Physical activity promotion in primary care: a Utopian quest?

Abstract The health benefits of physical activity (PA) are acknowledged and promoted by the scientific community, especially within primary care. However, there is little evidence that such promotion is provided in any consistent or comprehensive format. Brief interventions (i.e. discussion, negotiation or encouragement) and exercise referral schemes (i.e. patients being formally referred to a PA professional) are the two dominant approaches within primary care. These cost-effective interventions can generate positive changes in health outcomes and PA levels in inactive patients who are at increased risk for non-communicable diseases. Their success relies on the acceptability and efficiency of primary care professionals to deliver PA counselling. To this end, appropriate training and financial support are crucial. Similarly, human resourcing and synergy between the different stakeholders must be addressed. To obtain maximum adherence, specific populations should be targeted and interventions adapted to their needs. Key enablers include motivational interviewing, social support and multi-disciplinary approaches. Leadership and lines of accountability must be clearly delineated to ensure the success of the initiatives promoting PA in primary care. The synergic and multisectoral action of several stakeholders, especially healthcare professionals, will help overcome physical inactivity in a sustainable way.

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Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales

Health Education Journal ◽

10.1177/0017896914559785 ◽

2014 ◽

Vol 74 (6) ◽

pp. 743-757 ◽

Cited By ~ 29

Author(s):

Nafees U Din ◽

Graham F Moore ◽

Simon Murphy ◽

Clare Wilkinson ◽

Nefyn H Williams

Keyword(s):

Physical Activity ◽

Primary Care ◽

Process Evaluation ◽

Health Professionals ◽

Physical Activity Promotion ◽

Activity Promotion ◽

Exercise Referral ◽

Exercise Referral Scheme

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Effectiveness of physical activity promotion and exercise referral in primary care: protocol for a systematic review and meta-analysis of randomised controlled trials

Systematic Reviews ◽

10.1186/s13643-019-1198-y ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 2

Author(s):

Jean-Pierre Laake ◽

Joanna Fleming

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Primary Care ◽

Sedentary Behaviour ◽

Physical Activity Promotion ◽

Self Report ◽

Activity Promotion ◽

Randomised Controlled ◽

The Uk ◽

Exercise Referral

Abstract Background Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity; however, sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this, most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. This is a protocol for a systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care. Methods A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), Scopus, CINAHL, PsycINFO, and The Cochrane Library (CENTRAL) will be conducted for studies with a minimum follow-up of 12 months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. The authors will screen papers, first by title and abstract and then by full text, independently assess studies for inclusion, appraise risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12 months. Pooled effects will be calculated using random effects models. Results will be submitted for publication in a peer-reviewed journal and for presentation at UK national primary care conferences. Discussion This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long-term plan on preventive medicine, those making policy decisions. Systematic review registration The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831

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Experiences in physical activity promotion in health care settings for primary prevention in the UK

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/11 ◽

2014 ◽

Vol 62 (2) ◽

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Professionals ◽

Controlled Trial ◽

Full Range ◽

Tertiary Care ◽

Physical Activity Promotion ◽

Community Based ◽

Activity Promotion ◽

Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

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Communicating Prevention Messages to Policy Makers: The Role of Stories in Promoting Physical Activity

Journal of Physical Activity and Health ◽

10.1123/jpah.7.s1.s99 ◽

2010 ◽

Vol 7 (s1) ◽

pp. S99-S107 ◽

Cited By ~ 41

Author(s):

Katherine A. Stamatakis ◽

Timothy D. McBride ◽

Ross C. Brownson

Keyword(s):

Physical Activity ◽

Physical Activity Promotion ◽

Policy Makers ◽

Effective Interventions ◽

Prevention Messages ◽

Activity Promotion ◽

Health Promoting ◽

State And Local ◽

Public Health Practitioners ◽

Research To Policy

Background:While effective interventions to promote physical activity have been identified, efforts to translate these interventions into policy have lagged behind. To improve the translation of evidence into policy, researchers and public health practitioners need to consider new ways for communicating health promoting messages to state and local policymakers.Methods:In this article, we describe issues related to the translation of evidence supporting physical activity promotion, and offer some communication approaches and tools that are likely to be beneficial in translating research to policy.Results:We discuss the use of narrative (ie, stories) and describe its potential role in improving communication of research in policy-making settings. In addition, we provide an outline for the development and design of policy briefs on physical activity, and for how to target these briefs effectively to policy-oriented audiences.Conclusions:Improvements in researchers' and practitioners' abilities to translate the evidence they generate into high-quality materials for policy makers can greatly enhance efforts to enact policies that promote physical activity.

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