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Primary Care

Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial

BMJ 2003; 326 doi: (Published 12 April 2003) Cite this as: BMJ 2003;326:793
  1. C Raina Elley, senior lecturer (c.elley{at},
  2. Ngaire Kerse, Harkness fellowa,
  3. Bruce Arroll, associate professora,
  4. Elizabeth Robinson, statisticianb
  1. a Department of General Practice and Primary Health Care, University of Auckland, New Zealand
  2. b Department of Community Health, University of Auckland
  1. Correspondence to: C Raina Elley
  • Accepted 13 February 2003


Objective: To assess the long term effectiveness of the “green prescription” programme, a clinician based initiative in general practice that provides counselling on physical activity.

Design: Cluster randomised controlled trial. Practices were randomised before systematic screening and recruitment of patients.

Setting: 42 rural and urban general practices in one region of New Zealand.

Subjects: All sedentary 40–79 year old patients visiting their general practitioner during the study's recruitment period.

Intervention: General practitioners were prompted by the patient to give oral and written advice on physical activity during usual consultations. Exercise specialists continued support by telephone and post. Control patients received usual care.

Main outcome measures: Change in physical activity, quality of life (as measured by the “short form 36” (SF-36) questionnaire), cardiovascular risk (Framingham and D'Agostino equations), and blood pressure over a 12 month period.

Results: 74% (117/159) of general practitioners and 66% (878/1322) of screened eligible patients participated in the study. The follow up rate was 85% (750/878). Mean total energy expenditure increased by 9.4 kcal/kg/week (P=0.001) and leisure exercise by 2.7 kcal/kg/week (P=0.02) or 34 minutes/week more in the intervention group than in the control group (P=0.04). The proportion of the intervention group undertaking 2.5 hours/week of leisure exercise increased by 9.72% (P=0.003) more than in the control group (number needed to treat=10.3). SF-36 measures of self rated “general health,” “role physical,” “vitality,” and “bodily pain” improved significantly more in the intervention group (P<0.05). A trend towards decreasing blood pressure became apparent but no significant difference in four year risk of coronary heart disease.

Conclusion: Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months.

What is already known on this topic

What is already known on this topic Counselling patients in general practice on exercise has resulted in gains in physical fitness and activity, but no health benefits have been found

What this study adds

What this study adds Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months without evidence of adverse effects

The intervention may reduce blood pressure by an average of 1–2 mm Hg over 12 months

No changes in the risk of coronary heart disease were observed

The intervention is sustainable in usual general practice

Prompting practice staff to deliver the intervention may have increased its effectiveness


  • Funding The National Heart Foundation of New Zealand, Hillary Commission, Waikato Medical Research Foundation, Royal New Zealand College of General Practitioners, and the University of Auckland.

  • Competing interests A minor funder of this study was the Hillary Commission, a publicly and government funded organisation that promotes sport and recreation in New Zealand. The Hillary Commission (now known as SPARC, Sport and Recreation New Zealand) produces resources associated with the green prescription initiative and funds its promotion. This organisation played no part in the design, analysis, or writing of the paper.

  • Ethical approval: The study was approved by the Waikato Ethics Committee in 1999.

  • Accepted 13 February 2003
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