This study aims to describe physicians' knowledge and practices regarding PA prescription in the Province City of Kinshasa. As a result, only a small percentage of participants (40.2%) were interested in their patients' PA, and only 2.3% said that they would recommend PA by medical prescription. SP and PrH physicians, on the other hand, were more interested in their patients' PA than GP or PH physicians. On the contrary, being a specialist, an internist, and a cardiologist and knowing about PA benefits were all significantly associated with PA prescription. In terms of relevance, forgetting was the most frequently cited reason for not prescribing PA, followed by a lack of knowledge about current PA prescribing recommendations.
According to the literature, the percentage of physicians who are interested in their patients’ PA varies widely. One of the rare, if not the only, African studies have addressed the question of the prescription of PA focused on South African general practitioners (GPs). This study by Roos et al. (11) found substantially high prescription rates (90.9%). Possible reasons for this difference with our study may not only lie in possible self-report bias but also in the health systems differing between the Congolese and that of South-Africa. Outside Africa, a large study in Canada discovered that 85.2% of clinicians asked their patients about their PA habits (12). In Germany, 71.8% (13) to 90% (14) of GPs were said to be interested in the patients' PA. According to Reimers et al. (15) more than 80% of neurologists polled in a nationwide study “frequently” counseled their patients on PA. Some authors addressed the issue of physicians' interest in PA by examining the frequency with which patients reported receiving advice about PA from their doctors. According to a U.S. epidemiological study, 38% of this population received counseling that included a description of a specific activity (16). Another study, also conducted in the United States, found that 34% of the patients surveyed had received PA advice from their family doctor during their most recent consultation (17).
The profile of the physicians and patients interviewed may explain the large disparity in the proportion of physicians interested in PA. In this study, respondents were physicians of various qualifications and specializations, both of PrH and PH, who cared for patients with various pathologies. Methodological diversity could also be considered: We used a hard-copy declarative and anonymous questionnaire delivered manually to each respondent, whereas others used a self-administered electronic questionnaire without the interviewers and respondents having ever physically met. Still, others proceeded by direct interview. It is also possible that the existence or absence of a public health policy governing doctors’ involvement of in PA promotion plays a significant role. It appears that the highest proportions are found in studies conducted in countries with public health policies, such as “prescription physical activity” (14, 18–24). Among other things, these guidelines give GPs the authority to prescribe PA. The lack of similar programs in the DRC could explain physicians’ low participation in promoting PA. Only 11% of the participants who were interested in their patients’ PA quantified it primarily using pedometers or self-report activity diaries. It is critical to assess patients' PA levels because a dose-response relationship has been demonstrated with the risk of all-cause mortality and CVD morbidity and mortality in adults (25, 26). The pedometer's popularity may be explained by its simplicity, low cost and ability to record short periods of PA (often missed by self-report measures) (27). Furthermore, data from pedometers have been shown to correlate with biological outcomes (28, 29). The pedometer counts steps and enables subjects to become aware of their activity from a simple PA, walking, which is accessible to the greatest number of people, in a utilitarian or leisure form (27, 30, 31). For all these reasons, the pedometer is one of the most promoted means for PA objective evaluation (27), despite its drawbacks including not recording the intensity, frequency, or duration of PA (1, 2), inability to register PA involving horizontal movements that occur during periods of inactivity, leisure activities (3) and inducing reactivity in participants (4, 5).
Self-report diaries use real-time AP recording to collect the most detailed data (32), giving them an advantage over subjective declarative methods (questionnaires) (32, 33). In general, objective assessment of PA using devices such as the pedometer are preferred over subjective methods, explaining the preference of GPs for the pedometer, which was the only device included in the assertions of the questionnaire used in this study. However, the self-report activity diaries, a subjective method that was used more by SPs than by GPs, was validated when it was compared with camera and accelerometer recordings (27, 34) or the pedometer (27, 35), despite its main limitation, which is the possibility of memory loss (36, 37).
Specialist physician appears to be more interested in the patient's PA than GP in the current study. Furthermore, physicians in PrH, whether SP or GP, appear to be more concerned with their patients' PA rather than PH, which has not been previously reported in the literature. This difference could be explained by doctors in PrH being more motivated (well paid) than those in the PH. When compared with GPs, SPs appeared to be more interested in PA and prescribed it more frequently and folded correctly than GPs. This discovery could be explained by SPs’ understanding of the benefits of PA, as well as increased remuneration. Aside from remuneration, lessons on nonpharmacological measures, particularly the role of PA in the treatment of chronic noncommunicable diseases, may not yet be well inserted in the curriculum of physician training in the Democratic Republic of the Congo.
In this study, 38% of the study participants gave practical instructions on PA, and only 2% formulated these instructions in the form of a prescription. This proportion is lower than that found in a Nigerian study conducted by Ale et al. (38), who discovered that three quarters of respondents prescribe PA. It is also lower than a survey of GPs in Catalonia, Spain, which found that 88% of doctors prescribe PA at least occasionally (39). According to a 2001 Canadian survey, 69.8% of physicians prescribe PA in some way (12). Compared with almost all the studies conducted elsewhere, the very low rate of prescription observed in this study would be due to the health system organization in the DRC, characterized by the absence of national guidelines on PA promotion compared with other countries, and insufficient sensitization among DRC doctors of the importance of PA prescription.
Only 0.9% appeared to get it right, specifying the type of exercise, intensity, duration, and frequency of the prescribed PA. To the best of our knowledge, this study is the first to look into these aspects of prescribing among the surveyed physicians. It was important to get an idea of how doctors prescribe PA, that is to say the content of their prescription, which should normally specify, as for a prescription of a pharmacological treatment, the type of PA to be practiced (molecule), its intensity (dosage), frequency (frequency of taking the drug), and duration of each session. The very low percentage of doctors who appeared to know the exact content of a PA prescription reflects a deficit in the training on PA prescription in the training course of the doctors surveyed.
On the contrary, five factors were found to be independently associated with the prescription of PA. Being a cardiologist was the most important determinant of prescribing PA, increasing the likelihood of prescribing PA by a factor of 12. Being an SP and an internist increased this likelihood by eightfold and knowing the benefits of PA increased it by sixfold, respectively. Other authors have mentioned the physician's level of PA as a factor. Physicians who are physically active are more likely to recommend PA to their patients (40, 41).
The most common reason for not prescribing PA was forgetting, followed by a lack of knowledge about current PA prescribing recommendations and lack of time. Our findings on barriers to PA prescribing are consistent with those of other authors (41–47). Nauta et al. (47) identified forgetting as a major reason for not prescribing PA. Persson et al. (49) highlighted the current recommendations' ignorance. Similarly, other previous studies have been identified a lack of time as a barrier to prescribing daily PA (41, 44, 45).
Consulting in PrH, being an SP, an internist, and a cardiologist, and knowing the PA benefits were the determinants of PA prescribing in this study. To our knowledge, no previous study has investigated the determinants of PA prescription. Consulting in PrH as a determinant of PA prescription probably reflects the effort often made in PrH to provide the best service to patients, mainly for commercial reasons. However, some studies have demonstrated better medical service in PrH than in PH (48, 49). Being an SP as a determinant of PA prescription probably means that it is during specialist training that PA prescription is better taught than teaching in general medicine. Being a cardiologist as a determinant of PA prescription is probably due to the fact that the strongest evidence of the benefit of PA practice on health has been found in the field of cardiology (50).