nurse pa

7172019 Nurse PA

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22 CANADIAN983085NURSECOM

P E E R - R E V I E W E D F E A T U R E

By KIMBERLEY LAMARCHE and JEFF VALLANCE

PRESCRIPTION FORPHYSICAL ACTIVITY

A SURVEY OF CANADIAN NURSE PRACTITIONERS

I S T O C K P H O T O T H I N K S T O C K

Although nurse practitioners are well placed to counsel patients about getting enough exercise little

is known about their attitudes and practice in this area of health promotion The authors used a self-administered Internet-based questionnaire to explore how Canadian NPs perceive their competence in prescribing physical

activity and the importance they ascribe to doing so Participants were asked to identify factors that most commonly prompt

physical activity prescription Overall the respondents felt fairly competent in their ability to prescribe physical activity

(mean score 4496 SD 9 ) and felt that this function was important (mean score 426 SD 5) Competence in

prescribing physical activity and a perception that this intervention is important were both positively correlated with frequency

of prescribing The most commonly reported barrier to prescribing physical activity was a lack of time On average respondents

prescribed physical activity to 59 per cent of their patients The patient factors that most commonly prompted physical activity

prescription were overweight or obesity type 2 diabetes hypertension and cardiovascular health The lack of specic education

in preventive medicine (eg obesity prevention physical activity nutrition) reported by 6 per cent of respondents points to

the need for a physical activity prescription curriculum within nursing education to equip future NPs to respond to the high

prevalence of physical inactivity in Canadian society

abstract

7172019 Nurse PA


23OCTOBER 2013 VOLUME 109 NUMBER 8

any Canadians do not engage in physical activity of sufficient

frequency intensity or duration to achieve the well-documented

health bene1047297ts of regular physical activity Given the importance

of health promotion to their professional role nurse practitioners

(NPs) are well placed to counsel patients about physical exercise

(Peterson 2007) However little is known about NPsrsquo perceptions

and practice with regard to prescribing physical activity Weundertook this study to explore how Canadian NPs perceive their competence in

this area the importance they ascribe to prescribing physical activity and how

commonly they do so We also wanted to identify the factors or circumstances

that most commonly prompt NPs to prescribe physical activity

HEMERATHINKSTOCK

METHODS

Data collection We collected cross-

sectional data from Canadian NPs

using the online survey platform

SurveyMonkey Invitations to parti-

cipate were sent through nursing

associations nursing regulators NP

interest groups and national NP

electronic mailing lists o protect the

con1047297dentiality of membership and

mailing lists the invitations were sent

directly by the participating groups

the actual number of invitations sent

and received is therefore not known

Te invitation contained a link to theonline survey form A reminder was

sent one week after the initial invi-

tation Consent was implied by

completion and submission of the

questionnaire

Measures Socio-demographic

information was gathered by means

of survey questions concerning the

respondentrsquos age sex body mass index

(BMI) years in practice as a registered

nurse and NP and previous edu-cation in preventive medicine

(eg obesity prevention physical

activity nutrition)

