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Lifescripts methodology card: physical activity

Helping patients become more active.

Lifescripts methodology card: helping patients become more active (PDF 121 KB)

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Ask, assess, advise, assist, arrange
Evidence for the benefits of physical activity

Ask, assess, advise, assist, arrange

Ask

Less intensive (1-5 mins)

Identify patients who would benefit from increasing their physical activity

• Waiting room checklist and poster
• Patient record prompts: check lifestyle habits at least every two years
• Prompts by practice staff

Ask: 'How do you feel about your level of physical activity at the moment?'

More intensive (5-15 mins)

Identify patients who would benefit from increasing their physical activity

• Waiting room checklist and poster
• Patient record prompts: check lifestyle habits at least every two years
• Prompts by practice staff

Ask: 'How do you feel about your level of physical activity at the moment?' Top of page

Assess

Less intensive (1-5 mins)

Assess current physical activity level

• Assess:
  • level of physical activity - if high risk consider more intensive intervention
  • interest and confidence in quitting

Ask: 'Are you willing to try being more physically active?'

• Assess barriers to change (e.g. 'What would be the hardest thing about changing?')
• Record lifestyle habits in patient's record

More intensive (5-15 mins)

Assess current physical activity level

• Physical activity assessment tool:
  • aerobic
  • muscle strengthening
  • interest and confidence to change
• Identify individual barriers to change
• Assess mental health status
• Record lifestyle habits in patient's record
• Exclude contraindications for patients at higher risk Top of page

Is the person ready to increase their level of physical activity?

If yes, ready to attempt change, continue with the 5As approach

If no, not ready

• Advise on benefits of physical activity
• Offer information and resources
• Assess interest in changing at later date

Advise

Less intensive (1-5 mins)

Advise on benefits of change

• Provide brief, non-judgemental advice about positive benefits of physical activity
• Advise on recommended levels of physical activity
• Exclude contraindications*

More intensive (5-15 mins)

Provide tailored advice

• Give feedback on current activity level
• Provide brief, non-judgemental advice on recommended levels of physical activity
• Discuss individual benefits
• Exclude contraindications* Top of page

Assist

Less intensive (1-5 mins)

Offer resources and support

• Offer information/ resources
• Encourage social support

More intensive (5-15 mins)

Write physical activity prescription

• Jointly devise strategies for support
• Individualise the prescription (incl. goal setting)
• Make an individual plan to deal with common challenges e.g. habit, mood, weight, stress
• Offer information/ resources
• Encourage social support Top of page

Arrange

Less intensive (1-5 mins)

Arrange follow-up

• Negotiate a separate consultation about physical activity
• Organise follow-up review

More intensive (5-15 mins)

Arrange referral and follow-up

• Consider referral to local physical activity provider
• Consider referral to a physiotherapist and/or an accredited exercise physiologist
• Organise follow-up appointment in 2-4 months
• Recruit support (e.g. partner or family) Top of page

Evidence for the benefits of physical activity **

Physical inactivity is a major modifiable risk factor affecting the health of Australians. It accounts for 7% of the total disease burden and is estimated to cost the community at least $1,494 million per year in direct health costs¹.

Disease burden is a measure of years of healthy life lost to illness, injury or death, and takes into account the prevalence and amount of disability associated with a disease or risk factor¹.

Health benefits of physical activity

• Lower risk of early death
• Lower risk of coronary heart disease and stroke
• Lower risk of high blood pressure
• Lower risk of adverse blood lipid profile
• Lower risk of type 2 diabetes
• Lower risk of metabolic syndrome
• Lower risk of colon cancer
• Lower risk of breast cancer
• Prevention of weight gain
• Weight loss, particularly when combined with reduced calorie intake
• Improved cardiorespiratory and muscular fitness
• Prevention of falls
• Reduced depression Top of page

Inactivity in Australia

More than half of the Australian population is not active enough to achieve these documented health benefits. Females report higher levels of physical inactivity than males in all states and territories. Evidence connecting sedentary behaviours with increased morbidity and mortality, independent of physical activity is increasing.

