The Doctor's role in Promoting Physical Activity Flashcards
What should we be doing in primary care to promote physical activity
Ask about physical activity status at every consultation
-identify inactive adults, advise 30mins of moderate activity 5/7 days
Brief physical activity is almost just as effective as intensive intervention
NNT for physical exercise is lower than smoking cessation
Why is exercise under utilised by doctors
Own habits
Ignoring evidence and seeing reasons not to prescribe
- lack of time
- exercise addiction
- fear of being sued if injuries happen
Lack of financial incentive
Limited knowledge and confidence
How would you conduct a consultation on physical activity
5A's Ask = current status, PEH, PMH -what's the most active thing you've done in the last week, is this typical for you? -how much? -what are the barriers
Assess = where are they in the change cycle
Advise = come up with SMART goals together
Assist = provide resources and referrals to help to meet goals
Arrange = follow up to assess progress and barriers
What are the contraindications for physical activity
Absolute
-major acute injury/immediately post surgery
-heart failure with symptoms at rest
-uncontrolled disease
*diabetes
*asthma
*severe HTN 200/115+
*new arrythmias
Acute infection with systemic symptoms (viral myocarditis risk)
-red flag symptoms (chest pain, PND, SOB, pitting edema)
Name the 5 stages of change
How would you support the person at each stage
Precontemplation => raise awareness
Contemplation => assess barriers and worries, increase necessity and confidence
Preparation => set SMART goals
Action => come up with strategies to implement change and barriers
Maintenance => follow up and reassess barriers. If they have relapsed, explore why
How might you support your patients in engaging in physical activity
List of benefits, written summary
Knowledge of public health, community programmes
Apps
- Couch to 5k
- Nike Training
- Fitness Buddy Pro
What are the risks of exercise?
Low for most people but the risk to health of not exercising is likely to be greater
-MSK, CV events
Reduce risk
-warm up, cool down
How would you write an exercise prescription?
What considerations should you make?
FITT
Frequency
-3-5x/7 aerobic
-2/7 strengthening
Intensity
- low = singing
- moderate = conversation
- high = can’t talk
Time
-30mins or 15mins at high intensity
Type of activity
- cardio (accessible, sociable)
- strength (5-6 types, 8-10 reps)
- balance, coordination
Ensure that it is
- appropriate
- if sedentary, start low intensity and work up
- any chest pain/symptoms => seek medical help
Can you do an exercise referral?
NHS funded 12wks specialist exercise
-community walking, gym specialist
Green social prescriptions
-nature based interventions
Can phone exercise professional for motivational interview and advice
When would you consider a specialist exercise referral?
Cardiac/COPD rehab
Exercise, weight management for obese
Falls prevention classes for elderly
High risk patients may see a Sport and Exercise Medicine consultant