Te respondentsrsquo level of physical

activity was assessed using a modi1047297ed

Leisure Score Index (LSI) from the

Godin Leisure-ime Exercise Ques-

tionnaire (GLEQ) (Godin Jobin amp

Bouillon 1986 Godin amp Shephard

1985) Te LSI assesses the average

frequency and duration of mild mod-

erate and strenuous exercise during

leisure time over a typical week Te

validity of the GLEQ is well esta-

blished (Jacobs Ainsworth Hartman

amp Leon 1993) From these data we

calculated the average weekly physical

activity of each respondent and the

overall average for the study sample

Te degree of involvement in phy-

sical activity counselling was assessed

with an open-ended question that

asked respondents to specify the

percentage of their current patients

to whom they prescribed physical

activity Te respondentsrsquo perceptionof their competence to provide such

counselling and the importance they

ascribed to this aspect of their prac-

tice were assessed using the Exercise

and Physical Activity Competence

Questionnaire (Connaughton Weiler

amp Connaughton 2001) Te EPACQ

is a 17-item questionnaire originally

designed to assess the perceptions of

deans and medical school directors

with regard to the competence of

medical students in exercise prescrib-

ing (Part A) the importance of

exercise prescription (Part B) and the

medical school curriculum related to

exercise prescription (Part C) For the

purposes of our study we adapted the

12 items that comprise Parts A and B

In part A respondents rated their

competence using a 6-point Likert

scale (1 = not competent 6 = verycompetent) in the following skills with

respect to screening and advising heal-

thy adults (1) conducting a physical

exam to approve the patient to begin

a physical activity program (2) deter-

mining the maximum heart rate mdash

7172019 Nurse PA



the point at which a person is

lsquostrainingrsquo during physical activity

(3) determining daily caloric and

nutritional needs (4) determining

BMI (5) calculating the aerobic

training heart rate range (6) design-

ing a physical activity prescriptionincluding frequency duration and

intensity In Part B respondents

again used a 6-point Likert scale

(1 = not important 6 = very impor-

tant) to rate the importance they

ascribed to being able to perform

the six skills presented in Part A

Items for these two scales were

drawn from the ACSM Guidelines

for Exercise esting and Prescription

(Connaughton et al 2001)

Open-ended questions were usedto assess the respondentsrsquo beliefs

with regard to prescribing physical

activity speci1047297cally they were asked

to identify the main advantages and

disadvantages of prescribing physical

activity and the factors they thought

would make it easier or more difficult

to prescribe physical activity

Statistical analyses Statistical

analyses were performed using SPSS

version 20 (SPSS Inc Chicago IL)

Means and percentages were calcu-

lated for the socio-demographic

variables o test for the strength of

any correlations between the depen-

dent variables (beliefs about compe-

tence and importance) and theindependent variables (socio-demo-

graphic characteristics) we calculated

Pearsonrsquos r a measure of the strength

of a relationship between two vari-

ables We then conducted a multivari-

ate analysis of variance (MANOVA)

for independent variables shown to

have a statistically signi1047297cant associ-

ation with the composite scores for

perceived competence and perceived

importance

Responses to open-ended ques-tions were categorized by theme

RESULTS

One hundred forty-eight NPs

completed the survey 97 per cent of

respondents were women and 61 per

cent were masterrsquos prepared Eleven

provinces and territories were repre-

sented the largest proportion of

respondents (23) were from

Saskatchewan Approximately 87 per

cent of respondents were working full

time at the time of the study With

respect to work setting 34 per centof respondents reported that they

worked in a community health centre

Approximately 74 per cent of respon-

dents identi1047297ed their primary area of

responsibility (ie patient group) as

ldquofamilyall agesrdquo

Overall 63 per cent of respon-

dents indicated that during their

nursing studies they had received

no formal education (such as a course

or a module within a course) thatspeci1047297cally addressed preventive

medicine Te responses to questions

about the respondentsrsquo own level of

physical activity indicated that 56 per

cent were meeting current guidelines

for at least 150 minutes weekly of

moderate or vigorous exercise in

sessions lasting 10 minutes or more

On average respondents reported

that they were prescribing physical

activity to approximately 59 per cent

of patients seen About 58 per cent ofrespondents indicated they intended

in the future to prescribe physical

activity to their patients

Te mean scores for respondentsrsquo

perceptions regarding their compe-

tence in physical activity prescribing

and the importance they attached to

this function are shown in able 1

Overall the respondents felt fairly

competent in their ability to prescribe

physical activity (mean score 449

60 SD = 90) and felt that it wasimportant to discuss physical activity

with their patients (mean score

48260 SD = 85) Perceived com-

petence was positively correlated with

the number of minutes spent on

exercise in a week (r = 18 p = 031)

meeting guidelines for exercise (r =

23 p = 007) and current frequency

of physical activity prescribing (r =

24 p = 003) Perceived importance

was positively correlated with current I S T O C K P H O T O T H I N K S T O C K

7172019 Nurse PA


frequency of physical activity pre-

scribing (r = 18 p = 032) While

these correlations are small the level

of signi1047297cance indicates that these

1047297ndings are not due to chance

MANOVA showed a statistically

signi1047297cant association betweenmeeting guidelines for exercise and

the respondentsrsquo perceptions con-

cerning physical activity prescribing

that is those who met exercise

guidelines were more likely to rate

their competence in physical activity

prescribing highly and to view this

function as important [Wilksrsquo =

0955 F(2139) = 3311 p = 0039] A

signi1047297cant association was present

only for perceived competence NPs

who met current guidelines with

respect to their own levels of exercise

rated their competence in prescribing

physical activity signi1047297cantly higher

than NPs who did not meet theseguidelines (M

diff = 377 p = 0012)

