Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project

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Background: Sedentary lifestyle is associated with adverse health outcomes. Available evidence suggests that, despite positive attitudes toward regular exercise in promoting a healthy lifestyle, few physicians actually prescribe exercise for their patients. Barriers include lack of skills and standard office instruments. Because primary care physicians have regular contact with a large proportion of the population, the impact of preventive health interventions may be great. Objectives: To determine the effect of an exercise prescription instrument (i.e., Step Test Exercise Prescription [STEP]), compared to usual-care exercise counseling delivered by primary care doctors on fitness and exercise self-efficacy among elderly community-dwelling patients. Design: Randomized controlled trial; baseline assessment and intervention delivery with postintervention follow-up at 3, 6, and 12 months. Setting: Four large (>5000 active patient files) academic, primary care practices: three in urban settings and one in a rural setting, each with four primary care physicians; two clinics provided the STEP intervention and two provided usual care control. Participants: A total of 284 healthy community-dwelling patients (72 per clinic) aged >65 years were recruited in 1998-1999. Intervention: STEP included exercise counseling and prescription of an exercise training heart rate. Main outcome measures: The primary outcome measure was aerobic fitness (VO2max). Secondary outcomes included predicted VO2max from the STEP test, exercise self-efficacy (ESE), and clinical anthropometric parameters. Results: A total of 241 subjects (131 intervention, 110 control) completed the trial. VO2max was significantly increased in the STEP intervention group (11%; 21.3 to 24ml/kg/min) compared to the control group (4%; 22 to 23ml/kg/min) over 6 months (p <0.001), and 14% (21.3 to 24.9ml/kg/min) and 3% (22.1 to 22.8ml/kg/min), respectively, at 12 months (p <0.001). A similar significant increase in ESE (32%; 4.6 vs 6.8) was observed for the STEP group compared to the control group (22%; 4.2 vs 5.4) at 12 months (p < 0.001). Systolic blood pressure decreased 7.3% and body mass index decreased 7.4% in the STEP group, with no significant change in the control group (p <0.05). Exercise counseling time was significantly (p <0.02) longer in the STEP (11.7±3.0min) compared to the control group (7.1±7.0min), but more (p <0.05) subjects completed ≥80% of available exercise opportunities in the STEP group. Conclusions: Primary care physicians can improve fitness and exercise confidence of their elderly patients using a tailored exercise prescription (e.g., STEP). Further, STEP appears to maintain benefits to 12 months and may improve exercise adherence. Future study should determine the impact of combining cognitive/behavior change strategies with STEP. © 2003 American Journal of Preventive Medicine.




Petrella, R. J., Koval, J. J., Cunningham, D. A., & Paterson, D. H. (2003). Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. American Journal of Preventive Medicine, 24(4), 316–322.

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