Academic Training,Knowledge,and Perceptions of Physical Activity in Student Pharmacists

Abstract

Pharmacists are highly effective in providing chronic disease management services in both the community pharmacy and ambulatory clinic settings in large part because of their medication therapy management expertise. Lifestyle medicine, including physical activity, plays a major role in chronic disease prevention and management. As such, physical activity knowledge and counseling skills are an important component of pharmacy student education. However, the literature indicates that pharmacy students may not be receiving adequate training in these areas. The following will describe the academic training, knowledge, and perceptions of physical activity in student pharmacists.

‘Not surprisingly, physical activity is recommended first-line for the treatment of many prevalent chronic conditions.’

Pharmacists are highly effective in providing chronic disease management services in both the community pharmacy and ambulatory clinic settings.^1-6 This contribution comes, in large part, from the pharmacist’s expertise in medication therapy management, but many successful pharmacist-led initiatives include an emphasis on lifestyle medicine.^2,6,7 Lifestyle medicine, including physical activity, plays a major role in chronic disease prevention and management. In addition to reducing all-cause mortality, exercise has been shown to prevent cardiovascular disease, diabetes, and metabolic syndrome. ⁸ Not surprisingly, physical activity is recommended first-line for the treatment of many prevalent chronic conditions.^9-12 As such, physical activity knowledge and counseling skill building are an important component of pharmacy student education.

The 2013 Education Outcomes from the Center for Advancement of Pharmacy Education emphasize health and wellness and call pharmacy programs to prepare students for “design prevention, intervention and educational strategies for individuals and communities to manage chronic disease and improve health and wellness.” ¹³ Likewise, the Exercise is Medicine global initiative launched calls for all health care providers to screen for current physical activity levels, counsel patients, and prescribe exercise in the prevention and treatment of chronic disease. ¹⁴ However, the literature indicates that pharmacy students may not be receiving adequate training in these areas. The following will describe the academic training, knowledge, and perceptions of physical activity in student pharmacists.

Physical Activity in Pharmacy School Curricula

A 2007 survey of accredited pharmacy schools in the United States found that only 8% of the respondents required a course in a lifestyle medicine topic (nutrition was the most commonly required course topic, followed by smoking cessation, exercise, weight loss, and alcohol use). ¹⁵ A more recent study (published in 2016) evaluated the prevalence of exercise prescription–related course offerings in US pharmacy schools. ¹⁶ Investigators in this study evaluated pharmacy program websites for information regarding course offerings and found that no US pharmacy school offered courses dedicated to the role of exercise in disease prevention or exercise prescription in disease management. The same study found that only 10% of pharmacy schools offer a course with “exercise,” “fitness,” or “physical activity” in the title or course description, with the majority of courses offered as electives in the curriculum.

Although it is certainly shocking that so few pharmacy schools offer courses in lifestyle medicine considering the importance of lifestyle in chronic disease management, both the aforementioned studies are potentially limited by the nature of their course-level topic assessment. Many pharmacy schools include physical activity guideline recommendations (to varying degrees) within their required therapeutics course offerings. This training would not have been identified through the methods of either study.

Pharmacy Student Knowledge of Physical Activity

A study published in 2018 aimed to determine the exercise prescription knowledge base of pharmacy students. ¹⁷ The study evaluated survey responses from 246 third- and fourth-year pharmacy students from 2 schools in North Carolina. The 20-question survey included 9 questions assessing student demographics and opinions related to exercise and exercise prescription and 11 “quiz” questions related to basic knowledge of exercise prescription. Basic knowledge includes the ability to develop an individualized exercise plan designed for a specific purpose, including type, intensity, duration, and frequency of exercise as well as an understanding of contraindications to exercise.

The mean score for the 11 basic knowledge quiz questions was 28.9%. The only question from the quiz that the majority of students answered correctly assessed the recommended minimum volume of exercise to improve health (150 minutes of moderate-intensity activity per week), and only 59.8% of students answered this question correctly. Interestingly, 67.8% of student respondents agreed or strongly agreed that they had sufficient knowledge to accurately counsel patients on exercise prescription (this question was asked before the quiz questions were administered).

Despite what appears to be inadequate knowledge of exercise prescription, pharmacy student preceptors perceive fourth-year pharmacy students to be proficient in physical activity counseling during their Advanced Pharmacy Practice Experiences. ¹⁸ A questionnaire was developed to determine the level of preparedness of fourth-year pharmacy students to provide guideline-based Therapeutic Lifestyle Change (TLC) counseling to patients, including counseling on physical activity. The questionnaire was completed by 67 pharmacy preceptors who self-reported regular TLC counseling at their practice site. A total of 77.6% of preceptor respondents agreed that students adequately provided exercise recommendations based on guidelines, and 68.7% agreed that students adequately made specific and tailored exercise recommendations based on individual patient needs.

Pharmacy Student Perceptions of Physical Activity

Whereas only 43.1% of student pharmacists report exercising routinely (3-5 d/wk), 93.5% agree or strongly agree that it is important for pharmacists to counsel patients about exercise. ¹⁷ Furthermore, 87.8% of pharmacy students believe that the pharmacy curriculum should include more education on exercise prescription. ¹⁴

Discussion

Lifestyle medicine training, including training specific to physical activity and exercise prescription, is lacking in US schools of pharmacy. Less than 10% of schools offer lifestyle medicine–specific courses in their curriculum, and many of these offerings are elective in nature. Although physical activity guidelines and exercise prescription may be integrated within coursework in pharmacy programs, the current level of exposure seems to be inadequate based on assessments of pharmacy student knowledge in basic exercise prescription concepts.

Interestingly, there seems to be a gap in pharmacy student and pharmacy preceptor perception of student proficiency in physical activity counseling and actual student knowledge in physical activity guidelines and recommendations. This suggests that practicing pharmacists and student pharmacists may be unaware of their own deficiencies in knowledge and skill in this area.

Student pharmacists think that the ability to counsel patients on physical activity is important and that pharmacy curricula should include more education on exercise prescription. This is especially important as practice models and health care reimbursement evolve and more pharmacists are being added to primary care teams to provide chronic disease management services. Although pharmacists already contribute greatly to chronic disease care through their medication therapy management expertise, pharmacy education must enhance training in lifestyle medicine to ensure that graduates are equipped with the knowledge and skills to provide more comprehensive chronic care management. Practicing pharmacist continuing education, especially for those pharmacists providing chronic care management services and those precepting pharmacy students, should also work to elevate the knowledge base and skills in exercise prescription because these are the spaces where pharmacy students gain and apply their skills to practice.