Medical knowledge about physical activity: a literature review

Authors

DOI:

https://doi.org/10.11606/issn.1679-9836.v102i3e-200521

Keywords:

physical activity, exercise, medical education

Abstract

It is well established in the medical literature that the practice of physical activity is beneficial to health, being able to prevent and treat chronic diseases, in addition to promoting health and quality of life. However, the prevalence of physical inactivity in the population has increased in recent years, especially considering the context of the Covid-19 pandemic. A literature review was carried out to identify the level of medical knowledge about counseling and prescribing the regular practice of physical activity, strategies already documented as effective in increasing the population's level of physical activity. Medical advices on healthy lifestyle are well accepted by the population, and doctors are considered safe sources of information on health, characterizing the bond of trust present in the doctor-patient relationship. However, there are few professionals who put into practice the assessment of their patients' physical activity levels. Those who do are generally active and adopt healthy lifestyle habits. Among the barriers described, lack of time and specific knowledge were the most significant. In practice, rare are the universities that offer training or specific disciplines on counseling and prescription of physical activity in medical courses. As, in the context of medical residency, only those specialties related to primary care and health promotion, such as Family Medicine and Sports Medicine, address the issue so that their residents put into practice the recommendations on physical activity for their patients. Thus, for the regular practice of physical activity to be integrated into the health system, it is imperative to include theoretical and practical training on physical activity at all levels of medical training, from college to graduate programs.

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Author Biographies

  • Débora Borowiak Reiss, Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiologia Aplicada e Nutrição. São Paulo - SP. Brasil.

    Médica do Esporte pelo Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), com título de especialista em Medicina Esportiva pela Sociedade Brasileira de Medicina do Exercício e do Esporte (SBMEE). Fellow em Medicina Esportiva pelo HCFMUSP. Pós-Graduada em Ciências da Saúde: Atividade física para prevenção, tratamento de doenças crônicas e promoção de saúde pelo Hospital Israelita Albert Einstein (HIAE). Doutoranda em Ciências do Sistema Musculoesquelético pela Faculdade de Medicina da Universidade de São Paulo (FMUSP). Sócia proprietária da Pulse Medicina Esportiva Integrada e médica do Futebol Feminino do São Paulo Futebol Clube. Experiência na coordenação de serviços médicos de corrida de rua, com participação na WRun SP 2016, SP City Marathon 2017, Athenas 21k SP 2017 e na BSB Half Marathon 2017. Experiência como Team Physician na Seleção Brasileira de Futebol Feminino Sub17 e no Comitê Olímpico Brasileiro. Participação no serviço de Emergências Field of Play nos Jogos Olímpicos Rio 2016 e na Copa América de Futebol 2019.

  • Bruno Gualano, Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiologia Aplicada e Nutrição. São Paulo - SP. Brasil.

    Graduação e doutorado pela Escola de Educação Física e Esporte da USP e pós-doutorado em Ciências pela Faculdade de Medicina da USP. Pesquisador do Laboratório de Avaliação e Condicionamento em Reumatologia (HCFMUSP) e do Grupo de Pesquisa em Fisiologia Aplicada & Nutrição (FMUSP/EEFEUSP). Ex-Professor Associado do Departamento de Biodinâmica do Movimento Humano da Escola de Educação Física e Esporte da USP (2010-2018). Professor Associado do Departamento de Clínica Médica da Faculdade de Medicina da USP (desde 2018). Professor Visitante na Nottingham Trent University (UK) e Waikato Institute of Technology (NZ). Pesquisador Associado do Food Research Center (FoRC USP) e do Núcleo de Pesquisas Avançadas em Alimentos e Nutrição (NAPAN USP). Editor Associado do British Journal of Sports Medicine. Um dos criadores do canal de divulgação científica Ciência inForma. Membro da Coalizão Ciência e Sociedade. Tem como linhas de pesquisa: fisiologia do exercício; promoção de estilo de vida saudável; nutrição aplicada ao exercício.

References

Walsh JME, Swangard DM, Davis T, McPhee SJ. Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med. 1999;16(4):307–13. doi: https://doi.org/10.1016/S0749-3797(99)00021-5

World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. Disponível em: https://www.who.int/publications/i/item/9789240015128

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018. Disponível em: https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines

Paterson DH, Jones GR, Rice CL. Ageing and physical activity : evidence to develop exercise recommendations for older adults. Appl Physiol Nutr Metab. 2007;98(32):S69–108. doi: https://doi.org/10.1139/H07-111

Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–29. doi: https://doi.org/10.1016/S0140-6736(12)61031-9

National Center for Health Statistics. Healthy People Final Review 2010 [Internet]. 2012. Disponível em: https://www.cdc.gov/nchs/healthy_people/hp2010/hp2010_final_review.htm. Acesso em 15/05/19.

Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. doi: 10.1249/MSS.0b013e318213fefb

Weiler R, Feldschreiber P, Stamatakis E. Medicolegal neglect? The case for physical activity promotion and Exercise Medicine. Br J Sports Med. 2012;46(4):228–32. doi: http://dx.doi.org/10.1136/bjsm.2011.084186

Anderson LH, Martinson BC, Crain AL, Pronk NP, Whitebird RR, Fine LJ, et al. Health care charges associated with physical inactivity, overweight, and obesity. Prev Chronic Dis. 2005;2(4):1–12. Disponível em: https://www.cdc.gov/pcd/issues/2005/oct/04_0118.htm

Narici M, Vito GD, Franchi M, Paoli A, Moro T, et al. Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures, European Journal of Sport Science 2021;21(4):614-635. doi: https://doi.org/10.1080/17461391.2020.1761076

Sanchez A, Bully P, Martinez C, Grandes G. Effectiveness of physical activity promotion interventions in primary care: a review of reviews. Prev Med (Baltim). 2015;76(S):S56–67. doi: https://doi.org/10.1016/j.ypmed.2014.09.012

World Health Organization. Noncommunicable diseases and mental health Reducing risk factors: physical inactivity [Internet]. 2019. Disponível em: https://www.who.int/nmh/ncd-tools/physical-inactivity/en/. Acesso em 15/05/19.

Peçanha T, Goessler KF, Roschel H, Gualano B.Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease. Am J Physiol Heart Circ Physiol 318: H1441–H1446, 2020. doi: https://doi.org/10.1152/ajpheart.00268.2020

Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health 2018; 6: e1077–86. doi: https://doi.org/10.1016/S2214-109X(18)30357-7

Bielemann RM, da Silva BGC, Coll C de VN, Xavier MO, da Silva SG. Burden of physical inactivity and hospitalization costs due to chronic diseases. Rev Saude Publica. 2015;49:2–8. doi: https://doi.org/10.1590/S0034-8910.2015049005650

Turi BC, Codogno JS, Fernandes RA, Monteiro HL. Prática de atividade física, adiposidade corporal e hipertensão em usuários do Sistema Único de Saúde. Rev Bras Epidemiol. 2014;17(4):925–37. doi: https://doi.org/10.1590/1809-4503201400040011

de Rezende LFM, Rabacow FM, Viscondi JYK, Luiz O do C, Matsudo VKR, Lee IM. Effect of physical inactivity on major noncommunicable diseases and life expectancy in Brazil. J Phys Act Heal. 2015;12(3):299–306. doi: https://doi.org/10.1123/jpah.2013-0241

Tucker JM, Welk GJ, Beyler NK. Physical activity in U.S. adults: compliance with the physical activity guidelines for Americans. Am J Prev Med. 2011;40(4):454–61. doi: https://doi.org/10.1016/j.amepre.2010.12.016

Ahmed NU, Delgado M, Saxena A. Trends and disparities in the prevalence of physicians’ counseling on exercise among the U.S. adult population, 2000–2010. Prev Med (Baltim). 2017;99:1–6. doi: https://doi.org/10.1016/j.ypmed.2016.05.014

Ministério da Saúde, Departamento de Ciência e Tecnologia Secretaria de Ciência Tecnologia e Insumos Estratégicos. ELSA Brasil: maior estudo epidemiológico da América Latina. Rev Saude Publica. 2009;43(1):1–2. doi: https://doi.org/10.1590/S0034-89102009000100028

Bielemann RM, Knuth AG, Hallal PC. Atividade física e redução de custos por doenças crônicas ao Sistema Único de Saúde. Rev Bras Atividade Física e Saúde. 2010;15(1):9–14. doi: https://doi.org/10.12820/rbafs.v.15n1p9-14

Jacobson DM, Strohecker L, Compton MT, Katz DL. Physical activity counseling in the adult primary care setting: position statement of the American College of Preventive Medicine. Am J Prev Med. 2005;29(2):158–62. doi: https://doi.org/10.1016/j.amepre.2005.04.009

Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. Br Med J. 2012;344(1):1–17. doi: https://doi.org/10.1136/bmj.e1389

Garrett S, Elley CR, Rose SB, O’Dea D, Lawton BA, Dowell AC. Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence. Br J Gen Pract. 2011;61(584):125–33. doi: https://doi.org/10.3399/bjgp11X561249

