Although research has clearly documented telephone assisted exercise counseling as effective and beneficial, more work is needed to better understand how or why the interventions work, and what factors may moderate their effectiveness in different population segments. It appears that the greater convenience and flexibility afforded by telephone as opposed to face-to-face channels may be important factors for many individuals. It is less clear, however, which segments of the population may require even less intensive counseling (as can be delivered via print) or, conversely, which may require the additional interactive support that face-to-face channels can provide. In addition, as with other interventions that have been developed in this field, relatively little data are currently available documenting specific psychological, behavioral, and environmental factors serving as potential mediators for such interventions.
As we begin to understand more about how mediated interventions work, future research can explore different permutations of telephone-mediated exercise counseling, such as interventions that rely solely on the telephone with no face-to-face interaction, or interventions that test different combinations or dosages of telephone, print, or face-to-face contact. Additionally, as cellular telephone technology, teleconferencing, and web-based broadcast technologies are expanded and refined, multiple opportunities will become available to explore how newer forms of mediated exercise counseling perform against the older standards.
Some research has already begun to test variations of telephone-assisted exercise programs, including the use of technologically advanced delivery vehicles. Currently, a clinical trial (the CHAT Project) is under way at Stanford University, in collaboration with the Boston and Brown University Schools of Medicine, in which health educator-initiated, telephone-based exercise counseling is being tested against an automated telephone system. This automated system delivers exercise advice and stores keypad-entered data on participants’ exercise goals and progress for future automated counseling. At Brown University, another clinical trial (Project STRIDE) is directly comparing the relative effectiveness of print-mediated versus telephone mediated programs to promote adoption and maintenance of physical activity.
As research on telephone-mediated exercise programs continue to grow, both in the United States and in other countries, efforts are moving toward outreach and dissemination. The California Department of Health Services (DHS) has made initial attempts to translate the current research into public health practice. In the early 1990s, the DHS distributed a training manual to assist local agencies in developing physical activity promotion programs. Much of the content of the “Get Going.1” manual was based on the clinical trials at Stanford, and it provides practical and technical guidelines for programs that use telephone-mediated exercise counseling. In addition, the DHS has recently awarded grants to over 15 communities to develop local, telephone-based physical activity programs under the state-wide Physical Activity & Health Initiative. Termed the Active Aging Projects, these communities are currently implementing telephone-supervised exercise programs in areas throughout the state of California.
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