Physical activity promotion by health professionals is a key strategy to increase population physical activity levels. This strategy has been outlined in the World Health Organization’s “Global Action Plan on Physical Activity”1 and the International Society for Physical Activity and Health’s “Eight investments that work for physical activity.”2 To support this, recently, the Global Alliance for the Promotion of Physical Activity signed the “Hamburg Declaration,” calling on policymakers worldwide to take concrete actions to promote physical activity in health care settings, facilitating its integration into daily patient care.3
The World Health Organization Global Action Plan on Physical Activity action items 1.4 and 3.2 outline the need to strengthen preservice and postservice training of health professionals to increase their knowledge and skills for an active society and to implement and strengthen patient assessment and counseling on increasing physical activity and reducing sedentary behavior. These action items are part of a multifaceted approach to reach a 15% reduction in global prevalence of physical inactivity in adults and adolescents by 2030. Globally, health professionals perceive that physical activity promotion is part of their role, with limited counseling time the most reported barrier to promotion.4 All health professionals have the capability to promote physical activity; however, the activity level, the setting, and the type of advice should be considered so the right advice is given in the right setting at the right time.
Physical Activity and Sedentary Behavior
The World Health Organization provides physical activity guidelines for children, adolescents, adults, older adults, pregnant and postpartum women, and people living with chronic conditions or disability. For adults, with and without chronic conditions or disability, it is recommended that individuals should participate in 150 to 300 minutes of moderate-intensity aerobic physical activity or 75 to 150 minutes of vigorous-intensity aerobic physical activity or a combination of both per week.5 Muscle strengthening should be completed on at least 2 days per week, and varied functional balance and strength activities should be completed 3 days per week. In addition, long, unbroken time spent in sedentary behavior should be avoided, with the recommendation to replace and/or break up sedentary time with any intensity of physical activity, including light intensity.5 The evidence for increased moderate- to vigorous-intensity activity in reducing morbidity and mortality is strong,6 with evidence continuing to grow for reducing or breaking up long periods of sedentary behavior.7 Evidence is also emerging that increased light-intensity physical activity may improve health outcomes, such as reducing adiposity and improving lipidaemia.8
Health Care Setting
Across primary through to secondary and tertiary health care settings, there is evidence that health professional advice can increase physical activity and decrease sedentary behavior in healthy and unhealthy populations, improving health outcomes.9 In primary care, health professionals providing a range of physical activity promotion, beyond therapeutic exercise, are effective at improving moderate to vigorous physical activity levels and increasing the odds of patients meeting the physical activity guidelines.10,11 In hospital settings (secondary and tertiary care), physical activity advice provided by health professionals to inpatients has resulted in increased activity that has been associated with shorter lengths of stay and a lower risk of readmission.12,13 Improving physical activity is a core component of outpatient comprehensive cardiac and pulmonary rehabilitation programs, reducing recurrent cardiovascular events or chronic obstructive pulmonary disease exacerbations and decreasing mortality.14,15 Consequently, the delivery of physical activity behavior change interventions by health professionals across the range of health care settings is considered to be both effective and cost-effective.16–18
Physical Activity Advice
Patients want physical activity advice from their health professional and report that this advice would result in increased activity; however, few patients receive this advice.19,20 Health professionals (eg, nurses, allied health professionals, community health workers, and medical doctors) are well placed to provide general physical activity advice on the types and amount of activity appropriate for the individual’s goals, needs, abilities, conditions, preferences, functional limitations, medication regimes, and treatment within their scope of practice and when to refer for more specific physical activity advice.21 For a more specific physical activity prescription, exercise specialists, such as physiotherapists and exercise physiologists, should be consulted. Importantly, a medical review is generally unnecessary prior to beginning light- to moderate-intensity physical activity unless there are known contraindications.5,22 Thus, regardless of diagnosis, comorbidities, or age, all individuals should be safely encouraged to increase their physical activity and decrease their sedentary behavior levels, starting slowly at an appropriate level and progressing gradually.5,22
To allow every health professional to promote physical activity at every opportunity, we propose a continuum of physical activity advice considered alongside the energy expenditure continuum (sedentary behavior and physical activity levels) and the health care setting (Figure 1). The continuum is designed to illustrate how all health professionals, regardless of how much time they have or the setting in which they work, are able to provide effective and safe physical activity advice.
—Physical activity advice continuum tool—the right advice, in the right setting, at the right time. PA indicates physical activity.
Citation: Journal of Physical Activity and Health 21, 4; 10.1123/jpah.2023-0748
Very brief advice is delivered in <5 minutes.23 An example of very brief physical activity advice is a very brief discussion of the physical activity guidelines, followed by practical advice on implementing the guidelines, such as “moderate intensity physical activity means you should be able to talk in full sentences but not sing,” or “any activity is better than none.” Brief advice is delivered in <30 minutes and can include assessing physical activity levels, more specific physical activity prescription (eg, aerobic training, such as brisk walking, and resistance training, such as whole-body strength exercise), or signposting to physical activity programs and support.24 Extended physical activity advice is >30 minutes in duration and can include supervised group center- or home-based programs or an individual physical activity assessment and tailored physical activity prescription provided by an exercise specialist. Figures 2 and 3 provide examples of how the physical activity advice continuum can be applied in practice.
—Physical activity advice continuum tool example—a nurse working on the medical ward of a tertiary hospital providing very brief advice (<5 min) to a patient on safely breaking up long periods of sedentary behavior with any intensity PA throughout the day. PA indicates physical activity.
Citation: Journal of Physical Activity and Health 21, 4; 10.1123/jpah.2023-0748
—Physical activity advice continuum tool example—a community health worker delivering a 60-minute cardio dance class at a community health center to increase moderate-intensity PA. PA indicates physical activity.
Citation: Journal of Physical Activity and Health 21, 4; 10.1123/jpah.2023-0748
Conclusions
Physical activity advice provided by health professionals can vary between and within patients depending on the availability of time, the health care setting, and the specificity of advice required. All health professionals have a responsibility to promote physical activity, a major risk factor for morbidity and mortality globally. The physical activity advice continuum provides options for any health professional to promote physical activity within health care regardless of their discipline or their available time. Given that health professionals see a large number of patients across their careers, integrating and coordinating various levels of physical activity advice across health care settings by all health professionals has the potential to increase population physical activity significantly.
Acknowledgments
Freene is partly funded by the 2021 Medical Research Future Fund Grant (MRFF) Cardiovascular Health Mission Scheme Grant (ID 2015953). Seymour is funded by the 2021 MRFF Cardiovascular Health Mission Scheme Grant (ID 2015953), Solve-CHD, and the Digital Health Cooperative Research Centre. Gomersall is partly funded by the Health and Wellbeing Centre for Research Innovation (HWCRI), which is cofunded by the University of Queensland and Health and Wellbeing Queensland.
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