Hatziandreu EI, Koplan JP, Weinstein MC, Caspersen CJ, Warner KE. A cost-effectiveness analysis of exercise as a health promotion activity. Am J Public Health. 1988;78(11):1417–21. doi: https://doi.org/10.2105/AJPH.78.11.1417

Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity interventions into practice. Am J Prev Med. 2006;31(Suppl 4):45–56. doi: https://doi.org/10.1016/j.amepre.2006.06.019

Joy E, Blair SN, McBride P, Sallis R. Physical activity counselling in sports medicine: a call to action. Br J Sports Med. 2013;47(1):49–53. doi: http://dx.doi.org/10.1136/bjsports-2012-091620

Frank E, Tong E, Lobelo F, Carrera J, Duperly J. Physical activity levels and counseling practices of U.S. medical students. Med Sci Sports Exerc. 2008;40(3):413–21. doi: 10.1249/MSS.0b013e31815ff399

Frank E, Rothenberg R, Lewis C, Belodoff BF. Correlates of physicians’ prevention-related practices. Arch Fam Med. 2000;9:359–67. doi: https://doi.org/10.1001/archfami.9.4.359

Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009;43(2):89–92. doi: http://dx.doi.org/10.1136/bjsm.2008.055426

Hillsdon M. Brief health professional-provided interventions may lead to small improvements in physical activity. Evid Based Med. 2013;18(1):e1–2. doi: http://doi.org/ 10.1136/ebmed-2012-100761

Piazza J, Conrad K, Wilbur J. Exercise behavior among female occupational health nurses: influence of self efficacy, perceivedhealth control, and age. AAOHN J. 2001;49(2):79–86. doi: https://doi.org/10.1177/216507990104900204

Tsui JI, Dodson K, Jacobson TA. Cardiovascular disease prevention counseling in residency: resident and attending physician attitudes and practices. J Natl Med Assoc. 2004;96(8):1080–91. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568499/pdf/jnma00177-0076.pdf

Stanford FC, Durkin MW, Stallworth JR, Powell CK, Poston MB, Blair SN. Factors that influence physicians’ and medical students’ confidence in counseling patients about physical activity. J Prim Prev. 2014;35(3):193– 201. doi: https://doi.org/10.1007/s10935-014-0345-4

Buffart L, Van Der Ploeg H, Smith B, Kurko J, King L, Bauman A. General practitioners’ perceptions and practices of physical activity counselling: changes over the past 10 years. Br J Sports Med. 2009;43(14):1149–53. doi: http://dx.doi.org/10.1136/bjsm.2008.049577

Chakravarthy M V., Joyner MJ, Booth FW. An obligation for primary care physicians to prescribe physical activity to sedentary patients to reduce the risk of chronic health conditions. Mayo Clin Proc. 2002;77:165–73. doi: https://doi.org/10.4065/77.2.165

Petrella RoJ, Lattanzio, Chastity N, Overend TJ. Physical activity counseling and prescription among Canadian primary care physicians. Arch Intern Med. 2007;167(16):1774–81. doi: doi:10.1001/archinte.167.16.1774

Young A, Gray J, Ennis J. Exercise medicine’: the knowledge and beliefs of final‐year medical students in the United Kingdom. Med Educ. 1983;17(6):369–73. doi: https://doi.org/10.1111/j.1365-2923.1983.tb01122.x

McKenna J, Naylor P, McDowell N. Barriers to physical activity promotion by general practitioners and practice nurses. Br J Sports Med. 1998;32(3):242–7. doi: http://dx.doi.org/10.1136/bjsm.32.3.242

Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med. 2012;46(9):625–31. doi: http://dx.doi.org/10.1136/bjsports-2011-090734

Astley C, Pinto AJ, Bonfá E, Silva CAA, Gualano B. Gaps on rheumatologists’ knowledge of physical activity. Clinical Rheumatology 2021;40:2907–2911. doi: https://doi.org/10.1007/s10067-020-05540-3

Huijg JM, Gebhardt WA, Verheijden MW, van der Zouwe N, de Vries JD, Middelkoop BJC, et al. Factors influencing primary health care professionals’ physical activity promotion behaviors: a systematic review. Int J Behav Med. 2015;22(1):32–50. doi: https://doi.org/10.1007/s12529-014-9398-2

Association of American Meical Colleges. Medical school Graduation Questionnaire 2018 All Schools Summary Report [Internet]. 2018. Available from: https://www.aamc.org/download/490454/data/2018gqallschoolssummaryreport.pdf. Acesso em 20/05/19.

