[16] In addition, study was conducted to explore the attitudes and knowledge of European GPs in implementing health promotion in primary care, to determine barriers for implementing health promotion, and to assess the relationship between GPs' own health behaviors and their health promotion practice. It showed about 56.02% of the GPs answered that carrying-out health promotion activities and prevention are difficult. Two important barriers have been reported: heavy workload/lack of time and no reimbursement. In addition, they found an association between personal healthy behaviors and attitudes, and the health promotion practice, one example of that, GPs who practice PA felt that they were more effective in counseling and advising patients to practice regular PA than sedentary GPs (59.14% vs. 49.70%, P < 0.01).[17] Study published in 2014, done by ALJABERI, titled as “Assessment of Physical Activity (Counseling) at Primary Health Care Centers in Aseer Region, Saudi Arabia,” showed that 42% of primary care physicians were physically active and there was a significant relationship between physicians' PA level and their counseling habits about PA with P < 0.001.[5] In 2000, Abramson et al. did a study about US primary care physicians' counseling and personal physical exercise habits. It showed that physicians on regular PA are more likely to counsel their patients about PA, most of them were family practitioners and internists.[18] Hung et al. published a research in 2013 titled as “physicians' health habits are associated with lifestyle counseling for hypertension patient.” They found that physicians who practice PA and who are nonsmokers are more likely to counsel their patient regarding healthy lifestyle.[19] From India, a study was done in 2013 among primary care physicians, in Trivandrum (South India), with different specialty includes cardiology, pediatrics, endocrinology, and general internal medicine. They found that the majority of physicians are physically inactive, and physicians who believe that their own practice influence counseling practice and who practiced PA previously were more likely to practice PA counseling in comparison to other physicians.[20] In 2014, Morishita et al., published a study done among medical doctors who had graduated from Jichi Medical University in Japan, showed that counseling and advice about PA in hypertension, heart failure, and hyperlipidemia cases were associated positively with physicians own exercise habits. However, the primary care physicians whose specialties were general medicine and internal medicine significantly more often recommended PA practice in hyperlipidemia, heart failure, diabetes mellitus, and hypertension cases.[21] In addition, the study was done in 2014, in Japan, on primary care physicians who are managing chronic kidney disease (CKD) patient. They found that CKD primary care physicians' PA recommendations for CKD patients were significantly related to their own exercise frequency (P < 0.001), but they were not related to their exercise intensity, specialty, workplace, or age.[22] On the other hand, Ramírez-Cardona et al. published a study in 2013 studied the relationship between personal PA of GP and their counseling habits about PA. No relationship was found between GPs' personal PA and their counseling habits regarding PA or their current knowledge of the topic. However, it also revealed that only 46% of female and 35% of male GPs were familiar with the latest recommendations about PA.[23] Finally, Fraser et al. studied the “patients' perceptions of their GP's health and weight influences their perceptions of nutrition and exercise advice received.” The findings revealed that a GP's perceived status of health including GP's physical appearance, disclosure of a GP's health behaviors, and perceived absence of ill health influences patients' perceptions of the recommendation and advice regarding healthy lifestyle received during consultations.[24]

In light of the above, we realize the effect of this topic on primary and secondary prevention of many chronic diseases and overall patient health improvement. Hence, we have done this study to know the prevalence of physically active physicians, to study the relationship between their PA practice and their counseling practice about PA, and to look for the main barriers to provide an effective counseling about PA. We hope the result of this study to help in improvement of physicians PA and to encourage them to improve their counseling skills about PA. We aim in this study to prove that personal regular PA of primary care physicians will improve their counseling habits about PA. The primary objective of the study was to find out the association between primary care physicians PA and their counseling habits about PA at primary healthcare centers of PSMMC. The secondary objective of the study was to know the prevalence, determinants of physically active primary care physicians, and the common barriers to provide proper counseling about PA. We hypothesized that there is no difference between active and inactive primary care physicians in their counseling habits about PA.


  Methodology Top


Sample

Comprehensive sample was taken to involve all available primary care physicians. 268 physicians working in 17 primary healthcare centers belong to the family medicine department at PSMMC, distributed over Riyadh city, including residents of Saudi family medicine residency program at PSMMC. The questionnaires were distributed to primary care physicians by hand. Over 2 months, February and March 2018, 214 physicians have completed the questionnaire with response rate of 79.8%, which were analyzed to end with the research results.