Te factors most commonly

reported by survey respondents as

prompting them to prescribe physical

activity were as follows overweight or

obesity (119 responses) type 2

diabetes (54) hypertension (44) and

cardiovascular health (41) Te 1047297ve

most commonly mentioned ldquodisad-

vantagesrdquo of prescribing physical

activity to patients were lack of time

(46 responses) lack of patientcompliance or of followup (16) lack

of knowledge about prescribing

physical activity (15) risk of offend-

ing patients (10) and lack of patient

readiness (7) However 37 respon-

dents replied that there were no

disadvantages Te 1047297ve most com-

monly mentioned advantages of

prescribing physical activity were an

increase in the patientrsquos overall

physical health (27 responses)prevention of chronic illness (25)

achieving or maintaining a healthy

weight (20) improvement with

respect to chronic disease (19) and

improvement in mental health (17)

DISCUSSION

o our knowledge this is the 1047297rst

study to examine the beliefs of

Canadian NPs with respect to physical

activity prescribing and the preva-

lence of this function within NPpractice Our 1047297nding that NPs

ascribed high importance to prescrib-

ing physical activity (mean score 482

on a 6-point scale) is consistent with

the 1047297ndings of a US study in which

92 per cent of NPs surveyed perceived

that exercise counselling was as

valuable a component of their practice

as the prescribing of medications

(ompkins Belza amp Brown 2009)

Te moderately high rating that our

respondents gave to their competencein this area (mean score 449 on a

6-point scale) is also consistent with

the results of two other US studies

Grimstvedt (2011) reported an

overall score for NPsrsquo con1047297dence in

exercise counselling of 37 on a scale

of 5 and Vickers Kircher Smith

Petersen and Rasmussen (2007)

reported that approximately 86 per

cent of their sample of NPs were

con1047297dent in counselling on health

Skill Competence mean (SD) Importance mean (SD)

Conducting a physical exam toapprove the individual to begin

a physical activity program

Determining maximum heart rate

Determining daily caloric andnutritional needs

Determining body mass index

Calculating aerobic trainingheart rate range

Designing a physical activityprescription including frequencyduration and intensity

Overall mean score

SD standard deviationAll skills were rated on a scale from 1 (not competentimportant) to 6 (very competentimportant)

Table 1 Nurse practitionersrsquo perceptions of their competence in and the importance ofskills related to prescribing physical activity for a healthy adult

52 ( 97) 526 ( 9)

442 ( 4) 475 (116)

(1 ) 462 (112)

575 ( 59) 5 (17)

91 (145) 45 (121)

97 (1 ) 476 (122)

449 (090) 482 (085)

ISTOCKPHOTOTHINKSTOCK

7172019 Nurse PA


REFERENCES

counseling patterns of adult nurse practitioners Journal of the American Academy of Nurse Practitioners 19 (2) 86-92

Connaughton A V Weiler R M amp Connaughton D P (2001) Graduatingmedical studentsrsquo exercise prescription competence as perceived by deansand directors of medical education in the United States Implications forHealthy People 2010 Public Health Reports 116(3) 226-234

Dauenhauer J A Podgorski C A amp Karuza J (2006) Prescribing exercise forolder adults A needs assessment comparing primary care physicians nursepractitioners and physician assistants Gerontology amp Geriatrics Education26(3) 81-99

Douglas F Torrance N van Teijlingen E Meloni S amp Kerr A (2006) Primarycare staffrsquos views and experiences related to routinely advising patientsabout physical activity A questionnaire survey BMC Public Health 6 138

Godin G Jobin J amp Bouillon J (1986) Assessment of leisure time exercisebehavior by self-report A concurrent validity study Canadian Journal ofPublic Health 77 (5) 359-362

Godin G amp Shephard R J (1985) A simple method to assess exercise behavior

in the community Canadian Journal of Applied Sport Sciences 10(3) 141-146

Grimstvedt M (2011) Physical activity counseling knowledge attitudes andpractices among nurse practitioners and physician assistants (Unpublisheddoctoral dissertation) Arizona State University Phoenix AZ

Jacobs D R Jr Ainsworth B E Hartman T J amp Leon A S (1993) A simultaneous evaluation of 10 commonly used physical activityquestionnaires Medicine and Science in Sports and Exercise 25(1) 81-91

Peterson J A (2007) Get moving Physical activity counseling in primary care Journal of the American Academy of Nurse Practitioners 19 (7) 349-357

Tompkins T H Belza B amp Brown M-A (2009) Nurse practitioner practicepatterns for exercise counseling Journal of the American Academy of NursePractitioners 21(2) 79-86

