Physical activity counseling in primary care: Who has and who should be counseling?

Objective: To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA. Method: MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings. Results: Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (> 6 months). There was substantial variation in the location and counseling approach employed by allied health professionals. Conclusion: We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors. Practice implications: With physical activity counselors' specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance. (c) 2006 Elsevier Ireland Ltd. All rights reserved.