Clinical Effectiveness of the Physical Activity Vital Sign PAVS

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Clinical Effectiveness of the Physical Activity
Vital Sign (PAVS)

• Elizabeth Joy, M.D., M.P.H.
• Department of Family and Preventive Medicine
• University of Utah
• Salt Lake City, UT

2
PA Counseling

• USPSTF, ACSM, AHA recommend that physicians
  counsel patients on regular physical activity
  (PA)
• Promote health
• Prevent and control disease.
• Few physicians conduct PA counseling during
  routine office visits
• Primary care population 22-38 (Wee1999, Podl
  1999) )

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The 5 As

• Ask, advise, assess, assist, and arrange
• First step in physical activity promotion is
  asking the patient about their current physical
  activity levels.
• Just as weight is addressed in some manner at
  nearly every physician visit, so should attention
  be given to recommending the accumulation of 30
  minutes a day of moderate intensity physical
  activity at least 5 days per week (Steve
  Blair, Tim Church JAMA 2004)

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PA Assessment

• Several tools exist, but are impractical for a 15
  20 minute office visit

5

• For a tool to be effective in a clinical setting
• it must be something that can be administered
  quickly
• provides useful information to the clinician,
  and,
• prompts action in both the clinician and the
  patient

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Physical Activity Vital Sign (PAVS)

• How many days in the past week have you performed
  physical activity where your heart beats faster
  and your breathing is harder than normal for 30
  minutes or more? (can be 30 minutes in a row or
  3, 10 minute blocks)
• How many days in a typical week do you perform
  activity such asthis? 
• score 0 / 0 to 7 / 7

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PAVS Results

• The answers provided by patients and reviewed by
  the physician initiate the process of physical
  activity promotion

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Previous PAVS Studies

• How does the PAVS impact healthcare providers?
• Does use of the PAVS in primary care clinics
  increase PA counseling by healthcare providers?
• 37 53

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Current PAVS Study

• How does the PAVS impact patients?
• Does administration of the PAVS impact patients
  with respect to their attitudes and beliefs about
  exercise?

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Psychosocial Correlates of Exercise

• Exercise Self-efficacy (Sallis 1989, Poag 1992,
  Rodgers 1993)
• Degree of confidence an individual has in
  his/her ability to be physically active despite
  certain barriers
• Stage of Change (Prochaska, Marcus 1994)

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Study Objectives

• Examine the affect of the PAVS on patients
  attitudes and beliefs regarding exercise

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Study Design / Subjects / Procedures
Sugarhouse Clinic
Madsen Health Center
MAs recruited eligible patients (gt 18 yo)
Study Subjects (n186 )-Completed 2 ½ page
questionnaire (time 1)
Study Subjects (n186 )-Contacted by phone by RA
(72-96 hours after visit)-Asked same questions
(time 2)
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Controls
Greenwood Health Center
MAs recruited eligible patients (gt 18 yo)
Control Subjects (n53 )-Completed 2 ½ page
questionnaire (time 1)
Study Subjects (n53 )-Contacted by phone by RA
(72 hours after visit)-Asked same questions
(time 2)
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Questionnaire

• Demographics
• Age, height, weight
• Provider information (who seen, clinic, usual?)
• Visit information (first or return)
• Reason for visit
• Health problems
• Physical Activity Scales
• Barriers to Physical Activity
• Benefits of Physical Activity
• Stage of Readiness to Exercise (Marcus 1994)

(Sallis, et al 1989, 1999)
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Questionnaire

• Barriers to Physical Activity
• 24 questions
• Likert Scale (0Never, 1Rarely, 2Sometimes,
  3Often, 4Very Often)
• Summary Score (0-64)
• How often do the following prevent you from
  getting physical activity?
• e.g., I am usually too tired to exercise
  (never very often) Lack of interest in
  physical activity (never very often)

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Questionnaire

• Benefits to Physical Activity
• 14 questions
• Likert Scale (1Strongly Disagree, 2Somewhat
  disagree, 3Neutral, 4Somewhat Agree, 5Strongly
  Agree)
• Summary Score (14 70)
• If I participate in physical activity, then
• e.g., I will feel less depressed and/or
  bored I will increase my energy level

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Questionnaire

• Stage of Readiness for Exercise
• 5 questions (circle best response)
• I do not exercise, and have not thought about
  exercising.
• I do not exercise, but have thought of
  exercising.
• I currently exercise, but not regularly.
• I currently exercise regularly, and have been
  doing so for 6 months.
• I currently exercise regularly, and have been
  doing so for more than 6 months.

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Methods Variables

• Variables of Interest
• Age
• Gender
• BMI

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Methods Analysis

• Demographics
• Descriptive statistics and chi-square
• Barriers and Benefits Subscales
• Subscales were summed for visits 1 2
• Repeated-measures generalized linear model (GLM)
  to compare the means of the sums between visits
  and between the PAVS and Control groups
• BMI, age and gender were included in the model to
  determine interaction
• Current Exercise Levels by Time
• Descriptive statistics and chi-square

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Results - Demographics
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Results - Benefits
Benefits Mean Score
Overall incr. in perceived benefits between time
1 2, plt0.0001No difference between PAVS and
Control groups p0.6685No interaction with age,
gender, BMI
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Results - Barriers
Barriers Mean Score
No change in Barriers Score over time,
p0.5553No difference between PAVS and Control
groups,p0.7619No interaction with age, gender,
BMI
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Results Level of Exercise
Overall incr. in level of self-reported exercise,
p0.0029No difference between PAVS and Control
groups, p.6685
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Summary

• No change in perceived barriers
• PAVS Subjects or Controls
• Significant increase in perceived benefits
• PAVS Subjects and Controls
• Significant increase in the number of subjects
  exercising regularly at Time 2 compared to Time 1
• PAVS Subjects and Controls

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Limitations

• Questionnaire(s) was an intervention in and of
  itself
• Control group Providers were not blinded to the
  study and may have increased their PA counseling
• PA in PAVS and Control subjects was not
  objectively measured

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Conclusion

• Study Question
• Does administration of the PAVS impact patients
  with respect to their attitudes and beliefs about
  exercise?

???
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Conclusion

• No effect of the PAVS itself on benefits or
  barriers to exercise or readiness to change
• Both the PAVS and Control groups reported an
  increase in perceived benefits to exercise, and
  progressed in their stage of readiness to
  exercise
• Suggests that asking them about PA has a
  beneficial effect in and of itself
• Furthering the hypothesis that repeated
  discussion of PA has the potential to impact PA
  levels in patients

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The Next Steps

• Assess Benefits, Barriers and Readiness to
  Change relative to
• Usual provider?
• First visit or returning visit
• Health problems

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The Next Steps

• Is the PAVS a valid and sensitive measure of MVPA
  in adults?

NHLBI Improving Diet and Physical Activity
Assessment (R21)Submitted 2/7/07
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Thank You

• University of Utah Primary Care Research Center
• Madsen, Sugarhouse Greenwood Medical Assistants
• Elizabeth Dranow, Ph.D.
• Nick Waters
• Jerilin Nunu
• Han Kim, Ph.D.