A GUIDE TO PROMOTING PHYSICAL ACTIVITY IN PRIMARY CARE 1 NHS Health Scotland would like to Fiona Bell, NHS Education for Scotland; acknowledge the contribution of the Mary Colvin, NHS Tayside; members of the primary care guidance Claire Fitzsimons, University of reference group and to thank them for Strathclyde/SPARColl; their time and invaluable advice in the Liz Grant, NHS Greater Glasgow & Clyde; development of this resource: Maureen Kidd, NHS Health Scotland; Matthew Lowther, Scottish Government; Paul MacIntyre, Royal Alexandra Hospital/Scottish Government; Nanette Mutrie, University of Strathclyde/SPARColl; Lorna Renwick, NHS Health Scotland; Graeme Scobie, NHS Health Scotland; Morag Thow, Glasgow Caledonian University. Published by Health Scotland Edinburgh Office: Woodburn House, Canaan Lane Edinburgh, EH10 4SG Glasgow Office: Elphinstone House, 65 West Regent Street Glasgow, G2 2AF © NHS Health Scotland, 2008 All rights reserved. ISBN: 978-1-84485-427-1 Health Scotland is a WHO Collaborating 50% Centre for Health Promotion and Public Health Development 2 KEY FACTS • Adults should accumulate at least maximum cardiovascular benefit, this • In Scotland, 97% of the population 30 minutes of moderate-intensity level is likely to be unattainable and are registered with a GP practice and activity on five days of the week; unsustainable for the majority of the 88% of patients will have visited their children should accumulate at least population, and therefore encouraging local GP team at least once during one hour of moderate-intensity moderate activity will be the priority. the past year. In addition, around activity daily. This is the minimum For most people, the easiest and most one in every ten people in Scotland recommended level – in the simplest acceptable forms of physical activity visits a community pharmacy every terms, being ‘physically active’ is are those that can be incorporated into day. The primary care setting is defined as meeting this everyday life. therefore uniquely placed to raise recommended level. public awareness of the key messages • Only one in three adults living in around physical activity. • The majority of Scots do not meet Scotland is aware of the recommended the minimum recommended levels level of physical activity. of physical activity: 67% of women and 56% of men aged 16–74 years • Physical inactivity contributes to a are not active enough for their health1; broad range of chronic diseases, such 26% of boys and 37% of girls are not as coronary heart disease, stroke, active enough for their health. diabetes and some cancers. • ‘Moderate’ activity, such as brisk • Regular physical activity can have walking, noticeably increases the a high preventative and therapeutic heart rate to the level at which the effect on up to 20 chronic diseases or pulse can be felt and brings a feeling disorders. The greatest health benefits of increased warmth; ‘vigorous’ occur when the least active people activity, such as jogging, causes rapid become moderately active. breathing and a substantial increase 1 These figures are drawn from the Scottish Health Survey 2003. in heart rate. Although regular The Scottish Health Survey will run continuously from 2008 with national data available annually after 2009. Data at the health board level will be vigorous physical activity confers available for most boards from 2012. 3 COnTEnTS How to use this resource 5PArT ThrEE PArT FOur TranSlatinG evIdence Into ADDITIOnAl PATIENT ADVICE Engaging with patients or clients 6 practice 27 AND InFORMATIOn 41 What you should say The role of primary care in Benefits of physical activity 43 to your patient – promoting physical activity 29 if you have less than 30 seconds 7 What you should tell your GP A population approach? 30 or practitioner before you change your activity levels 44 Motivating patients to become PArT OnE more active 32 Getting started 45 Why promotinG PhysicAl Activity matters 9 Getting started 33 Symptoms during physical activity 46 Best buy in health 11 The four types of physical activity 34 how to avoid injuries 47 The health benefits of What activity can be included in being active 12 the recommended level? 35 calorie burning guide 48 Other benefits of being active 14 Building up gradually 37 Bibliography and further reading 50 local knowledge 38 useful contacts 52 PArT TwO GuIdelIneS And contraindications and risks 39 RecommendationS 17 children and young people 19 Adults 22 Older adults 25 4 hOw TO uSE ThIS rESOURCE Physical inactivity has been recognised as This guide has been put together for primary PArT OnE identifies the benefits of a significant risk factor for many chronic care staff and other health professionals physical activity and supports the view that diseases. yet, in Scotland, 6 out of 10 men (including GPs, practice nurses, health promoting physical activity is a ‘good buy’. and 7 out of 10 women are inactive and visitors, community pharmacists, dieticians, putting their health at risk because they do and podiatrists)2 