Physical Activity Counseling: Assessment of Physical Activity By Questionnaire

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1 European Journal of Sport Science, vol. 2, issue 4 Physical Activity Counseling / by Human Kinetics Publishers and the European College of Sport Science Physical Activity Counseling: Assessment of Physical Activity By Questionnaire Ingrid Frey and Aloys Berg Regular physical activity is regarded as an important component of a healthy lifestyle. Nevertheless, most adults remain essentially sedentary. Counseling by healthcare providers has the potential to increase physical activity in sedentary individuals. For effective counseling, healthcare professionals will need information on current recommendations on physical activity, and on the client s current level of physical activity and motivational readiness for change. A standardized questionnaire can be a helpful tool to assess physical activity levels. Administered by interview, the questionnaire will facilitate documentation and analysis of the client s physical activity patterns and will also provide information on the individual stage of motivational readiness for change. According to information derived from the questionnaire, appropriate interventions can be selected. Key Words: physical activity, counseling, recommendations, questionnaire Key Points: 1. Physical activity counseling by health care professionals is expected to promote physical active lifestyle in sedentary individuals. 2. Effective counseling will need information on current recommendations on physical activity, on individual s activity patterns and on the individual s stage of motivational readiness for change. 3. Assessment of physical activity by questionnaire can support counseling in many respects. Regular physical activity is regarded as an important component of a healthy lifestyle. New scientific evidence links regular physical activity to a wide array of physical and mental health benefits (8). Despite this evidence, most adults remain essentially sedentary. To promote a physically active lifestyle, especially among inactive members of the population, effective interventions are needed. Evidence is accumulating that behavioral-based physical activity intervention can be effective (4, 11). In this context, physical activity counseling by the primary care physician seems to be a promising approach. Some studies demonstrated that physician counseling was associated with a (short-term) increase in patients physical activity levels (3, 16). It is possible that counseling from a healthcare professional is salient to patients because of perceived physician credibility and authority. The authors are with the Department of Prevention, Rehabilitation and Sports Medicine in the Center of Internal Medicine at the University of Freiburg, Hugstetter Str. 55, D Freiburg, Germany. 1

2 2 / Frey and Berg Figure 1 Factors determining physical activity counseling. For effective counseling, healthcare professionals will need the following essential information: profound knowledge of current recommendations on physical activity, detailed information on the participant s current level of physical activity, and information on the participant s individual stage of motivational readiness for change (Figure 1). Current Recommendations on Physical Activity To encourage increased participation in physical activity among the general population, the Centers for Disease Control and Prevention and the American College of Sports Medicine issued a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention (14): Every American adult should accumulate 30 minutes of moderate intensity physical activity over the course of most, preferably all days of the week. (This approach is consistent with recommendations in the NIH consensus report on physical activity and health; see 17.) According to this recommendation, the total daily energy expenditure should be expanded to approximately 2 kcal/kg/d (14 kcal/kg/w). There are different ways to meet this recommendation, including a moderate activity approach and a vigorous exercise approach (or a combination of the two). The moderate approach encourages fitting more physical activity into one s daily routine by taking walks, climbing stairs, and engaging in more physically active leisure time. Multiple episodes of moderate intensity physical activity can be accumulated in sessions of at least 10 min to reach the total of 30 min a day (7, 12). The vigorous exercise approach involves more formal exercise modes. An increase in total energy expenditure of at least 14 kcal/kg/w can be accomplished by performing exercise three times a week for min per session at an intensity of 60 70% of maximal oxygen uptake.

3 Physical Activity Counseling / 3 The health benefits gained from increased physical activity depend on the initial activity level. Sedentary individuals are expected to benefit most from increasing their activity to the recommended level. People who already meet the basic recommendation are also likely to derive some additional health and fitness benefits from becoming more physical active (9). Epidemiological research has shown that maximum health benefits will be met when an energy expenditure of 4 7 kcal/kg/d (30 50 kcal/kg/w) is reached through increased engagement in everyday activities, recreational activities, and sports (10, 13). Assessment of Physical Activity Knowledge of the participant s current level of physical activity is essential in every counseling session. This raises the question of how physical activity should be assessed. Valid and appropriate measurement of physical activity is a challenging task, because physical activity is a highly variable component and is comprised of activities of daily living, sports and leisure, and occupational activities. In practice, standardized questionnaires can be very helpful in documenting and analyzing physical activity levels. If one wants to compare individual activity levels with the current recommendations on physical activity, the applied questionnaire has to ask about everyday activities as well as formal exercise modes and should also allow estimation of energy expenditure. The previously published original, as well as the modified (shortened) version of the Freiburger Questionnaire on Physical Activity, meet these criteria (5, 6). The shortened version of the questionnaire includes eight questions. The first question asks for occupational physical activity (rating: mostly sitting, moderate movement, or intensive movement). The following questions focus on physical activities during leisure time (e.g., habitual walking and cycling, gardening, stairclimbing, recreational activities and sports). Participants are asked to report the amount of time spent in the different activities over the past 7 days (everyday activities), respectively, and the past month (sport and recreational activities). Subsequent to the documentation of the physical activities, data can be analyzed and compared with the recommended physical activity goals. As mentioned above, physical activity goals often are expressed as total energy expenditure per day or week. An estimate of energy expenditure can be derived by multiplying hours of reported activity by the average intensity (expressed in MET). One MET represents the metabolic rate of an individual at rest (approximately 3.5 ml O 2 /kg/min, or 1 kcal/kg/h). Energy requirements for specific physical activities can be taken from widely available and comprehensive lists (1, 2). Our shortened questionnaire provides a table that facilitates the estimation of energy expenditure. In this table, energy requirements (MET) correspond to physical activities listed in the questionnaire. Knowing the time spent in the specific activity, one can easily determine the appropriate energy expenditure (expressed in MET-hours per week). Total weekly energy expenditure can be calculated by summating all MET-hours per week. These results can then be compared with current recommendations for physical activity, and individual activity patterns can be rated. To facilitate the rating of individual activity patterns, the Freiburger questionnaire provides a score. With this score, the participant s current level of activity can be rated as: not active enough (<15 MET-h per week), meets the basic goal according

