Efficacité du counseling en matière d'activité physique et de formation à la prescription d'exercices physiques chez les étudiants en médecine : une revue systématique
DOI :
https://doi.org/10.36834/cmej.77065Résumé
Contexte : Les conseils en matière d'activité physique et la prescription d'exercices augmentent l'activité et la condition cardiorespiratoire des patients, mais les prestataires de soins de santé éprouvent des difficultés à promouvoir l'activité auprès des ceux-ci. La mise en œuvre d'une intervention éducative au cours de la formation médicale peut être une stratégie efficace pour promouvoir l'activité physique auprès des patients et le conseil/prescription d'exercices. L'objectif de cette étude était d'évaluer l'impact des interventions éducatives sur les perceptions et les pratiques des étudiants en médecine en matière de conseils concernant l'activité physique et la prescription d'exercices.
Méthodes : La procédure de revue systématique a été enregistrée dans PROSPERO (ID# CRD42022331755) avant la réalisation de l'étude. Les études ont été incluses si elles menaient une intervention éducative auprès d'étudiants en médecine ou de résidents en vue d'améliorer la pratique d'activités. Les moteurs de recherche bibliographique ont été explorés en mai 2022 et comprenaient Scopus, EMBASE, MEDLINE, CINAHL et Academic Search Premier (n = 3412 citations sans doublons). Les outils d'évaluation de la qualité du National Institutes of Health ont été utilisés.
Résultats : Au total, 15 interventions ont été incluses. La qualité moyenne des essais contrôlés inclus (n = 6) et des études pré-post sans groupe de contrôle (n = 9) était respectivement de 5,0±1,5/12 et de 6,2±1,3/14. La plupart des études (n = 4/6) qui ont rapporté le nombre total d'étudiants en médecine fournissant des conseils d'activité aux patients avant et après l'intervention ont observé des améliorations dans les comportements en matière de conseils d'exercice physique. Onze études sur douze et dix études sur onze ont fait état d'une augmentation de la confiance et des perceptions à l'égard de diverses caractéristiques du conseil en matière d'exercice et de la promotion de l'activité physique, respectivement.
Conclusion : Malgré la nature hétérogène des modèles d'intervention, cette revue systématique soutient que des interventions relativement brèves utilisant un format de cours structurés incorporé dans le programme d'études favorisent de nettes améliorations des perceptions et de la confiance des étudiants en médecine dans la prestation de conseils en matière d'exercice physique, bien que la qualité de l'étude soit faible à modérée.
Références
McKinney J, Lithwick D, Morrison B, et al. The health benefits of physical activity and cardiorespiratory fitness. BCMJ. 2016;58(3):131-137.
Kohl HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294-305. https://doi.org/10.1016/S0140-6736(12)60898-8
Chudasama Y V., Khunti KK, Zaccardi F, et al. Physical activity, multimorbidity, and life expectancy: a UK Biobank longitudinal study. BMC Med. 2019;17(1):108. https://doi.org/10.1186/s12916-019-1339-0
Thornton JS, Frémont P, Khan K, et al. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. Br J Sports Med. 2016;50(18):1109-1114. https://doi.org/10.1136/bjsports-2016-096291
O’Brien MW, Bray NW, Kivell MJ, Fowles JR. A scoping review of exercise referral schemes involving qualified exercise professionals in primary health care. Appl Physiol Nutr Metab. Published online April 2021:apnm-2020-1070. https://doi.org/10.1139/apnm-2020-1070
O’Brien MW, Shields C, Crowell S, Theou O, McGrath P, Fowles J. The effects of previous educational training on physical activity counselling and exercise prescription practices among physicians across Nova Scotia: a cross-sectional study. Can Med Educ J. 2018;9(4):e35-45. https://doi.org/10.36834/cmej.43098
O’Brien M, Shields CA, Oh PI, Fowles JR. Health care provider confidence and exercise prescription practices of Exercise is Medicine Canada workshop attendees. Appl Physiol Nutr Metab. 2017;42(4):384-390. https://doi.org/10.1139/apnm-2016-0413
Petrella R, Lattanzio C, Overend T. Physical activity counseling and prescription among Canadian primary care physicians. Arch Intern Med. 2007;167(16):1774-1781. https://doi.org/10.1001/archinte.167.16.1774
