How physicians changed their attitudes and behavior

1. Exercise Council of Iowa
November 2008 Conference
‘Exercise for Doctors and
Patients’
90‐Day Followup Report
Prepared by Fredrick Arnstein, Ph.D.
This is a sample report. The real report on which it is
based has been altered.

2. Background and Methods
• Background: The ‘Exercise for Doctors and Patients’ conference
was held for three days in November 2008. The primary goal was to
make attendees (physicians and other providers) more confident
and skillful in promoting physical activity to their patients,
ultimately increasing the portion of their patients with whom they
discuss and prescribe physical activity. (Other lifestyle issues were
also covered.) The conference included two sessions at a nearby
health club, where attendees could become personally familiar with
various forms of exercise. This report examines how attendees
changed from the time of the conference to 90 days later.
• Three surveys: Attendees filled out two surveys—pre and post—at
the conference (T1) and a third survey 90 days later (T2).
• Matched samples: The sample size for the November conference
(T1) was 109. The 90‐day follow‐up sample (T2) consists of 54
individuals whose records could be matched to T1 records. T1‐T2
comparisons are based on this subset of 54 individuals.

3. Comparison of Those Who Did and
Didn’t Respond at 90‐Days
• Attitudes and behavior: We tested to determine if there were significant
differences between people who did respond at T2 (90‐day) and those
who did not. Five variables from T1 were examined. The results
suggested a pattern: the 90‐day responders had initial (T1) attitudes and
behaviors that were slightly more in tune with conference goals.
However, none of these differences were statistically significant.
• Demographics: The 90‐day responders closely matched the demographic
profile of the original set of respondents. Differences were not
significant.
– Sixty‐eight percent of the conference attendees were physicians,
compared to 60% of the T2 respondents.
– Sixty percent of the conference attendees were women, compared to
54% of the T2 respondents.
– Most T2 respondents had BMIs between 20 and 28 and were getting
adequate exercise. This matches the profile of the total group of
attendees at the conference.

4. Summary of Key Findings (1)
• A number of statistically significant positive changes occurred
between T1 and T2. According to their self reports, attendees:
– Prescribe exercise more often with patients (slide 7)
– Discuss stress management more often with patients (slide 7)
– Feel less inhibited by lack of knowledge from discussing lifestyle with their
patients (slide 10)
– Feel less inhibited by lack of tools and materials from discussing lifestyle
with their patients (slide 10)
– Are doing better at managing their own stress (slide 11)
– Are doing better at maintaining their own diet and nutrition (slide 11)
– Rate themselves as having better knowledge of exercise and physical
activity (slide 12)
– Are more confident about discussing exercise and physical activity with
their patients (slide 12)

5. Summary of Key Findings (2)
• Other findings of note
– Comments about the conference and its impact were extremely
positive (comments are in separate document)
– The percent of patients with whom providers discuss various
lifestyle issues has not changed (slide 8)
– The portion of patients seen as making progress in lifestyle
behaviors has remained about constant. It was 48% at T2. (slide 9)

6. Were 90‐day Responders Different
from Other Responders
Did Didn’t Nature of There is a
Variables measured at T1 respond respond differences suggestive pattern:
at T2* at T2
The 90‐day
No. of patients seen (1‐4 scale) 2.2 2.6 T2 Responders responders started
had lower out more in tune
patient load
with the conference
Pct. of patients w/ whom provider 77% 72% T2 Responders philosophy,
discusses lifestyle better at outset compared with the
Inhibited by lack of incentives 4.2 4.4 T2 Responders non‐responders at
(lower score is better: less better at outset 90 days.
inhibition) (low is better)
However, none of
Inhibited by limited time (lower 4.9 5.7 T2 Responders
these differences
score is better: less inhibition) better at outset
(low is better) are statistically
significant.
Minutes per week doing 251 218 T2 Responders
moderate‐to‐intense physical better at outset
activity
*Numbers in the ‘Did respond’ column may differ slightly from T1‐T2 comparisons
later in this report because the full 54‐person T2 set was used in this table.

