The Physical Activity Advice Continuum—A Guide for Physical Activity Promotion in Health Care

Click name to view affiliation

Nicole Freene Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
Health Research Institute, University of Canberra, Bruce, ACT, Australia

Search for other papers by Nicole Freene in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-2047-7012 *
,
Stephen Barrett Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
Research and Innovation, Bendigo Health, Bendigo, VIC, Australia
Holsworth Research Initiative, La Trobe Rural Health School, Bendigo, VIC, Australia

Search for other papers by Stephen Barrett in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0003-2505-733X
,
Emily R. Cox Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
Active Living Research Program, Hunter Medical Research Institute, New Lambton, NSW, Australia
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia

Search for other papers by Emily R. Cox in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-1687-3522
,
Jessica Hill Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia

Search for other papers by Jessica Hill in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0003-2650-455X
,
Roger Lay Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
Cancer Institute NSW, St Leonards, NSW, Australia

Search for other papers by Roger Lay in
Current site
Google Scholar
PubMed
Close
,
Jessica Seymour Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
Health Research Institute, University of Canberra, Bruce, ACT, Australia

Search for other papers by Jessica Seymour in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0001-9282-0580
,
Kimberley Szeto Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

Search for other papers by Kimberley Szeto in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0001-9469-9139
, and
Sjaan R. Gomersall Asia-Pacific Society for Physical Activity “Physical Activity in Healthcare” Special Interest Group, Burwood, VIC, Australia
School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, The University of Queensland, Saint Lucia, QLD, Australia

Search for other papers by Sjaan R. Gomersall in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0001-6808-0180
Free access

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.1618

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.

Figure 1
Figure 1

—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.

Figure 2
Figure 2

—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

Figure 3
Figure 3

—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.

References

  • 1.

    World Health Organization. Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier World. World Health Organization; 2018.

    • Search Google Scholar
    • Export Citation
  • 2.

    International Society for Physical Activity and Health. ISPAH’s eight investments that work for physical activity. 2020. Accessed December 1, 2023. www.ISPAH.org/Resources

    • Search Google Scholar
    • Export Citation
  • 3.

    Steinacker JM, Mechelen Wv, Bloch W, et al. Global alliance for the promotion of physical activity: the Hamburg declaration. BMJ Open Sport Exerc Med. 2023;9(3):e001626. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical activity promotion: a systematic review of the perceptions of healthcare professionals. Int J Environ Res Public Health. 2020;17(12):4358. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Posadzki P, Pieper D, Bajpai R, et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health. 2020;20(1):1724. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Saunders TJ, McIsaac T, Douillette K, et al. Sedentary behaviour and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab. 2020;45(10 suppl 2):S197S217. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Chastin SFM, De Craemer M, De Cocker K, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med. 2019;53(6):370376. PubMed ID: 29695511 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Todd JW, Scarborough H. Medicine. 2023. Accessed December 11, 2023. https://www.britannica.com/science/medicine

  • 10.

    Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Kettle VE, Madigan CD, Coombe A, et al. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ. 2022;376:e068465. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Daskivich TJ, Houman J, Lopez M, et al. Association of wearable activity monitors with assessment of daily ambulation and length of stay among patients undergoing major surgery. JAMA Netw Open. 2019;2(2):e187673. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Fisher SR, Graham JE, Ottenbacher KJ, Deer R, Ostir GV. Inpatient walking activity to predict readmission in older adults. Arch Phys Med Rehabil. 2016;97(9):S226S231. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Woodruffe S, Neubeck L, Clark RA, et al. Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart Lung Circ. 2015;24(5):430441. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. An official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(5):e12e29. PubMed ID: 33929307 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Liu S, Zhao Q, Li W, Zhao X, Li K. The cost-effectiveness of pulmonary rehabilitation for COPD in different settings: a systematic review. Appl Health Econ Health Policy. 2021;19(3):313324. PubMed ID: 33079374 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Vijay GC, Wilson ECF, Suhrcke M, et al. Are brief interventions to increase physical activity cost-effective? A systematic review. Br J Sports Med. 2016;50(7):408417. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. 2018;104(17):14031410. PubMed ID: 29654096 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Falskog F, Landsem AM, Meland E, Bjorvatn B, Hjelle OP, Mildestvedt T. Patients want their doctors’ help to increase physical activity: a cross sectional study in general practice. Scand J Prim Health Care. 2021;39(2):131138. PubMed ID: 33871303 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Kunstler B, Fuller R, Pervan S, Merolli M. Australian adults expect physiotherapists to provide physical activity advice: a survey. J Physiother. 2019;65(4):230236. PubMed ID: 31521552 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Alsop T, Lehman E, Brauer S, et al. What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement. Br J Sports Med. 2023;57(22):14191427. PubMed ID: 37793699 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med. 2022;56(8):427438. PubMed ID: 34649919 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Lamming L, Pears S, Mason D, et al. What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews. Prev Med. 2017;99:152163. PubMed ID: 28232098 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    National Institute for Clinical Excellence. Physical Activity: Brief Advice for Adults in Primary Care. Nice Public Health Guidance. 2013;44.