Windt J, Windt A, Davis J, Petrella R, Khan K. Can a 3-hour educational workshop and the provision of practical tools encourage family physicians to prescribe physical activity as medicine? A pre–post study. BMJ Open. 2015;5(7):e007920. https://doi.org/10.1136/bmjopen-2015-007920
Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals. Int J Environ Res Public Health. 2020;17(12):4358. https://doi.org/10.3390/ijerph17124358
Pasarica M, Boring M, Lessans S. Current practices in the instruction of lifestyle medicine in medical curricula. Patient Educ Couns. 2022;105(2):339-345. https://doi.org/10.1016/j.pec.2021.05.042
McFadden T, Fortier M, Sweet SN, Tomasone JR, McGinn R, Levac BM. Canadian medical students’ perceived motivation, confidence and frequency recommending physical activity. Prev Med Reports. 2019;15:100898. https://doi.org/10.1016/j.pmedr.2019.100898
Solmundson K, Koehle M, McKenzie D. Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription. Can Med Educ J. 2016;7(2):e79-e96. https://doi.org/10.36834/cmej.36702
Brennan AM, D’Urzo KA, Fenuta AM, Houlden RL, Tomasone JR. Integrating exercise counseling into the medical school curriculum: A workshop-based approach using behavior change techniques. Am J Lifestyle Med. 2021;15(1):84-107. https://doi.org/10.1177/1559827617722754
Erickson M, Marks D, Karcher E. Characterizing student engagement with hands-on, problem-based, and lecture activities in an introductory college course. Teach Learn Inq. 2020;8(1):138-153. https://doi.org/10.20343/teachlearninqu.8.1.10
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Published online March 2021:n71. https://doi.org/10.1136/bmj.n71
Armellini A, Padilla Rodriguez BC. Active blended learning: definition, literature review, and a framework for implementation. Cases on Active Blended Learning in Higher Education. 2021:1-22. https://doi.org/10.4018/978-1-7998-7856-8.ch001
National Heart Lung and Blood Insitute. Study Quality Assessment Tools. Published 2021. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
Conroy MB, Delichatsios HK, Hafler JP, Rigotti NA. Impact of a preventive medicine and nutrition curriculum for medical students. Am J Prev Med. 2004;27(1):77-80. https://doi.org/10.1016/j.amepre.2004.03.009
Frank E, Elon L, Hertzberg V. A quantitative assessment of a 4-year old intervention that improved patient counseling through improving medical student health. MedGenMed Medscape Gen Med. 2007;9(2):58. http://www.ncbi.nlm.nih.gov/pubmed/17955112
Eckstrom E, Hickam DH, Lessler DS, Buchner DM. Changing physician practice of physical activity counseling. J Gen Intern Med. 1999;14(6):376-378. https://doi.org/10.1046/j.1525-1497.1999.00356.x
Flood SM, D’Urzo KA, Shallow S, Dobrowolski S, Howse K, Tomasone JR. Determining the impact of an educational intervention on family medicine residents’ social cognitions and behavior for discussing physical activity. Teach Learn Med. 2022;34(1):89-104. https://doi.org/10.1080/10401334.2021.1891542
Malatskey L, Bar Zeev Y, Tzuk-Onn A, Polak R. Lifestyle medicine course for family medicine residents: preliminary assessment of the impact on knowledge, attitudes, self-efficacy and personal health. Postgrad Med J. 2017;93(1103):549-554. https://doi.org/10.1136/postgradmedj-2016-134726
Mandic S, Wilson H, Clark-Grill M, O’Neill D. A physical activity learning module improves medical students’ skills and confidence for advising patients about physical activity. Montenegrin J Sport Sci Med. 2018;7(1):31-38. https://doi.org/10.26773/mjssm.180304
Jadczak AD, Visvanathan R. The sustained impact of a medical school-based physical activity module on interns’ perceived competence in advising older adults about exercise. J Frailty Aging. 2020;9(3):155-157. https://doi.org/10.14283/jfa.2019.39
Jadczak AD, Tam KL, Visvanathan R. Educating medical students in counselling older adults about exercise: The impact of a physical activity module. J Frailty Aging. 2018;7(2):113-119. https://doi.org/10.14283/jfa.2017.44
Jadczak AD, Tam KL, Yu S, Visvanathan R. Medical students’ perceptions of the importance of exercise and their perceived competence in prescribing exercise to older people. Australas J Ageing. 2017;36(3):E7-E13. https://doi.org/10.1111/ajag.12412
Jones PR, Brooks JHM, Wylie A. Realising the potential for an Olympic legacy; teaching medical students about sport and exercise medicine and exercise prescribing. Br J Sports Med. 2013;47(17):1090-1094. https://doi.org/10.1136/bjsports-2013-092386