Figure 1: Prevalence of no exercise in previous 2 weeks, 2007–08³

Text version of graph:

	25-34	35-44	45-54	55-64	65-74	75 and over
Males	30.0	32.6	38.4	35	37.1	51.5
Females	30.2	34.6	33.3	37.3	41.2	58.9

Top of page

Physical activity guidelines for adults

The Australian guidelines² recommend at least 30 minutes of moderate-intensity physical activity (either continuous or accumulated in bouts of 10 minutes or more) on most, preferably all, days of the week to gain a health benefit and reduce the risk for a range of conditions.
Evidence in this area is always emerging and the 2008 American Physical Activity guidelines also acknowledge the benefits of strength training, particularly in relation to diabetes outcomes. It is recommended that adults perform muscle strengthening activities of moderate or high intensity and involve all major muscle groups on two or more days of the week.

Can general practice make a difference?

Evidence demonstrates that clinicians can effectively increase patients' physical activity levels through brief clinical interventions that include⁴:

• brief advice
• provision of written information
• follow-up over subsequent consultations.

Who can benefit from this advice?

All sectors of the population can benefit from regular, moderate physical activity. There is evidence that the greatest benefit can be derived by people who are currently inactive, those with cardiovascular disease, hypertension, depression, anxiety or obesity, and those who are at higher risk of diabetes and osteoporosis. Top of page

What has been shown to work?

The '5 As' approach (Ask, Assess, Advise, Assist, Arrange) has proved a powerful tool to assist clinicians to structure advice on physical activity.

Having identified a patient who can benefit from increased physical activity levels and excluded major contraindications to exercise, the clinician can work with the patient to identify individual barriers to positive behaviour change and identify specific activities that are suitable. The patient and clinician can then negotiate realistic goals, and the advice is reinforced by an individually tailored physical activity prescription. Clinicians can also arrange referral to suitable activity providers within the community, and arrange appropriate follow up to review the patient's progress.

What referral options are available?

Many local communities run both formal and informal physical activity programs that would support your patients to participate in regular physical activity.

Patients with pre-existing medical conditions may require a referral to a cardiac rehabilitation program or physical activity program supervised by a physiotherapist or an accredited exercise physiologist.

The National Heart Foundation of Australia has a telephone counselling service, Heartline, which is staffed by trained health professionals who can provide further information on physical activity as well as a range of other risk factor areas.

Information on your local physical activity programs may also be available from your local division, local council and/or state government. Top of page

Recommended reading

• Department of Health and Aged Care. 1999. National Physical Activity Guidelines for Adults, Australian Government, Canberra.
• US Department of Health and Human Services. 2008 Physical activity Guidelines for Americans. Department of Health and Human Services, Centre for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion; USA: 2008.
• Royal Australian College of General Practitioners. Smoking, Nutrition, Alcohol and Physical Activity (SNAP): A population health guide to behavioural risk factors in general practice. RACGP; South Melbourne: 2004.
• Bauman A, Bellow B, et al. Getting Australia Active: Towards better practice for the promotion of physical activity. National Public Health Partnership; Melbourne: 2002.
• Huang N. Motivating patients to move. Aust Fam Physician: 2005;34:413–7.
• Brown WJ, Moorhead GE & Marshall AL. Choose Health: Be Active. A physical activity guide for older Australians. Canberra: Commonwealth of Australia and the Repatriation Commission; Canberra: 2005.

Useful resources

• Baker IDI Heart and Diabetes Institute www.bakeridi.edu.au
• Exercise & Sports Science Australia (ESSA) www.essa.org.au
• Sports Medicine Australia www.sma.org.au
• National Heart Foundation www.heartfoundation.org.au

References

See www.health.gov.au/lifescripts

* Practice nurses and allied health professionals: A general practitioner will need to assess any patients with the below medical conditions prior to the commencement of moderate physical activity:
- unstable angina
- acute infection or fever
- severe aortic stenosis
- resting tachycardia and/or arrhythmias
- uncontrolled heart failure
- recent complicated acute myocardial infarction (<3 months)
- uncontrolled hypertension or grade 3 (severe) hypertension (e.g. systole 180 or more and diastole 110 mmHg or more)
- diabetes with poor blood glucose level control (e.g. <6 mmol/L or >15 mmol/L)
- chest discomfort or shortness of breath on low-intensity activity

General practitioners: If a patient has any of the medical conditions listed above, their level of physical activity may need closer monitoring. Consider referral to an activity program supervised by a physiotherapist or an accredited exercise physiologist. Patients who have a chronic medical condition with complex care needs may benefit from an Enhanced Primary Care (EPC) multidisciplinary care plan.

** References in this section are listed in risk factor area evidence references from the practice manual.

Page last reviewed: 18 March 2011