Physical activity recommendation by health care providers to adults with and without functional limitations

Highlights

• Health care providers recommend physical activity to about one-third of all adults

• Health care providers recommend physical activity to almost half of adults with functional limitations

• The health care setting can be leveraged for behavior changes like increasing physical activity

Abstract

Adults with functional limitations are more likely to be physically inactive than those without functional limitations, despite evidence that regular physical activity (PA) slows the progression of functional decline. The health care setting provides an opportunity to communicate with patients about positive behavior changes, including increased PA, but there is little information about provider recommendation for PA to adults with functional limitations. This study investigated health care provider recommendation to increase PA among adults with and without functional limitations.

Adults (≥18 years) who participated in the 2016 National Health Interview Survey and reported ≥1 primary care encounter within the previous 12 months were included (unweighted n = 23,540; weighted N = 170,004,764). Receipt of PA recommendation and physical functioning limitations were self-reported. Statistical analyses were weighted to account for complex survey sampling design.

One-third (35.88%) of adults received a PA recommendation and 19.71% reported functional limitations. Adults who received a PA recommendation were more likely to have a functional limitation than those who did not (28.64% vs. 14.70%; p < 0.001), even after adjusting for covariates and current activity level (aOR = 1.48; 95% CI:1.33,1.65). PA recommendation for those with functional limitations appeared to increase during middle age and peak for adults aged 65–75 years (57.01%) but declined substantially for adults ≥75 years.

Only one-third of adults in the United States received PA recommendations. Health care providers recommended PA to approximately half of adults with functional limitations. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adults.

Introduction

Insufficient physical activity is a leading risk factor for chronic conditions, including heart disease, obesity, and type 2 diabetes (Booth et al., 2012; Centers for Disease Control and Prevention, 2019a). Regular physical activity improves brain health, prevents cancer, boosts cardiometabolic health, and prevents weight gain (Di Liegro et al., 2019; Lee, 2003; Camhi et al., 2011; Fogelholm and Kukkonen-Harjula, 2000). The U.S. Department of Health and Human Services recommends that adults achieve ≥150 min of moderate-intensity or ≥ 75 min of vigorous-intensity physical activity, along with muscle strengthening activities, each week (U.S. Department of Health and Human Services, 2018a). However, more than 80% of adults fail to meet aerobic and muscle strengthening guidelines and approximately one-third of adults in the United States report no physical activity during a usual week (U.S. Department of Health and Human Services, 2020a; U.S. Department of Health and Human Services, 2018b).

In the United States, 16.3% of adults experience physical functioning limitations(Centers for Disease Control and Prevention, 2019b) and less than half of adults in the United States with a functional limitation engage in aerobic activity (NTD et al., 2020; Kamil-Rosenberg et al., 2019). Further, there are significant differences in physical activity for adults with a disability or functional limitations across age groups (Kamil-Rosenberg et al., 2019). Physical activity is important for all adults, including those with functional limitations, because physical activity can prevent or delay age-related declines in functioning. Increasing physical activity among those with functional limitations can also lead to related health benefits, including increased strength, improved cardiovascular function, reduced stress and depression, reduced joint swelling, and improved pain management (U.S. Department of Health and Human Services, 2020b; Centers for Disease Control and Prevention, 1999). The majority of physically active adults with functional limitations were adults during their middle age years (aged 45–64 years) (NTD et al., 2020). This demographic pattern differs from physical activity in the larger population, where younger adults report more activity than other age groups (Centers for Disease Control and Prevention, 1999) and men tend to be more active than women (Ham and Ainsworth, 2010; Basterfield et al., 2010).

One method for increasing physical activity among all adults, including those with functional limitations or disability, is through recommendation by a health care provider. The health care setting is a unique opportunity to support healthy behaviors like physical activity because physicians meet with patients face-to-face and can make in-person recommendations to increase preventive health behaviors like screening or engagement in physical activity (Auyoung et al., 2016). In fact, Healthy People 2030, the U.S. Preventive Services Task Force, and the National Council for Behavioral Health recommend that physicians should include physical activity education and counseling during regular office visits (U.S. Department of Health and Human Services, 2020a; U.S. Preventive Services. Recommendation, 2017). This is particularly relevant for adults with arthritis and/or obesity (U.S. Department of Health and Human Services, 2020c; U.S. Department of Health and Human Services, 2020d).

Previous surveillance work has shown that approximately 44% of adults with disabilities receive a recommendation to increase physical activity from their health care provider (Carroll et al., 2014). Functional limitations are a known intermediary between risk factors, such as chronic disease or impairment, and disability (Lawrence and Jette, 1996). It is unclear if recommendations for physical activity to persons with functional limitations differ by sex, age, or other sociodemographic characteristics. Using a representative sample of U.S. adults, the purpose of this paper is to determine the prevalence of adults who received a recommendation from a health care provider to increase physical activity, and determine if recommendations differed by functional limitation status, age, or other sociodemographic characteristics.