Departmental approval for undertaking research study was taken, as well as research ethics committee approval (Reg. # HAP-01-R-015) (Project No. 949, approved on May 2, 2017). It was clearly explained on the questionnaire that participation in the study is voluntary, filling the questionnaire is considered as consent for participation in this study, and all information is for confidential use and will be used only for the current study.

Procedure

  • Appendix 1 Study design: Cross-sectional study
  • Appendix 1 Target population and study area: primary care physicians of PSMMC, Riyadh city, SA, in 2018.


Self-administered questionnaire was used for data collection, which was designed by the researcher. Conceptual framework for validation of the questionnaire was done with the help of four family medicine consultants and researchers, in PSMMC, to assess the following: clarity of the question, question relevance, and appropriateness of the design, display, or structure of the question. The questionnaire then was pretested and was reliable with no changes needed to be done. It was written in English language and designed as the following: first page includes study title, purpose of the study, name of researcher and supervisor, and e-mail address and mobile number for any inquiry regarding the questionnaire, clarifying that filling the questionnaire is considered as consent for participation in this study and all information are for confidential use. The next two pages were containing questions about (1) demographic data (age, gender, nationality, job title and years of practice); (2) physician's PA habits (on regular PA [yes OR no], what type of PA, and how much physician is practicing per week); (3) physician's counseling habits about PA (what kind of patients they usually counsel about PA, what type of PA they recommend, and how much time they recommend for patient to practice); (4) two more questions, one to know what guideline they follow and the last question about the barriers that prevent physicians to do a proper PA counseling.

Statistical analysis

Statistical analysis was done using International Business Machines Corporation , Statistical Package for the Social Sciences (IBM SPSS) Statistics for Windows, (IBM Corp., Armonk, N.Y., USA). Descriptive analysis of the data and frequency tables were used and produced for all variables. Categorical data were summarized as numbers (n) and percentages (%) while continuous data would be as means ± standard deviation. For studying the difference between proportions and the categorical variables, a Chi-square test or Fisher's exact test was used for calculating P values. For continuous variables, t-test was used instead. The value of the statistical level of significance was set at 0.05.


  Results Top


Demographic data and basic characteristics

A total of 214 primary care physicians participated in our study with age ranged from 22 to 62 years, with the mean of 36.8 ± 9.5 years. 56.5% were male, and 43.5% were female. By nationality, 59.3% were Saudi while 40.7% were non-Saudi. Regarding job title or physician's position; 36.4% were family medicine residents, 22.4% were registrars, 17.3% were consultants, 17.3% were senior registrars, and 6.5% were senior house officer physicians. Regarding years of practice after graduation from medical school, 34.1% had less than 5 years of practice, 23.4% had from 5 to 10 years, 17.3% from 11 to 15 years, 12.1% from 16 to 20 years, and 13.1% had more than 20 years of practice [Table 1].
Table 1: Demographic data and basic characteristics

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Physician's physical activity practice

Of our participants, 70.1% of physicians practice PA on regular basis while the remaining 29.9% are not. Among physically active physicians, males represent 57.3%, while females represent 42.7%, and in regard to nationality, Saudis represent 59.3% while 40.7% were non-Saudi [Table 2]. When physicians were asked about the type of PA they practice, 54.7% choose walking, 11.7% swimming, 9.8% resistance exercises, 9.3% running, 9.3% football, 9.3% cycling, 8.9% jogging, 4.2% flexibility exercises, and 0.5% neuromotor exercises. When they asked about times of PA per week they spend for PA practice, 29.9% said that they did not practice PA regularly, 26.6% practice PA less than 60 min per week, 16.8% practice PA from 60 to 149 min per week, 11.7% practice PA for about 150 min per week, and 15% practice PA for more than 150 min per week [Table 3].
Table 2: Demographic data and physical activity practice

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Table 3: Physical activity practice among primary care physicians

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Counseling habits about physical activity

Physicians were asked about their PA counseling habits they practice with their patients, 34.6% usually counsel all of their patients about PA, 53.7% usually counsel patients who are at risk, such as patient with increased body weight, high blood pressure, and high blood sugar, 8.4% counsel their patients sometimes, and 3.3% rarely counsel their patients about PA. Regarding type of PA that physicians usually recommend to their patients, most physicians (97.2%) recommend walking, 27.1% recommend swimming, 11.2% recommend jogging, 9.8% recommend running, 7.9% recommend resistance exercises, 7% recommend football, 4.2% recommend cycling, 3.3% flexibility exercises, and no one have recommended neuromotor exercises for his/her patients. Regarding the time they recommend for their patients to practice PA per week, 56.1% of physicians recommend PA practice for about 150 min per week, 15.9% recommend less than 60 min/week, 15% recommend 60–149 min/week, and 13.1% recommend more than 150 min/week [Table 4].
Table 4: Physical activity counseling patterns among primary care physicians

