title: Evaluation of internal medicine residents as exercise role models and associations with self-reported counseling behavior, confidence, and perceived success.
abstract: BACKGROUND
  Patients perceive physicians who practice healthy personal behaviors as more credible and better able to motivate patients to make healthy lifestyle choices.
  
  
  OBJECTIVE
  To evaluate internal medicine resident physicians as role models for promoting exercise by an assessment of physician physical activity behavior, cardiovascular fitness, physical activity knowledge, personal use of behavior modification techniques, attitudes toward personal physical activity practice, and confidence (i.e., self-efficacy) in the knowledge and personal utilization of behavior modification techniques and to explore the associations with self-reported patient counseling behavior, confidence, and perceived success.
  
  
  METHODS
  Cross-sectional study of internal medicine resident physicians with a self-administered survey, treadmill fitness testing, and a 7-day physical activity recall.
  
  
  RESULTS
  Fifty-one resident physicians agreed to participate (response rate = 81%). Fitness levels were below average for 60%, average for 25%, and above average or excellent for 15%. The mean energy expenditure was 234 kcal/kg/week, with 41% of physicians meeting recommended physical activity guidelines. Few reported high self-efficacy (33%) or perceived success (25%) in the ability to be regularly active. Few demonstrated adequate knowledge useful for patient counseling (e.g., listing 3 ways to integrate physical activity into daily life [27%], calculating target heart rate [29%], and identifying personal exercise stages of change [25%]). Personal use of behavior modification techniques was reported infrequently. Although 88% reported confidence in the knowledge of exercise benefits, less than half reported confidence in the knowledge of local facilities, American College of Sports Medicine (ACSM) guidelines, and behavior modification techniques. Multiple linear regression demonstrated that a higher level of training (p = .02) and a greater confidence in the knowledge of ACSM guidelines (p = .048, total R2 = .21) independently predicted more frequent self-reported counseling. Sex (i.e., male; p = .01) and greater physical activity self-efficacy (p = .017, total R2 = .23) independently predicted greater perceived counseling success. Greater physical activity enjoyment (p = .03) and greater perceived success at engaging in regular physical activity (p = .028, total R2 = .28) independently predicted greater counseling self-efficacy.
  
  
  CONCLUSIONS
  Most internal medicine resident physicians may not be adequate role models for promoting exercise adherence. Confidence in the knowledge of current guidelines, personal physical activity enjoyment, and perceived success and self-efficacy in engaging in regular physical activity may be useful targets for enhancing resident physician physical activity counseling for their patients.
authors.affiliation: Department of Medicine, Medical College Georgia, Augusta, Georgia, USA. lrogers@siumed.edu
authors.forename: Laura Q
authors.initials: LQ
authors.lastname: Rogers
authors.forename: Bernard
authors.initials: B
authors.lastname: Gutin
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Humphries
authors.forename: Christian R
authors.initials: CR
authors.lastname: Lemmon
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Waller
authors.forename: Tom
authors.initials: T
authors.lastname: Baranowski
authors.forename: Ruth
authors.initials: R
authors.lastname: Saunders
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001521:Behavior Therapy; D003376:Counseling; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D020377:Self Efficacy; D014481:United States