Narrative review – Barriers and facilitators to promotion of physical activity in primary care

Abstract

The objective to provide an overview of the literature on the barriers and facilitators to physical activity (PA) promotion in primary care, as experienced by practitioners and patients. Method A search strategy of the English‐language literature was conducted in EMBASE, MEDLINE and the COCHRANE LIBRARY. Search terms were primary care OR general practice OR family medicine OR family practitioner AND physical activity OR exercise AND barriers OR facilitators. Databases were searched from inception until 21 October 2022. Results After screening, 63 articles were included within the summary and content analysis of this review. Analysis of the barriers to the implementation of PA highlighted four main themes perceived by practitioners: time, knowledge/skills, resources/support and financial implications. Analysis of the patient perspective identified themes which were categorised into individual (pre‐existing health conditions, knowledge of benefits of PA, time/capacity), societal (social support and cultural norms) and environmental (availability of facilities and weather). Conclusions As the importance of PA increases through the manifestation of sedentary behaviour‐related disease, a combined primary care and public health approach to increase PA is required. By identifying the main barriers to PA promotion in primary care, resources and funding can be directed to address this. This is particularly relevant in the United Kingdom, with the re‐negotiation of the primary care contract and the changes to healthcare delivery as a consequence of the Covid‐19 pandemic. Throughout this review, we have explored ways of addressing the identified barriers through evidence‐based interventions.

Delivery of Interventions for Multiple Lifestyle Factors in Primary Healthcare Settings: A Narrative Review Addressing Strategies for Effective Implementation

“…Regarding PA promotion, primary care practitioners commonly cite four main reasons limiting its delivery: (a) time constraints, (b) insufficient knowledge and skills, (c) a lack of resources and support and (d) negative financial implications [56,57]. These findings were consistent with barriers to smoking cessation [58] and alcohol interventions [59].…”

Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system

“…30 While that study identified use of paper referral as their main barrier, our study identified lack of time and training among MAs as main barriers, which is consistent with existing literature. [31][32][33][34] Future areas of improvement may explore ways to further streamline PAVS entry and emphasising EIM documentation by encouraging providers to add the smartphrase to their note templates. Addressing time constraints remains challenging given competing priorities within the broader healthcare structure.…”

Introducing lifestyle medicine into family medicine: Theory and applications

“…Physicians also face barriers when it comes to addressing and evaluating lifestyle changes and their impact on chronic diseases 16 . Time constraints imposed by the typical office visit can limit education and counseling opportunities about lifestyle medicine topics.…”

“…Patients may face various barriers to making lifestyle changes to positively impact their chronic diseases 16 . Patients may lack awareness of the efficacy of lifestyle changes in managing chronic diseases, e.g., Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement from the American College of Lifestyle Medicine 17 .…”

“…Overcoming these barriers requires a multifaceted approach 16,20 . Enhancing medical education and training in lifestyle medicine, advocating for policy changes that prioritize preventive care and lifestyle counseling, improving reimbursement for these services, and fostering interdisciplinary collaborations can help address the physician barriers to evaluating and addressing lifestyle changes in a family medicine practice.…”