Elsevier

Progress in Cardiovascular Diseases

Volume 64, January–February 2021, Pages 72-76
Progress in Cardiovascular Diseases

Training health professionals to provide physical activity counselling

https://doi.org/10.1016/j.pcad.2020.12.005Get rights and content

Abstract

There is strong evidence that physical activity (PA) counselling from a health professional (HPs) leads to increased PA of their patients. Despite this, there remains a large evidence-practice gap between HP knowledge of the contribution of physical inactivity to chronic disease prevention and management, and routine effective assessment and prescription of PA. This article will present evidence on the effectiveness of HP- PA counselling and suggested behaviour change frameworks that can be used by HP. Four case studies are provided as examples of programs integrated into current HP student and post-graduate training programs.

Introduction

Physical inactivity is the fourth leading risk factor for global mortality.1 Substantial research supports the benefits of regular physical activity (PA) in the prevention and treatment of chronic medical conditions.2,3 Sedentary patients cost more to care for4 and a 2016 report5 conservatively estimated that physical inactivity cost international health care systems over INT$53.8 billion worldwide in 2013. Despite the substantive evidence, 27.5% of adults globally participate in insufficient levels of PA to maintain health with the highest incidence of sedentarism in high income countries (36.8%).6

The World Health Organization (WHO) defines a health professional (HP) as individuals that study, diagnose, treat and prevent human illness, injury and other physical and mental impairments.7 For the purposes of developing guidelines for their education and training, the WHO provide a list of HP occupations that includes medical doctors (generalists and specialists), nurses and midwifes, dentists, pharmacists, dieticians and nutritionists, and other therapy related occupations.7 These HPs are ideally placed to promote PA. Patients view them as credible sources of health information including advice regarding PA.8 Of all HPs, primary care medical doctors tend to have longer-term relationships with their patients, with 80% of individuals in the United States (US) visiting at least once per year.9 This makes the primary care setting ideal for long-term behaviour change counselling. The aims of this paper are to provide evidence for the effectiveness of PA counselling by HPs along with current best practice models. Further, we will present several case studies that the authors have been involved with to improve PA counselling behaviours of HPs, with a focus on primary care medical doctors.

Section snippets

Effectiveness of HPs PA counselling

There is strong evidence that HP PA counselling leads to increases in PA of patients.10, 11, 12 A recent systematic review that included 16 studies found that HP PA counselling increased PA energy expenditure by 1.8 metabolic equivalent (MET)hours/week and with a more intensive HP patient interaction this increased to 2.8 METhours/week.12 This is an improvement of approximately 60 extra minutes/week of moderate PA equating to more than a third of the current PA guidelines. Cost effectiveness of

Changing HP PA counselling behaviour

HP PA counselling behaviour is dependent on three components: capability, opportunity and motivation (COM-B).21 Barriers to HP providing PA counselling include a poor understanding of how and why to prescribe exercise or where to refer a patient to obtain the best PA prescription (capability),22 lack of time within consultations (opportunity),22,23 as well as limited PA and behaviour change counselling skills (capability).24,25 Education in lifestyle medicine is considered necessary to allow

Changing patient PA behaviour

Effectively encouraging patients to change their health behaviours is a critical skill for HPs. Implementing a behaviour change intervention may appear to be a daunting task without adequate training in the area. The 5 A's behaviour change framework (Fig. 1) is recommended to guide a HP/patient PA behaviour change interaction: 1) Assess current PA (type, frequency, intensity, and duration); PA contraindications; patient's readiness for change and self-confidence to change behaviour; 2) Advise

Brief PA counselling

Implementing the 5 A's behaviour change framework illustrated in Fig. 1 is hampered by a lack of time within HP consultations. Often these are patient initiated and therefore generally based around an acute complaint/condition experienced by the client/patient. Therefore, a standard consultation time is usually insufficient to implement all aspects of the 5 A's framework to influence PA behaviour. This can be exacerbated for the HP when there are a range of lifestyle related issues to consider,

Case studies

The following case studies detail different approaches that the authors have been involved in to improve the training of HPs to provide PA counselling to their patients. The discussion of these cases covers the context, overview, and key learnings of the cases. Table 2 lists key considerations when including PA curriculum into HP training.

Conclusions

The PA counselling from HPs leads to increased PA and better health outcomes for their patients. However, there remains a large evidence-practice gap between HP knowledge of the contribution of physical inactivity to chronic disease prevention and management, and routine effective assessment and prescription of PA. This is recognized as being partially due to insufficient coverage of these topics in the HP curricula, especially for medical students. While significant barriers exist to adding

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgement

AW is a Medical Research Future Fund (MRFF) Translating Research into Practice (TRIP) Fellow funded by the Australian Government.

References (41)

  • World Health Organisation

    Global health risks: mortality and burden of disease attributable to selected major risks

  • I.M. Lee et al.

    Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy

    Lancet

    (2012)
  • B.K. Pedersen et al.

    Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases

    Scand J Med Sci Sports

    (2015)
  • L.H. Anderson et al.

    Health care charges associated with physical inactivity, overweight, and obesity

    Prev Chronic Dis

    (2005)
  • D. Ding et al.

    The economic burden of physical inactivity: a global analysis of major non-communicable diseases

    Lancet

    (2016)
  • R. Guthold et al.

    Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants

    Lancet Glob Health

    (2018)
  • World Health Organization

    Transforming and scaling up health professionals' education and training: World Health Organization guidelines 2013

  • M.L. Booth et al.

    Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians

    Prev Med

    (1997)
  • M. Lethbridge-Cejku et al.

    Summary health statistics for U.S. adults: National Health Interview Survey, 2002

    Vital Health Stat

    (2004)
  • G. Orrow et al.

    Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials

    BMJ

    (2012)
  • I.M. Vuori et al.

    Physical activity promotion in the health care system

    Mayo Clin Proc

    (2013)
  • Y. Goryakin et al.

    Impact of primary care-initiated interventions promoting physical activity on body mass index: systematic review and meta-analysis

    Obes Rev

    (2018)
  • F. Campbell et al.

    A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

    Health Technol Assess

    (2015)
  • G.C. Vijay et al.

    Are brief interventions to increase physical activity cost-effective? A systematic review

    Br J Sports Med

    (2016)
  • C. D. C. Diabetes Cost-effectiveness Group

    Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes

    JAMA

    (2002)
  • A. Green et al.

    Exercise: an essential evidence-based medicine

    Med J Aust

    (2018)
  • C.R. Elley et al.

    Why target sedentary adults in primary health care? Baseline results from the Waikato Heart, Health, and Activity Study

    Prev Med

    (2003)
  • L. Mosca et al.

    National study of physician awareness and adherence to cardiovascular disease prevention guidelines

    Circulation

    (2005)
  • H. Britt et al.

    General practice activity in Australia 2009–10

  • M.L. Dacey et al.

    Physical activity counseling in medical school education: a systematic review

    Med Educ Online

    (2014)
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