Physical activity promotion in primary care: a Utopian quest?

Abstract

The health benefits of physical activity (PA) are acknowledged and promoted by the scientific community, especially within primary care. However, there is little evidence that such promotion is provided in any consistent or comprehensive format. Brief interventions (i.e. discussion, negotiation or encouragement) and exercise referral schemes (i.e. patients being formally referred to a PA professional) are the two dominant approaches within primary care. These cost-effective interventions can generate positive changes in health outcomes and PA levels in inactive patients who are at increased risk for non-communicable diseases. Their success relies on the acceptability and efficiency of primary care professionals to deliver PA counselling. To this end, appropriate training and financial support are crucial. Similarly, human resourcing and synergy between the different stakeholders must be addressed. To obtain maximum adherence, specific populations should be targeted and interventions adapted to their needs. Key enablers include motivational interviewing, social support and multi-disciplinary approaches. Leadership and lines of accountability must be clearly delineated to ensure the success of the initiatives promoting PA in primary care. The synergic and multisectoral action of several stakeholders, especially healthcare professionals, will help overcome physical inactivity in a sustainable way.

Perceptions of Care Sport Connectors’ Tasks for Strengthening the Connection Between Primary Care, Sports and Physical Activity: A Delphi Study

“…Although most professions reached consensus about several or all the statements related to collaboration, general practitioners and nurse practitioners did not reach consensus about these statements, which is in line with other studies [23,31]. This is critical because general practitioners and nurse practitioners are at the forefront of primary care, know the target group and their backgrounds, and patients accept their role in discussing lifestyle [32][33][34]. Vision documents about prevention in the general practice setting endorse their important role as a linking pin to other primary care professionals and their pivotal position in strengthening the connection between preventive and curative care [32,35].…”

“…However, time for referring adults with overweight and obesity to combined lifestyle interventions and intersectoral collaboration by primary care providers are not reimbursed [34,39,40], where the questioned other professions get a reimbursement for these activities [2,41]. On the other hand, general practitioners and nurse practitioners mentioned that they would collaborate if they found it useful.…”

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

“…In the UK, multiple HCPs present with diverse levels of training and experience [41]. In this study we encountered instances where HCPs lacked knowledge on the recommended guidelines on PA, including PA and diabetes, as reported elsewhere [39,42]. In these circumstances HCPs expressed understandable discomfort.…”

“…The commitment to PA promotion, including to those patients with diabetes is important, given the pivotal role of HCPs in national strategies and programmes designed for promoting PA, including those focused on patients with long-term conditions [10,13,39]. Indeed, the RCGP [14] identify PA as a strategic priority, while the 2019 CMO Physical Activity Guidelines have identified HCPs as being important in implementing PA messages to a range of groups [13].…”

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

“…10,13 The origins of the programme are atheoretical, and the design and implementation are heterogeneous across and within countries. 9,14 The diversity and complex evolution of ERS impinges making direct inferences about what works, for whom, in what circumstances, and why. 15 The recommendation to utilize theory to provide focus and target potential mechanisms of service adherence as well as to refine models in specific circumstances is widespread in the literature.…”