to provide the evidence PArT TwO summarises the current not recognise its importance or relevance base for promoting physical activity and guidelines around recommended levels of to their lives. to recommend the key messages that physical activity for the following life stages: should be communicated to patients. A children over three years, young people, The challenge to primary care staff large number of patients will see a range of adults and older adults.3 across Scotland is to make physical activity primary care practitioners in the course of a higher priority in the promotion of a any single day and therefore the latter will PArT Three explains why the primary person’s health and wellbeing. have the opportunity to initiate conversations care setting is particularly critical in raising about physical activity. We hope that this public awareness of the key messages doctors, nurses and pharmacy staff can guide will give you the information and around physical activity. It also attempts to all play a key role in helping patients to support you need to do this. support practitioners by translating these understand the value of physical activity recommendations into practical advice for their health and providing access to This resource provides guidance on how for patients. information, motivation and advice about to offer routine advice and encouragement what patients can do. to patients around physical activity. It does Finally, in PArT FOur, details are not cover the more extended, individually- provided for other sources of professional focused interventions to identify and modify or patient support, including where to go those factors that influence activity levels. for information on local opportunities to be Further guidelines on these will be published physically active. separately when evaluation of current uK and Scottish programmes have been completed. 2 Hereafter, the collective term for these different professional groups will be ‘primary care practitioners’. 3 Note that this guidance focuses on individuals who have no serious physical limitations that might inhibit progress towards a more active lifestyle. 5 EnGAGInG wITh PATIEnTS Or CLIEnTS Primary care professionals were The key messages that frontline staff involved in the development of this should aim to get across to patients guide, and the message from them are summarised on the next page. was clear. In the lived reality of the even in a brief exchange with patients, primary care setting, time is always there might be an opportunity to at a premium. A distinction therefore supplement these messages with needs to be made between what can useful tips about getting started and realistically be achieved within different providing leaflets or information about time-length scenarios, ranging from local opportunities to be active a very brief exchange of less than (see Part Four). By engaging with 30 seconds to slightly longer (but patients in this way, primary care probably still less than two minutes). practitioners will be ‘sowing the Beyond two minutes, it is assumed seed’ for subsequent health-related that there will be an opportunity for behaviour change. more in-depth tailored advice and goal setting. 6 what you ShOuLd say to your patienT – if you hAvE less ThAn 30 secondS • In order to benefit your • Walking is an easy way to get health, make you feel better started. This should be at a and maintain your body weight, brisk pace; enough to make you should do regular physical you feel warmer and breathe activity and try not to sit for more deeply but without any long periods of time. discomfort. Slowly increase the length of each session and then • You should do at least 30 think about trying other minutes of moderate-intensity activities; include some physical activity, above usual stretching and resistance activity at work or home, on at exercises (these can be least five days of the week. If performed at home and need you are already overweight or not involve any obese, then you should aim to special clothing or do between 60 and 90 minutes equipment). on five days of the week. This can be achieved in shorter • You are more likely bouts of 10 or 15 minutes to remain physically throughout the day. active if you find an activity that you enjoy and that can be fitted into your everyday life. 7 8 P A r T PArT 1 1 whY PrOmotinG Physical ACTIvity MatterS 9 WHY PrOmOTInG PhYSICAL ACTIvITY mATTErS Let’s Make Scotland More Active (2003)4 is the national physical activity strategy and it provides the rationale and impetus for encouraging more people in Scotland to adopt more active lifestyles. 10 BEST BuY In Health As a nation, Scotland is inactive, unfit and This breadth of action, combined with the The national strategy recognises that the increasingly overweight or obese. The health current prevalence of inactivity in Scotland, prevalence of inactivity cannot be changed of two-thirds of the Scottish adult population makes the encouragement of active lifestyles overnight.