Rogers LQ, Gutin B, Humphries MC, et al. A physician fitness program: Enhancing the physician as an “exercise” role model for patients. Teach Learn Med. 2005;17(1):27-35. https://doi.org/10.1207/s15328015tlm1701_6
Katz DL, Shuval K, Comerford BP, Faridi Z, Njike VY. Impact of an educational intervention on internal medicine residents’ physical activity counselling: the Pressure System Model. J Eval Clin Pract. 2008;14(2):294-299. https://doi.org/10.1111/j.1365-2753.2007.00853.x
Mohler MJ, D’Huyvetter K, Tomasa L, O’Neill L, Fain MJ. Healthy aging rounds: Using healthy-aging mentors to teach medical students about physical activity and social support assessment, interviewing, and prescription. J Am Geriatr Soc. 2010;58(12):2407-2411. https://doi.org/10.1111/j.1532-5415.2010.03125.x
Pugh G, O’Halloran P, Blakey L, Leaver H, Angioi M. Integrating physical activity promotion into UK medical school curricula: Testing the feasibility of an educational tool developed by the Faculty of Sports and Exercise Medicine. BMJ Open Sport Exerc Med. 2020;6(1):e000679. https://doi.org/10.1136/bmjsem-2019-000679
Weiler R, Chew S, Coombs N, Hamer M, Stamatakis E. Physical activity education in the undergraduate curricula of all UK medical schools. Are tomorrow’s doctors equipped to follow clinical guidelines? Br J Sports Med. 2012;46(14):1024-1026. https://doi.org/10.1136/bjsports-2012-091380
Minhas PS, Ghosh A, Swanzy L. The effects of passive and active learning on student preference and performance in an undergraduate basic science course. Anat Sci Educ. 2012;5(4):200-207. https://doi.org/10.1002/ase.1274
O’Brien MW, Shields C, Solmundson K, Fowles J. Exercise is medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level. Can Med Educ J. 2020;11(5):e5-e15. https://doi.org/10.36834/cmej.68376
Bowen P, Mankowski R, Harper S, Buford T. Exercise Is Medicine as a Vital Sign: Challenges and Opportunities. Transl J ACSM. 2019;4(1):1-7. https://doi.org/10.1249/TJX.0000000000000076
Frémont P, Fortier M, Frankovich RJ. Exercise prescription and referral tool to facilitate brief advice to adults in primary care. Can Fam Physician. 2014;60(12):1120-1122, e591-2.
Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. https://doi.org/10.1136/BMJ.E1389
Rowley N, Mann S, Steele J, Horton E, Jimenez A. The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review. BMC Public Health. 2018;18(1):949. https://doi.org/10.1186/s12889-018-5868-9
Ross R, Chaput J-P, Giangregorio LM, et al. Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020;45(10 (Suppl. 2)):S57-S102. https://doi.org/10.1139/apnm-2020-0467
Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. https://doi.org/10.1136/bjsports-2020-102955
Tremblay MS, Warburton DE, Janssen I, et al. New Canadian physical activity guidelines. Appl Physiol Nutr Metab. 2011;36(1):36-46. https://doi.org/10.1139/H11-009
Dogra S, Copeland JL, Altenburg TM, Heyland DK, Owen N, Dunstan DW. Start with reducing sedentary behavior: A stepwise approach to physical activity counseling in clinical practice. Patient Educ Couns. 2022;105(6):1353-1361. https://doi.org/10.1016/j.pec.2021.09.019
Téléchargements
Publié-e
Versions
- 2024-11-12 (2)
- 2024-04-23 (1)
Comment citer
Numéro
Rubrique
Licence
© Madeline E Shivgulam, Jennifer L Petterson, Liam Pellerine, Matthew J Kivell, Taylor Wilson, Olga Theou, Myles W O'Brien 2023
Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
La soumission d’un manuscrit original à la revue constitue une indication qu’il s’agit d’un travail original, qu’il n’a jamais été publié et qu’il n’est pas envisagé pour publication dans une autre revue. S’il est accepté, il sera publié en ligne et ne pourra l’être ailleurs sous la même forme, à des fins commerciales, dans quelque langue que ce soit, sans l’accord de l’éditeur.
La publication d’une recherche scientifique a pour but la diffusion de connaissances et, sous un régime sans but lucratif, ne profite financièrement ni à l’éditeur ni à l’auteur.
Les auteurs qui publient dans la Revue canadienne d’éducation médicale acceptent de publier leurs articles sous la licence Creative Commons Paternité - Pas d’utilisation commerciale, Pas de modification 4.0 Canada. Cette licence permet à quiconque de télécharger et de partager l’article à des fins non commerciales, à condition d’en attribuer le crédit aux auteurs. Pour plus de détails sur les droits que les auteurs accordent aux utilisateurs de leur travail, veuillez consulter le résumé de la licence et la licence complète.
