Factors contributing to the effectiveness of physical activity counselling in primary care: A realist systematic review

•Physical activity (PA) counselling in primary care is not consistently practiced.•A realist systematic review was conducted to identify optimal design features.•Ten studies were eligible but provided limited detail so further research is needed.•Single counselling sessions exploring motivation increased PA.•Multiple sessions may sustain increased PA beyond 12 months.

ObjectivePhysical activity (PA) counselling in primary care increases PA but is not consistently practiced. This study examined factors that optimise the delivery and impact of PA counselling.MethodsA realist systematic review based on the PRECEDE–PROCEED model and RAMESES principles was conducted to identify essential components of PA counselling. MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Physical Education Index were searched from 2000 to 2013 for studies that evaluated family practice PA counselling.ResultsOf 1546 articles identified, 10 were eligible for review (3 systematic reviews, 5 randomised controlled trials, 2 observational studies). Counselling provided by clinicians or counsellors alone that explored motivation increased self-reported PA at least 12 months following intervention. Multiple sessions may sustain increased PA beyond 12 months.ConclusionGiven the paucity of eligible studies and limited detail reported about interventions, further research is needed to establish the optimal design and delivery of PA counselling. Research and planning should consider predisposing, reinforcing and enabling design features identified in these studies.Practice implicationsSince research shows that PA counselling promotes PA but is not widely practiced, primary care providers will require training and tools to operationalize PA counselling.