Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals

Abstract

Americans are sitting more and moving less, with serious repercussions for health. Only 23% of Americans meet the recommended guidelines for both aerobic and strength training activities. The 2018 Physical Activity Guidelines Advisory Committee Scientific Report identifies the clinical setting as a scalable opportunity to influence population-level physical activity if effective approaches can be implemented, and specifically mentions exercise prescriptions/referrals. Exercise prescriptions are written prescriptions from clinicians involving specific physical activity recommendations, which may include referrals to exercise facilities and professionals. Using a mixed methods explanatory sequential design, data was collected and analyzed from quantitative surveys completed by 50 physicians and 12 exercise professionals, as well as semi-structured qualitative interviews with 7 physicians and 5 exercise professionals. The study site was a New England healthcare organization and its hospital-affiliated health & fitness center. This doctoral project identified evidence-based physician practices around exercise prescriptions/referrals to be writing prescriptions, identifying risk factors, tailoring prescriptions, refilling prescriptions, referring to exercise facilities/professionals, and using motivational interviewing. It concluded that limited time, concerns about costs to patients, insufficient training and confidence in providing appropriate prescriptions are barriers to physicians writing exercise prescriptions/referrals. It synthesized ten steps—focused around communication and collaboration, education and training, and tools and technology (e.g., electronic medical record systems)—that the study site and other healthcare organizations can take to address the barriers. The results demonstrated marked differences in physicians’ practices and comfort in referring based on facility type, with a higher mean comfort level referring to hospital-based versus community-based exercise facilities and professionals. A roadmap was developed for health & fitness centers—ten steps toward being facilities that physicians would trust to take good care of patients and help them achieve their health & fitness goals. Applying a social ecological lens to exercise prescriptions/referrals, this doctoral project examines the multilevel factors influencing individuals’ exercise behavior. It calls for more research on the impact of exercise prescriptions/referrals on patient exercise behavior and health outcomes. It raises the potential of framing exercise prescriptions/referrals within social prescribing and social determinants of health movements, as part of a larger discussion about connecting healthcare to community-based resources to improve population health.