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Exercise Advice for Men Falls on Deaf Ears

Study: Women likelier to take counseling to heart

TUESDAY, Aug. 7, 2001 (HealthDayNews) -- Counseling can induce women to increase their physical activity, but for some reason men don't seem to respond, a government study finds.

The two-year Activity Counseling Trial (ACT), sponsored by the National Heart, Lung and Blood Institute (NHLBI), produced results encouraging enough to urge doctors across the country to try the same methods for their inactive patients, says Dr. Denise Simons-Morton, deputy director of the NHLBI clinical applications and prevention program.

"We have shown that counseling about physical activity can improve fitness in women," says Simons-Morton. Why men did not show the same improvement is not known, she says.

"Maybe women are just more amenable to improving their lifestyles," she says.

A report in the Aug. 8 issue of the Journal of the American Medical Association says that medical research centers in California, Texas, and Tennessee recruited 874 men and women for ACT. All were physically inactive, meaning they did not follow the standard recommendation for at least 30 minutes of moderately intense physical activity five days a week. And while they had many risk factors for coronary disease -- more than 70 percent were overweight, a third had high blood pressure, and 20 percent had high blood cholesterol -- none had active cardiovascular disease.

A third of the participants got the kind of advice any doctor would give an inactive patient, a pep talk lasting two to four minutes and referral to a health educator for more information. Another third got the same treatment, plus behavioral counseling by a health educator, one telephone call, an electronic device to measure activity and a monthly newsletter. The third group got all that, plus regular telephone counseling and weekly classes about exercise and its benefits.

After two years, all participants filled out questionnaires about their physical activity and had their fitness measured by a treadmill test. The results for men were nil -- no more physical activity, no improvement in oxygen intake in the two active intervention groups compared with the group that got just advice. But women in the two active groups reported more physical activity and had a 5 percent improvement in oxygen intake on the treadmill test.

The fact that both moderate and more intensive intervention produced the same benefits was a surprise, Simons-Morton says. Looking on the bright side, she says, "This study provides evidence that if you sit down with patients and do counseling on a one-to-one basis, if you do that with women you can help them become more physically fit."

Dr. Christina C. Wee, an instructor in medicine at Harvard Medical School and author of an accompanying editorial, was less optimistic.

"The results are somewhat mixed," she says. "They are encouraging in the sense that this is the first study that is well done and shows that counseling that is this intensive can make a difference. But the differences are quite small, and even in women the improvement is small. There is a lot of effort for a small improvement."

The counseling needed to show that improvement was "fairly aggressive and intensive," and "perhaps more than any primary care physician can offer patients," Wee says.

Nevertheless, she says, "From a public health point of view, even a small improvement could have important implications if counseling is done throughout the country."

Efforts to do that are under way, Simons-Morton says. "We at NHLBI are taking the interventional materials and refining them for distribution nationally, so primary care physicians should be able to use the same materials we used in ACT," she says. The material will be made available in about a year, she says.

What To Do

Study after study has shown that activity as basic as a 30-minute brisk walk five days a week can produce a significant reduction in the risk of cardiovascular disease.

Information about physical activity and its benefits for the heart and lungs is available from the American Heart Association and the American Council on Exercise.

SOURCES: Interviews with Denise G. Simons-Morton, M.D., Ph.D., deputy director, NHLBI clinical applications and prevention program, Bethesda, Md., and Christina C. Wee, M.D., instructor in medicine, Harvard Medical School, Boston; Aug. 8, 2001, Journal of the American Medical Association
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