Are family medicine residents trained to counsel patients on physical activity? The Canadian experience and a call to action

Physical inactivity is a leading risk factor for non-communicable diseases (NCDs) and early mortality. Family physicians have an important role in providing physical activity counselling to patients to help prevent and treat NCDs. Lack of training on physical activity counselling is a barrier in undergraduate medical education, yet little is known regarding physical activity teaching in postgraduate family medicine residency. We assessed the provision, content and future direction of physical activity teaching in Canadian postgraduate family medicine residency programs to address this data gap. Fewer than half of Canadian Family Medicine Residency Programme directors reported providing structured physical activity counselling education to residents. Most directors reported no imminent plans to change the content or amount of teaching. These results reflect significant gaps between the recommendations of WHO, which calls on doctors to prescribe physical activity, and the current curricular content and needs of family medicine residents. Almost all directors agreed that online educational resources developed to assist residents in physical activity prescription would be beneficial. By describing the provision, content and future direction of physical activity training in family medicine, physicians and medical educators can develop competencies and resources to meet this need. When we equip our future physicians with the necessary tools, we can improve patient outcomes and do our part to reduce the global epidemic of physical inactivity and chronic disease.

Physical Activity Counselling and Exercise Prescription Practices among Dietitians Across Nova Scotia

The purpose of this study was to assess the perceptions and practices around physical activity counselling and exercise prescription of dietitians in Nova Scotia. Dietitians (n = 95) across Nova Scotia completed an online self-reflection survey regarding their current physical activity and exercise (PAE) practices. Most (51%; n = 48) reported no previous PAE educational training. Dietitians infrequently prescribed exercise to their patients (16% ± 26% of appointments) or provided PAE referrals (17% ± 24%). Dietitians reported moderate confidence (57% ± 21%) performing PAE counselling and included PAE-related content in half of patient appointments (52% ± 31%). Almost all respondents (95%) identified interest in further PAE education or training. Open-ended responses also demonstrated the need for community-based exercise programs (28% of providers) and qualified exercise professionals to refer to (25%). Overall, dietitians report rarely providing patients with written exercise prescriptions or referrals to other professionals for PAE content but do frequently include PAE in patient appointments. Dietitians in Nova Scotia are well positioned to promote PAE, but more educational training and improved referral systems to qualified exercise professionals or community exercise programs is strongly desired. Exercise professionals and dietitians should concurrently advocate for these changes and collaborate to help more patients lead physically active lifestyles.

Usability testing of an e-learning resource designed to improve medical students’ physical activity prescription skills: a qualitative think-aloud study

ObjectiveAn e-learning resource (MEdic GAming, MEGA) was developed based on the contents of the Faculty of Sports and Exercise Medicine exercise prescription booklet. This study aimed to (i) explore medical students’ perspectives of physical activity promotion and e-learning and (ii) investigate medical students’ response to the design, content and usability of the MEGA e-learning resource.DesignQualitative think-aloud interview study.SettingA London medical school.Participants19 undergraduate medical students were interviewed using the think-aloud method while using the e-learning resource concurrently.ResultsIn general, medical students felt current education on physical activity is inadequate and held a strong desire for more teaching on exercise medicine. Students believed the MEGA e-learning resource addressed a gap in their knowledge on physical activity but noted e-learning should not replace face-to-face teaching and suggested physical activity education would be best delivered through a blended learning approach. Students felt such an approach would allow better opportunity to practice physical activity counselling skills with patients while on clinical placement. Students’ motivation to engage with the MEGA e-learning resource was positively impacted by aesthetically appealing design and interactive gamification elements such as self-assessment quizzes and visual progress tracking.ConclusionMedical students value the role of physical activity in health but are disappointed by the lack of teaching within the current medical curriculum. E-learning resources, such as MEGA, which contain interactive features are a viable means to integrate physical activity into the undergraduate curriculum but should be supplemented by the opportunity to practice physical activity counselling in-person.

Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counselling Intervention: A Qualitative Study Using a Relational Ethics Lens (Preprint)

BACKGROUND Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. Recent evidence also identifies, however, some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides in using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ways that are ethically aware. OBJECTIVE Using an ethics lens, describe a range of experiences from persons with knee OA who used a wearable during a physical activity counselling intervention study. METHODS This is a secondary analysis of qualitative interviews (60-90 mins) nested within a randomized controlled trial (RCT). Guided by phenomenography, we explored the experiences of persons with knee OA, following participation in a physical activity counselling intervention. The intervention consisted of a 1.5-hour education session about physical activity, using a Fitbit Flex, and receiving 4 biweekly phone calls for activity counselling with a study physiotherapist (PT) in an 8-week period. All PTs were trained in the Brief Action Planning approach, whereby they guided participants to identify activity goals, develop an action plan, and identify barriers and solutions. Benefits or downsides experienced in participants’ relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens. RESULTS Interviews with 21 participants (12 females, 9 males) aged 40-82 years were analyzed. Education ranged from high school graduate (n=4) to bachelor’s degree or above (n=11). Three categories of description were identified: 1) Participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; 2) Some participants felt a sense of accomplishment from seeing progress in their wearable data, which fuelled motivation. One participant experienced negative emotions (e.g., self-blame) if his wearable data indicated physical activity goals were not met; 3) For some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. They also expressed, however, there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate. CONCLUSIONS To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation. Findings also provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in an RCT to support physical activity.

Current Practice of Physical Activity Counselling within Physiotherapy Usual Care and Influences on Its Use: A Cross-Sectional Survey

Physical activity counselling has demonstrated effectiveness at increasing physical activity when delivered in healthcare, but is not routinely practised. This study aimed to determine (1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals; and (2) influences on this behaviour. A cross-sectional survey of physiotherapists was conducted across five hospitals within a local health district in Sydney, Australia. The survey investigated physiotherapists’ frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model. The sample comprised 84 physiotherapists (79% female, 48% <5 years of experience). Physiotherapists reported using on average five (SD:3) elements of physical activity counselling with at least 50% of their patients who could be more active. A total of 70% of physiotherapists raised or discussed overall physical activity, but less than 10% measured physical activity or contacted community physical activity providers. Physiotherapists reported on average 25 (SD:9) barriers influencing their use of physical activity counselling. The most common barriers were related to “opportunity”, with 57% indicating difficulty locating suitable community physical activity opportunities and >90% indicating their patients lacked financial and transport opportunities. These findings confirm that physical activity counselling is not routinely incorporated in physiotherapy practice and help to identify implementation strategies to build clinicians’ opportunities and capabilities to deliver physical activity counselling.

A Scoping Review of Exercise Referral Schemes Involving Qualified Exercise Professionals in Primary Health Care

Qualified exercise professionals (QEPs) have the training, knowledge, and scope of practice to effectively provide physical activity counselling, prescribe exercise, and deliver exercise programming to patients with or without chronic diseases. Healthcare providers identify an interest in referring patients to QEPs; however, the impact of exercise referral schemes (ERS) involving QEPs on patients’ physical health is unclear. A scoping review regarding the available evidence of ERS involving healthcare provider referrals to QEPs was performed. A literature search was conducted in six databases (initially: n=6011 articles), yielding n=23 articles examining QEP delivered physical activity counselling (n=7), QEP supervised exercise training (n=4), or some combination (n=12). Although studies were heterogeneous in methods, procedures, and populations, ERSs increased patients’ subjective physical activity levels. Few studies incorporated objective physical activity measures (n=5/23), and almost half measured aerobic fitness (n=11/23). ERS involving a QEP that includes activity counselling and/or exercise programming/training report favourable impacts on patients’ subjectively measured physical activity and objectively measured aerobic fitness. Based on the existing literature on the topic, this scoping review provides recommendations for designing and/or evaluating ERS with QEPs that include: objective measures, long-term follow-up, QEP qualifications, and the cost-effectiveness of ERS. Novelty: • ERS involving QEPs report increased patients’ perceived physical activity level and may improve patients’ cardiorespiratory fitness. • Promoting the collaboration of QEPs with other healthcare providers can enhance patients’ physical fitness and health. • This scoping review provides recommendations for the design and evaluation of ERS involving QEPs.