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Guidelines followed for physical activity practice and counseling

Regarding guidelines or recommendations of PA our participants follow in their own personal PA practice and in counseling patients about PA, physicians are divided into two groups; the first group includes primary care physicians who follow a certain guideline or recommendation, they represent the majority of our population (74.3%), while the second group includes the primary care physicians who do not follow any guideline or recommendation (25.7%) [Table 5]. Of physicians who follow a certain guideline or recommendation, 36.9% follow recommendations of ADA, 21.5% follow AHA recommendations, 17.3% follow ACSM recommendations, 12.1% follow United Kingdom PA guideline, and 5.6% follow Canadian PA guideline [Table 5].
Table 5: Guidelines followed by primary care physicians for physical activity practice and counseling

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Barriers to practice proper physical activity counseling

When our participating primary care physicians were asked about barriers that prevent primary care physician doing a proper patient counseling about PA, the majority of them (72.9%) reported that the lack of time was the common cause, 35.5% reported conditions that could affect quality of patient's PA (osteoarthritis, old age, heart disease, etc.), 29.9% reported being physically inactive, 26.2% reported lack of knowledge or training about PA counseling, 22% reported patients' wrong believes about the importance of PA, and 8.4% reported physicians' wrong believes about the importance of PA [Table 6].
Table 6: Barriers to practice proper physical activity counseling

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Association between physically active physicians and their counseling practice about physical activity

It was clear from [Table 2] that 70.1% of physicians practice PA on regular basis while the remaining 29.9% are not. However, most of the guidelines and recommendations, such as CSEP, ACSM, AHA, and ADA, recommend for adult to practice 30 min of moderate-intensity PA 5 days per week or more OR 20–25 min of high-intensity PA 3 days per week or more. As a result, we considered the physician to be physically active if he/she is practicing moderate-intensity PA for 150 min/week or more or high-intensity PA for 60 min/week or more. Accordingly, we found that 62.1% of our primary care physicians were physically inactive, while 81 out of 214 participants (37.9%) were found to be physically active. However, 167 out of 214 participants (78%) recommend for their patient to practice moderate-intensity PA for 150 min/week or more or high-intensity PA for 60 min/week or more. Thus, statistical analysis of our results estimated a significant association between physician's PA practice and providing an effective PA counseling [Table 7] and showing confidence to counsel all patients about PA as a part of preventive care provided by primary care physicians [Table 8] (P = 0.008, 0.038, respectively).
Table 7: Association between physician's physical activity status and counseling practice about physical activity

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Table 8: Association between physician's physical activity status with physical activity counseling habits

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  Discussion Top


The physiological and psychological benefits of PA are well known, as well as many studies approved that PA practice improves the overall health.

It was encouraging to find in our study that most physicians (71.4%) were actually performing physical exercise on a regular basis. This results agreed with similar study evaluated in SA, alJouf region, by Banday et al., as they found that 65.2% of respondent primary care physicians were physically active and they advise their patients about PA better than inactive physicians.[7] However, we found that the prevalence of physicians who are practicing moderate-intensity PA for 150 min/week or more or high-intensity PA for 60–75 min/week or more, as recommended by most guidelines and recommendations (such as CSEP, ACSM, AHA, and ADA), was only 81 out of 214 (37.9%); this result is similar to Saudi study conducted by al-Reshidi, among PSMMC resident physicians, who reported that the majority of resident physicians (68.4%) at PSMMC were not physically active.[8] On the other hand, Suija et al. in their study done on female family doctors in Estonia found that 92% of them were physically active.[15] In addition, a study carried out by Gnanendran et al. in Australia found 70% of doctors and medical students satisfying the NAPA Guidelines, which was higher than 30% as seen in the general population.[16] Study done by Stanford et al. found that 78% of physicians and medical student included in the study meet US DHHS 2008 guidelines for PA, but only 64.5% of the general US adult population meet DHHS guidelines.[6]

Unfortunately, the prevalence of our physically active physicians remains low despite their knowledge about the importance of PA in preventive care. This difference between the prevalence of active physicians in local studies and in national studies could be attributed mainly to the cultural differences, hot climate in our region, sedentary lifestyle, conservative social and religious norms, and others. However, most of the national studies show availability of supportive environment to practice PA such as parks, footpaths, sports clubs, and gym centers compared to our poor healthy environment, which start to be addressed and positively changed recently in the new vision of our country, 2030 vision.