4 4 / Frey and Berg to public health recommendation for physical activity (15 30 MET-h per week), and satisfactorily active (>30 MET-h per week). Analyzing physical activity patterns also provides insight into the individual stage of motivational readiness for change, which in turn helps to develop appropriate interventions. Individual Stage of Motivational Readiness for Change The transtheoretical model describes behavior change as a process running through different stages (15). These stages (of motivational readiness for change) are: precontemplation, contemplation, preparation, action, and maintenance. Each stage requires specific intervention techniques. Physical activity precontemplation means that the individual is not interested in becoming more active. Precontemplators will profit from talking about advantages and disadvantages of being physically active. The aim of the counseling is to raise the client s awareness of the problem and to acknowledge the need for action. Contemplators intend to become physically active; however, they lack precise perceptions of how to achieve this. In this case, counseling should focus on reflecting participant motivation and discussing factors that could inhibit or promote readiness for change. The aim of the counseling is to emphasize the personal benefit of being physically active and to increase motivation. In the stage of preparation, individuals are occasionally, but not regularly, physically active. Individuals may need encouragement to put plans into practice for example, by defining realistic goals, planning, self-monitoring, and self-reinforcement. The aim is to support the transfer of ideas into one s everyday routines. Individuals in the stage of action are regularly active but not sure that their behavior will be consistent. Within this group, focus should be shifted to relapse prevention (e.g., social support, provision of coping strategies). Being in the stage of maintenance means that one is regularly physically active and that physical activity is part of the individual s lifestyle. Conclusion Effective physical activity counseling should be targeted at different personal factors including cognitions, emotions, and self-regulatory skills. The implementation of a suitable questionnaire in physical activity counseling can be very helpful. Administered by interview, the questionnaire will help participants to reflect on their own physical activity patterns. This will raise the client s awareness of his or her present level of physical activity and possible need for change. The detailed assessment will lead to profound knowledge of the participant s current level of physical activity and provide information about the participant s stage of motivational readiness. This essential information is crucial for devising appropriate intervention strategies. As the process of changing behavior patterns takes time and relapses may occur at different stages, it is unlikely that one session of counseling will lead to long-lasting success. Regular review at certain intervals is therefore important. Repeated application of a standardized questionnaire facilitates the comparison of activity patterns. Changes in behavior become apparent and self-monitoring is supported, which has an impact on motivation.

5 Physical Activity Counseling / 5 Physical activity counseling supported by questionnaire is a promising approach to enhance participants ability to integrate physical activity into their daily life. References 1. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR, Jr., Montoye HJ, Sallis, JF, Paffenbarger RS, Jr Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25: Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O Brien WL, Bassett DR, Jr., Schmitz KH, Emplaincourt PO, Jacobs DR, Jr., Leon AS Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl.):S498-S Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med 25: Eaton CB, Menard LM A systematic review of physical activity promotion in primary care office settings. Br J Sports Med 32: Frey I, Berg A Erfassung der körperlichen aktivität in klinik und praxis. In: Samitz GMG, editor. Körperliche aktivität in prävention und therapie. München: Hans Marseille Verlag GmhH. p Frey I, Berg A, Grathwohl D, Keul J Freiburger fragebogen zur körperlichen aktivität entwicklung, prüfung und anwendung. Soz Präventivmed 44: Hardman AE Issue of fractionization of exercise (short vs long bouts). Med Sci Sports Exerc 33:S421-S Kesaniemi YK, Danforth E, Jr., Jensen MD, Kopelman PG, Lefebvre P, Reeder BA Dose-response issues concerning physical activity and health: an evidence-based symposium. Med Sci Sports Exerc 33(6 Suppl.):S351-S Lee IM, Hsieh CC, Paffenbarger RS, Jr Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA 273: Leon AS, Casal D, Jacobs D Effects of 2,000 kcal per week of walking and stair climbing on physical fitness and risk factors for coronary heart disease. J Cardiopulmonary Rehabil 16: Marshall SJ, Biddle SJ The transtheoretical model of behavior change: a metaanalysis of applications to physical activity and exercise. Ann Behav Med 23: Murphy MH, Hardmann AE Training effects of short and long bouts of brisk walking in sedentary women. Med Sci Sports Exerc 30: Paffenbarger RS, Jr., Hyde RT, Wing AL, Hsieh CC Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 314: Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH Physical activity and public health. JAMA 273: Prochaska JO, Velicer WF The transtheoretical model of health behavior change. Am J Health Promot 12: Steptoe A, Doherty S, Rink E, Kerry S, Kendrick T, Hilton S Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. BMJ 319:

6 6 / Frey and Berg 17. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: Author.

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