BACKGROUND: Sedentary lifestyle is associated with adverse health outcomes. Available evidence suggests that, despite positive attitudes toward regular exercise in promoting a healthy lifestyle, few physicians actually prescribe exercise for their patients. Barriers include lack of skills and standard office instruments. Because primary care physicians have regular contact with a large proportion of the population, the impact of preventive health interventions may be great. OBJECTIVES: To determine the effect of an exercise prescription instrument (ie, Step Test Exercise Prescription (STEP)), compared to usual-care exercise counseling delivered by primary care doctors on fitness and exercise self-efficacy among elderly community-dwelling patients. DESIGN: Randomized controlled trial; baseline assessment and intervention delivery with postintervention follow-up at 3, 6, and 12 months. SETTING: Four large (> 5,000 active patient files) academic, primary care practices: three in urban settings and one in a rural setting, each with four primary care physicians; two clinics provided the STEP intervention and two provided usual care control. PARTICIPANTS: A total of 284 healthy community-dwelling patients (72 per clinic) aged > 65 years were recruited in 1998 to 1999. INTERVENTION: STEP included exercise counseling and prescription of an exercise training heart rate. MAIN OUTCOME MEASURES: The primary outcome measure was aerobic fitness (VO2max). Secondary outcomes included predicted VO2max from the STEP test, exercise self-efficacy (ESE), and clinical anthropometric parameters. RESULTS: A total of 241 subjects (131 intervention, 110 control) completed the trial. VO2max was significantly increased in the STEP intervention group (11%; 21.3 to 24ml/kg/min) compared to the control group (4%; 22 to 23ml/kg/min) over 6 months (p < 0.001), and 14% (21.3 to 24.9ml/kg/min) and 3% (22.1 to 22.8ml/kg/min), respectively, at 12 months (p < 0.001). A similar significant increase in ESE (32%; 4.6 versus 6.8) was observed for the STEP group compared to the control group (22%; 4.2 versus 5.4) at 12 months (p < 0.001). Systolic blood pressure decreased 7.3% and body mass index decreased 7.4% in the STEP group, with no significant change in the control group (p < 0.05). Exercise counseling time was significantly (p < 0.02) longer in the STEP (11.7 +/- 3.0 min) compared to the control group (7.1 +/- 7.0 min), but more (p < 0.05) subjects completed >= 80% of available exercise opportunities in the STEP group. CONCLUSIONS: Primary care physicians can improve fitness and exercise confidence of their elderly patients using a tailored exercise prescription (eg, STEP). Further, STEP appears to maintain benefits to 12 months and may improve exercise adherence. Future study should determine the impact of combining cognitive/behavior change strategies with STEP.

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