Primary care physicians are well positioned to provide an effective counseling about PA and other healthy lifestyles. Prevalence of physicians who counsel their patient to practice moderate-intensity PA for 150 min/week or more or high-intensity PA for 60 min/week or more, as recommended by most of the PA guidelines and recommendations, as we discussed earlier, was 167 out of 214 (78%). Similarly, in Germany, study done in 2015 among primary care physicians to study the knowledge, attitude, and implementation of PA counseling revealed that the majority (87%) of primary care physicians rated their own competence level in counseling about PA as high, while 52.3% rated their capability to motivate their patient as not good.[9] In 2018, study esd done on Canadian SOT physicians to determine the proportion of physicians who are practicing counseling about PA. The result was that about 97% of them were providing counseling about PA to their patient.[11] This result reveals that the physicians are aware of the importance of their positions to promote their patients toward healthy lifestyles such as regular PA and that the physicians included in our study and the other previous studies show high level of awareness regarding the importance of regular PA. However, Bloy et al., published a research in 2016 about GPs and PA counseling in Paris, found that counseling about PA is not addressed systematically in patient care, and even when they advise their patients about PA, their advice and assessment are succinct.[10] This result can be attributed to the small sample size of their study, as they studied the PA counseling habits in details among 20 GPs only and to other factors such as lack of knowledge and training, confidence, and policies to counsel patients about PA.

It was approved in many studies that physician's PA status is associated with his PA counseling practice. 81 out of 214 participants (37.9%) found to be physically active as per most of the PA recommendations. However, 167 out of 214 participants (78%) recommend for their patients to practice moderate-intensity PA for 150 min/week or more or high-intensity PA for 60–75 min/week or more, as per most of the PA recommendations. Statistical analysis of our results estimated a significant correlation between personal physician's PA practice, as recommended by most of the PA recommendations, in regard to providing an effective PA counseling with P = 0.008. In addition, among physically active physicians, 43.2% usually counsel all their patients about PA, compared to inactive physicians (29.3%), with P = 0.038. This result agrees with the study published in 2017, done by Pojednic et al. and they found that the physicians with an interest in sport understand the importance of PA counseling. 74% regularly recommended PA, 66% talked about exercise with patients, and 49% included as a vital sign.[13] In addition, a study done in 2008 by Lobelo et al. found that personal PA among physicians influences their PA counseling habits.[3] This result also agrees with multiple local, regional, and international studies. Local studies (inside Saudi Arabia) like the study by Aljaberi at PHC level Aseer region in 2014[5], and the study done in aljouf region, by Banday et al. about the prevalence of PA among PHC physicians.[7] And examples of regional (studies performed in continent of Asia); the study by Hung et al. about physician health habits& their counseling behaviors for hypertensive patients[19], the study done in 2013 among primary care physicians in Trivandrum (South India)[20], and the study done in 2014 in Japan on primary care physicians who are managing CKD patient.[22] On the international level; the study by Askew D. about the physical activity counseling practice among PHC practitioners in North Dakota department of health[2], the study by Abramson et al. for the same primary objective like this study about Personal exercise habits and counseling practices of primary care physicians[18], and the study done in 2014, by Morishita et al. for Exercise counseling of primary care physicians in metabolic syndrome.[21] All these previous studies showed a positive relationship between physician's PA and their counseling habits about PA. On the other hand, the study done by Ramírez-Cardona et al. in Argentina revealed that no relationship was found between GPs' personal PA and their counseling habits regarding PA;[23] this result could be attributed mainly to the inappropriate assessment of personal GP's PA level in their study, as they did not assess their PA in details.

Many barriers may prevent physicians doing proper PA counseling. Our study showed that 72.9% of physicians reported main barrier that prevents doing a proper counseling about PA is lack of time, 35.5% reported that conditions could affect quality of patient PA (osteoarthritis, old age, heart disease, etc.), 29.9% reported being physically inactive, 26.2% reported lack of knowledge or training, 22% reported patients' wrong believes about the importance of PA and 8.4% reported physicians' wrong believes about the importance of PA. Similarly, many studies have discussed barriers that prevent proper counseling about healthy lifestyles including counseling about PA. Brotons et al. found that lack of time was the most reported barrier, followed by lack of incentives and patient compliance.[17] Stanford et al. reported that several barriers affect counseling about PA, including insufficient training, motivation, time, and knowledge.[12] Similar results were reported by Pang et al., who said that the main barriers to counsel their patient about PA were lack of time (56%) and lack of PA guidelines (53%).[11]

Lack of time is the main barrier that prevents physicians doing a proper PA counseling to their patients, especially among primary care physicians, where they have a very high load of patients need to be seen every day with a lot of care need to be provided to them.