Scott CS, Neighbor WE. Preventive care attitudes of medical students. Soc Sci Med. 1985;21(3):299–305. doi: https://doi.org/10.1016/0277-9536(85)90105-4

Garry JP, Diamond JJ, Whitley TW. Physical activity curricula in medical schools. Acad Med. 2002;77:818–20. doi: http://doi.org/10.1097/00001888-200208000-00011.

Fowles JR, O’Brien MW, Solmundson K, Oh PI, Shields CA. Exercise is Medicine Canada physical activity counselling and exercise prescription training improves counselling, prescription, and referral practices among physicians across Canada. Appl Physiol Nutr Metab. 2018;43:535–9. doi: https://doi.org/10.1139/apnm-2017-0763

Solmundson K, Koehle M, McKenzie D. Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription. Can Med Educ J. 2016;7(2):e79–96. doi: https://doi.org/10.36834/cmej.36702

Bauman AE, Nelson DE, Pratt M, Matsudo V, Schoeppe S. Dissemination of physical activity evidence, programs, policies, and surveillance in the international public health arena. Am J Prev Med. 2006;31(Suppl 4):57–65. doi: https://doi.org/10.1016/j.amepre.2006.06.026

Frank E, McLendon L, Denniston M, Fitzmaurice D, Hertzberg V, Elon L. Medical students’ self-reported typical counseling practices are similar to those assessed with standardized patients. Medscape Gen Med. 2005;7(1):2. Disponíel em: https://www.medscape.com/viewarticle/497041

Connaughton A V, Weiler RM, Connaughton DP. Graduating medical students’ exercise prescription competence as perceived by Deans and Directors of Medical Education in the United States: implications for Healthy People 2010. Public Health Rep. 2001;116(3):226–34. doi: 10.1093/phr/116.3.226.

Williford HN, Barfield BR, Lazenby RB, Olson MS. A survey of physicians’ attitudes and practices related to exercise promotion. Prev Med (Baltim). 1992;21(5):630–6. doi: https://doi.org/10.1016/0091-7435(92)90070-X

Weiler R, Chew S, Coombs N, Hamer M, Stamatakis E. Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow’s doctors equipped to follow clinical guidelines? Br J Sports Med. 2012;46(14):1024–6. doi: http://dx.doi.org/10.1136/bjsports-2012-091380

Burke EJ, Hultgren PB. Will physicians of the future be able to prescribe exercise? J Med Educ. 1975;50(6):624–6. doi: 10.1097/00001888-197506000-00008.

Gasparini C. As 15 melhores faculdades de medicina do Brasil em 2018 [Internet]. Exame. 2019. Available from: https://exame.abril.com.br/carreira/as-15-melhores-faculdades-de-medicina-do-brasil-em-2018/. Acesso em 11/06/19.

Nawaz H, Petraro P V, Via C, Ullah S, Lim L, Wild D, et al. Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes. Med Educ Online. 2016;21(1):1–7. doi: https://doi.org/10.3402/meo.v21.29339

Antognoli EL, Seeholzer EL, Gullett H, Jackson B, Smith S, Flocke SA. Primary care resident training for obesity, nutrition, and physical activity counseling: a mixed-methods study. Health Promot Pract. 2017;18(5):672–80. doi: https://doi.org/10.1177/1524839916658025

Conroy MB, Delichatsios HK, Hafler JP, Rigotti NA. Impact of a preventive medicine and nutrition curriculum for medical students. Am J Prev Med. 2004;27(1):77–80. doi: https://doi.org/10.1016/j.amepre.2004.03.009

Pandya T, Marino K. Embedding sports and exercise medicine into the medical curriculum; a call for inclusion. BMC Med Educ. 2018;9:9–11. doi: https://doi.org/10.1186/s12909-018-1422-9

Gates AB. Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients. Br J Sports Med. 2015;49(4):207–8. doi: http://dx.doi.org/10.1136/bjsports-2014-094442

Dunlop M, Murray AD. Major limitations in knowledge of physical activity guidelines among UK medical students revealed: Implications for the undergraduate medical curriculum. Br J Sports Med. 2013;47(11):718–20. doi: http://dx.doi.org/10.1136/bjsports-2012-091891

Published

2023-06-29

Issue

Section

Artigos de Revisão/Review Articles

How to Cite

Reiss, D. B., Rezende, D. A. N., & Gualano, B. (2023). Medical knowledge about physical activity: a literature review. Revista De Medicina, 102(3), e-200521. https://doi.org/10.11606/issn.1679-9836.v102i3e-200521