Vickers K S Kircher K J Smith M D Petersen L R amp Rasmussen N H(2007) Health behavior counseling in primary care Provider-reported rate Family Medicine 39 (10) 730-735


KIMBERLEY LAMARCHE RN NP DNP IS AN ASSISTANT

PROFESSOR FACULTY OF HEALTH DISCIPLINES

ATHABASCA UNIVERSITY

JEFF VALL ANCE PhD IS AN ASSOCIATE PROFESSOR

FACULTY OF HEALTH DISCIPLINES ATHABASCA

UNIVERSITY HE IS A TIER 2 CANADA RESEARCH CHAIR

IN HEALTH PROMOTION AND CHRONIC DISEASE

MANAGEMENT AND AN ALBERTA INNOVATES mdash HEALTH

SOLUTIONS POPULATION HEALTH INVESTIGATOR

behaviours that they engaged in

themselves In the Vickers et al study

no differences between NPs who met

current guidelines for physical activity

and those who did not were found

with respect to their perceptions of

their clinical competence in this areaor their views of its importance

however NPsrsquo views of their compe-

tence in prescribing exercise were

strongly correlated with their own

level of physical activity

Our 1047297nding that 63 per cent of

respondents had not received any

speci1047297c training in preventive

medicine during their undergraduate

and NP education is consistent with

survey 1047297ndings from the US In a

survey involving primary care

providers (physicians physician

assistants and NPs) 85 per cent of

respondents said that they had no

formal training in exercise prescrip-

tion (Dauenhauer Podgorski amp

Karuza 2006) In Grimstvedtrsquos study

(2011) 75 per cent of NPs and

physician assistants reported that

they routinely counselled patients

about physical activity about half

(51) reported that they had receivedtraining in this area and nearly three-

quarters (72) indicated they were

interested in receiving additional

education in physical activity counsel-

ling In a survey of NPs conducted

by Buchholz and Purath (2007)

61 per cent of respondents said they

had received no training in physical

1047297tness counselling

NPs are ideally placed to prescribe

physical activity In view of the fact

that only 59 per cent of thosesampled were currently engaging in

physical activity prescription future

work needs to be directed at raising

awareness and improving education

exposure with respect to physical

activity prescription However the

literature points to a lack of guide-

lines for physical activity prescription

Douglas orrance van eijlingen

Meloni and Kerr (2006) reported

that the NPs they surveyed had

insufficient educational materials

available NPs need consistent

evidence-based information to

support their competence in this area

Further exploration of educational

tools to assist them in managing

chronic illness with physical activity

prescription is warranted

Te most commonly reported

barrier to counselling patients about

physical activity was lack of time

Tere is a need to ensure that NPs andother health-care providers under-

stand that time allocated to such

counselling is well invested as it can

result in positive measurable health

outcomes Our 1047297ndings also point to

the need for a physical activity pre-

scription curriculum within nursing

education to equip future NPs to

respond to the high prevalence of

physical inactivity in Canadian

society Tere is still a gap between

evidence-based guidelines for healthylevels of physical activity and the

application of those guidelines in

clinical practice

Limitations of our study include

its small sample size and reliance on

self-reporting and the uneven repre-

sentation across the provinces and

territories Larger studies with

Canada-wide representation will help

us gain a clearer understanding of the

challenges faced by NPs in the realm

of physical activity prescription and

ultimately will help NPs engage in

productive discussions with their

patients about their physical 1047297tness

Finally speci1047297c interventions to

promote and improve physical acti-

vity counselling should be a focus

for future research

7172019 Nurse PA


C o p y r i g h t o f C a n a d i a n N u r s e i s t h e p r o p e r t y o f C a n a d i a n N u r s e s A s s o c i a t i o n a n d i t s c o n t e n t

m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e c o p y r i g h t

h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l a r t i c l e s f o r

i n d i v i d u a l u s e

7172019 Nurse PA


23OCTOBER 2013 VOLUME 109 NUMBER 8

any Canadians do not engage in physical activity of sufficient

frequency intensity or duration to achieve the well-documented

health bene1047297ts of regular physical activity Given the importance

of health promotion to their professional role nurse practitioners

(NPs) are well placed to counsel patients about physical exercise

(Peterson 2007) However little is known about NPsrsquo perceptions

and practice with regard to prescribing physical activity Weundertook this study to explore how Canadian NPs perceive their competence in