  Conclusion Top


The prevalence of physically active primary care physicians of PSMMC, Riyadh city, according to CSEP, AHA, ACSM, ADA, and other PA recommendations was 81 out of 214 (37.9%). Prevalence of physicians who recommend an effective PA according to these recommendations was 167 out of 214 (78%). Significant association was found between physician's PA practice and providing an effective PA counseling (P = 0.008) and showing confidence to counsel all patients about PA as a part of preventive care provided by primary care physicians (P = 0.038). The lack of time was the major barrier to counsel patients about PA.

Additional effort should be made to educate and encourage primary care physicians to practice PA and to provide an effective counseling regarding PA to their patients through educational programs, campaigns, conferences, etc.

Recommendations

Teaching about the importance of PA should start at school age, as this will well improve our society awareness about PA effect on overall health. Additional effort should be made to improve the counseling skills about PA. Lack of time is the main barrier to counsel the patients about PA properly. Policies to overcome the high load of patient among primary care physicians will give additional improvement for their counseling practice.

Limitations of the study

The study was done among primary care physicians of PSMMC, while the other specialty physicians need to be addressed in similar studies, as they have good exposure for patients with different diseases. In addition, if the study was done among GPs at primary health care centers that belong to the Ministry of Health, it will be more representative to generalize the result over our country. Finally, visualizing the physicians while they are counseling their patients will provide us more information about their counseling habits and to assess the competency level in providing an effective counseling regarding PA.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Appendix 1: Questionnaire Top


1. Demographic data:

1. Age:………. year

2. Gender: ◯ Male ◯ Female

3. Nationality: ◯ Saudi ◯ Non Saudi (specify):…………….

4. Job title: ◯ Consultant ◯ Senior registrar ◯ Registrar

◯ Resident ◯ SHO

5. Years of practice: (after graduation from medical school)

◯ <5 years ◯ 5–10 years ◯ 11–15 years

◯ 16 -20 years ◯ >20 years

2. Your Personal physical activity:

6. Do you practice physical activity on regular basis, as you have specific or dedicated time for physical activity every day or week? (Choose one from options below) ◯Yes.

◯ No.

7. What type of physical activity do you practice? (you can choose more than one type)

□ I don't practice physical activity regularly.

□Walking □ Jogging □ Running □ Football □ Swimming

□ Cycling □ Resistance exercises □ Flexibility exercises

□ Neuromotor exercises □Others:

8. How much time do you practice physical activity per week?(choose one from options below)

◯ I do not practice physical activity regularly.

◯ <60 min

◯ 60–149 min

◯ About 150 min

◯ >150 min

3. Counseling habits about physical activity:

9. Regarding your counseling habits about physical activity (choose one from options below)

◯ Usually, I counsel all my patients about physical activity.

◯ Usually, I counsel patients who are at risk, such as patient with increased body weight, high blood pressure, high blood sugar, etc.

◯ Sometimes I counsel my patients about physical activity.

◯ Rarely I counsel my patient about physical activity.

10. What type of physical activity do you advice or recommend to your patient to practice? (You can choose more than one type)

□ I don't advice my patients to practice physical activity regularly.

□Walking □ Jogging □ Running □ Football □ Swimming

□ Cycling □ Resistance exercises □ Flexibility exercises

□ Neuromotor exercises □Others:

11. How much time do you advice your patient to practice physical activity per week? (choose one from options below)

◯ I do not advice my patients to practice physical activity regularly.

◯ <60 min

◯ 60–149 min

◯ About 150 min

◯ > 150 min

12. What guidelines or recommendations do you follow in your personal physical activity practice and in your patient counseling about physical activity? (You can choose more than one guideline or recommendation)

□ I don't follow any guidelines or recommendations about physical activity.

□ American College of Sport Medicine. □ American Diabetes Association.

□ American Heart Association. □ Canadian Physical Activity Guidelines.

□ UK Physical Activity Guidelines. □ Others:

13. Barriers that prevent primary care physician doing a proper patient counseling about physical activity:

(You can choose more than one)

□ Lack of Knowledge or training. □ Lack of time.

□ Physicians wrong believes about the importance of physical activity.

□ Patients wrong believes about the importance of physical activity.

□ conditions could affect quality of patient physical activity (osteoarthritis, old age, heart disease, etc)

□ Being physically inactive. □ Others:



End of questionnaire.

Thank you.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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