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Zachary Milano DO

  • Graduate 2020
Scholarly Research Project

Exercise and Anxiety: Improving Provider Counseling

Zach Milano – Behavioral Health LOPIR


Treatment of anxiety includes cognitive-behavioral therapy (CBT), pharmacotherapy, and lifestyle modification. Regular exercise reduces symptoms of anxiety, particularly when coupled with CBT and pharmacotherapy. Providers who use motivational interviewing (MI) have more success in eliciting behavior change. This project’s purpose was to improve the frequency and quality of exercise counseling in patients with primary diagnoses of anxiety using a new Epic smartset which employs MI.


We created an EpicCare anxiety smartset that included an exercise treatment plan (ETP). The ETP is a tool for physicians and patients to collaboratively create an exercise plan. The ETP uses MI-oriented questions to assess patients’ willingness and ability to incorporate exercise into their anxiety treatment. Shadyside Family Health Center (SFHC) residents received 1-2 didactic sessions on MI and were surveyed on their comfort and ability in using MI prior to and following the MI didactics and incorporation of the ETP smartset. The use of the ETP smartest was tracked over 6 months.


From 11/2019 - 4/2020, the ETP was utilized by 75% of SFHC residents (n=29) and was provided to patients with anxiety 120 times. Of the ETP users, 20% reported that at least one patient returned the ETP at follow-up for review. Following MI teaching, 53% of residents reported increased use of MI and 46% of residents (n=22) reported an increase in confidence in using MI. The most cited barriers to using MI in exercise counseling were time (85%), patient willingness to change (55%), and real-time practice of MI (25%) (n=22).


The development of an anxiety smartset allows providers to conveniently introduce exercise as part of their treatment plan for patients with anxiety. Further development of MI skills, in addition to continued smartset use, may improve the frequency and quality of exercise counseling in patients with anxiety.