this area the importance they ascribe to prescribing physical activity and how

commonly they do so We also wanted to identify the factors or circumstances

that most commonly prompt NPs to prescribe physical activity

HEMERATHINKSTOCK

METHODS

Data collection We collected cross-

sectional data from Canadian NPs

using the online survey platform

SurveyMonkey Invitations to parti-

cipate were sent through nursing

associations nursing regulators NP

interest groups and national NP

electronic mailing lists o protect the

con1047297dentiality of membership and

mailing lists the invitations were sent

directly by the participating groups

the actual number of invitations sent

and received is therefore not known

Te invitation contained a link to theonline survey form A reminder was

sent one week after the initial invi-

tation Consent was implied by

completion and submission of the

questionnaire

Measures Socio-demographic

information was gathered by means

of survey questions concerning the

respondentrsquos age sex body mass index

(BMI) years in practice as a registered

nurse and NP and previous edu-cation in preventive medicine

(eg obesity prevention physical

activity nutrition)

Te respondentsrsquo level of physical

activity was assessed using a modi1047297ed

Leisure Score Index (LSI) from the

Godin Leisure-ime Exercise Ques-

tionnaire (GLEQ) (Godin Jobin amp

Bouillon 1986 Godin amp Shephard

1985) Te LSI assesses the average

frequency and duration of mild mod-

erate and strenuous exercise during

leisure time over a typical week Te

validity of the GLEQ is well esta-

blished (Jacobs Ainsworth Hartman

amp Leon 1993) From these data we

calculated the average weekly physical

activity of each respondent and the

overall average for the study sample

Te degree of involvement in phy-

sical activity counselling was assessed

with an open-ended question that

asked respondents to specify the

percentage of their current patients

to whom they prescribed physical

activity Te respondentsrsquo perceptionof their competence to provide such

counselling and the importance they

ascribed to this aspect of their prac-

tice were assessed using the Exercise

and Physical Activity Competence

Questionnaire (Connaughton Weiler

amp Connaughton 2001) Te EPACQ

is a 17-item questionnaire originally

designed to assess the perceptions of

deans and medical school directors

with regard to the competence of

medical students in exercise prescrib-

ing (Part A) the importance of

exercise prescription (Part B) and the

medical school curriculum related to

exercise prescription (Part C) For the

purposes of our study we adapted the

12 items that comprise Parts A and B

In part A respondents rated their

competence using a 6-point Likert

scale (1 = not competent 6 = verycompetent) in the following skills with

respect to screening and advising heal-

thy adults (1) conducting a physical

exam to approve the patient to begin

a physical activity program (2) deter-

mining the maximum heart rate mdash

7172019 Nurse PA














































importance


RESULTS






















































7172019 Nurse PA
















0955 F(2139) = 3311 p = 0039] A








diff = 377 p = 0012)


























DISCUSSION



































Overall mean score



52 ( 97) 526 ( 9)

442 ( 4) 475 (116)

(1 ) 462 (112)

575 ( 59) 5 (17)

91 (145) 45 (121)

97 (1 ) 476 (122)

449 (090) 482 (085)


7172019 Nurse PA


REFERENCES

































































































clinical practice
















for future research

7172019 Nurse PA






7172019 Nurse PA














































importance


RESULTS






















































7172019 Nurse PA
















0955 F(2139) = 3311 p = 0039] A








diff = 377 p = 0012)


























DISCUSSION



































Overall mean score



52 ( 97) 526 ( 9)

442 ( 4) 475 (116)

(1 ) 462 (112)

575 ( 59) 5 (17)

91 (145) 45 (121)

97 (1 ) 476 (122)

449 (090) 482 (085)


7172019 Nurse PA


REFERENCES

































































































clinical practice
















for future research

7172019 Nurse PA






7172019 Nurse PA
















0955 F(2139) = 3311 p = 0039] A








diff = 377 p = 0012)


























DISCUSSION



































Overall mean score



52 ( 97) 526 ( 9)

442 ( 4) 475 (116)

(1 ) 462 (112)

575 ( 59) 5 (17)

91 (145) 45 (121)

97 (1 ) 476 (122)

449 (090) 482 (085)


7172019 Nurse PA


REFERENCES

































































































clinical practice
















for future research

7172019 Nurse PA






7172019 Nurse PA


REFERENCES

































































































clinical practice
















for future research

7172019 Nurse PA






7172019 Nurse PA






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