    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand
  • Figure 1

    —Physical activity advice continuum tool—the right advice, in the right setting, at the right time. PA indicates physical activity.

  • Figure 2

    —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.

  • Figure 3

    —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.

  • 1.

    World Health Organization. Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier World. World Health Organization; 2018.

    • Search Google Scholar
    • Export Citation
  • 2.

    International Society for Physical Activity and Health. ISPAH’s eight investments that work for physical activity. 2020. Accessed December 1, 2023. www.ISPAH.org/Resources

    • Search Google Scholar
    • Export Citation
  • 3.

    Steinacker JM, Mechelen Wv, Bloch W, et al. Global alliance for the promotion of physical activity: the Hamburg declaration. BMJ Open Sport Exerc Med. 2023;9(3):e001626. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical activity promotion: a systematic review of the perceptions of healthcare professionals. Int J Environ Res Public Health. 2020;17(12):4358. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Posadzki P, Pieper D, Bajpai R, et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health. 2020;20(1):1724. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Saunders TJ, McIsaac T, Douillette K, et al. Sedentary behaviour and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab. 2020;45(10 suppl 2):S197S217. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Chastin SFM, De Craemer M, De Cocker K, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med. 2019;53(6):370376. PubMed ID: 29695511 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Todd JW, Scarborough H. Medicine. 2023. Accessed December 11, 2023. https://www.britannica.com/science/medicine

  • 10.

    Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Kettle VE, Madigan CD, Coombe A, et al. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ. 2022;376:e068465. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Daskivich TJ, Houman J, Lopez M, et al. Association of wearable activity monitors with assessment of daily ambulation and length of stay among patients undergoing major surgery. JAMA Netw Open. 2019;2(2):e187673. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Fisher SR, Graham JE, Ottenbacher KJ, Deer R, Ostir GV. Inpatient walking activity to predict readmission in older adults. Arch Phys Med Rehabil. 2016;97(9):S226S231. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Woodruffe S, Neubeck L, Clark RA, et al. Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart Lung Circ. 2015;24(5):430441. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. An official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(5):e12e29. PubMed ID: 33929307 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Liu S, Zhao Q, Li W, Zhao X, Li K. The cost-effectiveness of pulmonary rehabilitation for COPD in different settings: a systematic review. Appl Health Econ Health Policy. 2021;19(3):313324. PubMed ID: 33079374 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Vijay GC, Wilson ECF, Suhrcke M, et al. Are brief interventions to increase physical activity cost-effective? A systematic review. Br J Sports Med. 2016;50(7):408417. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. 2018;104(17):14031410. PubMed ID: 29654096 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Falskog F, Landsem AM, Meland E, Bjorvatn B, Hjelle OP, Mildestvedt T. Patients want their doctors’ help to increase physical activity: a cross sectional study in general practice. Scand J Prim Health Care. 2021;39(2):131138. PubMed ID: 33871303 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Kunstler B, Fuller R, Pervan S, Merolli M. Australian adults expect physiotherapists to provide physical activity advice: a survey. J Physiother. 2019;65(4):230236. PubMed ID: 31521552 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Alsop T, Lehman E, Brauer S, et al. What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement. Br J Sports Med. 2023;57(22):14191427. PubMed ID: 37793699 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med. 2022;56(8):427438. PubMed ID: 34649919 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Lamming L, Pears S, Mason D, et al. What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews. Prev Med. 2017;99:152163. PubMed ID: 28232098 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    National Institute for Clinical Excellence. Physical Activity: Brief Advice for Adults in Primary Care. Nice Public Health Guidance. 2013;44.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 3963 3962 1224
PDF Downloads 1867 1867 111