7. How do you currently approach lifestyle choices
with your patients? Check all that apply.
How
Discuss physical activity/exercise
85%
82% Providers
Deal with
Coach/Discuss lifestyle 83%
& health w patient 74%
69%
Advise patient to lose weight
Patients
69%
39%
Refer to nutritionist/dietician
48%
Discuss stress management 72%
(sig = .05) 52%
Prescribe exercise 63%
Providers increased their use of
(sig = .05) 41% most options.
Refer to support group 33%
(e.g., Weight Watchers) 37%
46%
Average use of all options was
Handout or written material
35% 36% pre‐conference, increasing
Refer to health club
35%
32%
to 42% post conference
20% 90 Days After (p = .05).
Refer to specialist
28%
Pre-Conference
Prescribe pharma medication
7%
6%
Note the significant increases
Refer to health or 11%
in prescribing exercise and
wellness coach 9%
discussing stress management.
Do not discuss
4%
2%
(McNemar non‐parametric test
0% 20% 40% 60% 80% 100%
for significance of changes.)

8. How Frequently Attendees
Discuss and Prescribe Exercise
With what percent of your patients do you
currently...
55%
Prescribe exercise
51%
59%
77% discuss
Discuss stress exercise, while 55%
54%
67%
prescribe it.
Discuss nutrition
63%
These percents are
90 Days After
53%
Discuss smoking Pre‐conference
up from T1, though
59%
not at the .05 level
66%
Discuss weight of significance.
66%
77%
Discuss exercise
75%
76%
Discuss lifestyle issues
79%
0% 25% 50% 75% 100%

9. What portion of patients are
making progress?
Change in Pct of Patients
Making Progress (T2-T1)
20
On average, 48% of patients*
were making lifestyle progress,
up slightly and nonsignificantly
10
from 45% at T1.
*Among patients with whom the
attendees did discuss lifestyle.
Count
0
-40
-60
-50
-20
-10
15
20
30
10
0
Among patients with whom lifestyle was discussed

10. Inhibitors of Lifestyle Counseling
How much do the following factors inhibit your • By T2, attendees
lifestyle counseling of patients? concerns about lack of
Low scores are better knowledge and lack of
materials had
decreased significantly.
4.9
Limited time
5.5 • But the three other
4.2 factors measured –
Lack of incentives
3.5
90 Days After time, incentives, and
Lack of knowledge 2.3 Pre‐conference compliance – had not
(sig = .000) 4.1
decreased.
Lack of materials 3.0
(sig = .000) 4.6 • This suggests that the
4.3 non‐changing factors
Pcvd poor compliance
4.8 require other
1.0 3.0 5.0 interventions besides
Average ratings: education and training
'Does not inhibit' (1) to 'Completely inhibits' (10) of the providers.

11. Personal Health Behaviors
Rate these items from 1 to 10 based on your • These scales allow people to
personal health behaviors evaluate their own behaviors.
• Both stress management and
Your stress 6.8 eating habits improved
management
6.3
significantly, on average.
(sig = .047)
• Weight also changed
Your eating 7.9 significantly, from 5.5 to 5.2,
habits/ nutrition
(sig = .021) 7.5 both numbers being solidly in
the normal range.
Your weight 5.2 90 Days After • Actual reported weight (in
(sig = .005) 5.5
Pre‐conference pounds) did not change at
all—it was 151 pounds at
1.0 3.0 5.0 7.0 9.0 both T1 and T2.
• So people apparently wanted
• Scale for ‘Your stress management’: Unmanageable Stress (1) to Very
Well Managed Stress (10). to think of themselves as
• Scale for ‘Your eating habits/ nutrition’: Unhealthy (1) to Very Healthy lighter, and this could have
(10). had to do with the message of
• Scale for ‘Your weight’: Underweight (1), Normal (5‐6), Overweight (10). the conference.
• Significances determined by paired‐samples t‐test.

12. Pre‐ to Post‐Session Changes
Changes in Knowledge and Confidence
10.0
8.9
8.3
7.0
7.1 7.4
4.0
1.0
Rate your current knowledge of How confident are you discussing
exercise and phys activity exercise and phys activity
(sig = .000) w/ your patients
(sig = .000)
Pre‐conference
90 Days After
• Scale for ‘Rate your knowledge...’ Not knowledgeable (1) to Very
knowledgeable (10).
• Scale for ‘...Confident discussing exercise...’ Not confident (1) to Very confident
(10).
• Significances determined by paired‐samples t‐test.