What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement

[Physical Activity-Related Health Services in Germany: Relevance and Necessary Framework Conditions - a Position Paper of the DNVF Working Group Physical Activity-Related Health Services Research]

Based on the relevance of an established and broad foundation of physical activity in healthcare, this position paper of the DNVF working group Physical Activity-Related Health Services research presents current conceptual approaches to physical activity-related health services in Germany and highlights the need for interprofessional and interdisciplinary approaches. Three central positions are outlined and elaborated in order to integrate the evidence on health benefits of physical activity and exercise more strongly into healthcare and to show that, against the background of the challenges in the German healthcare system, physical activity-related health services can make a cost-effective and high-quality contribution to improve healthcare. These three positions include 1) the integration of all professional groups involved in healthcare into physical activity-related health services, 2) the greater integration of physical activity professions and physical activity interventions into all healthcare contexts and 3) the systematic consideration of physical activity- and exercise-related expertise in clinical guidelines.

Analysis of Madrid Primary Health-Care staff for the implementation of exercise prescription

OBJECTIVE

To assess the self-perception of nurses and general practitioners (GPs) toward Physical Activity on Prescription (PAP) in Madrid Primary Health-Care (PHC).

DESIGN

A survey-cohort study. SITE: Nurses and GPs of Madrid PHC System.

PARTICIPANTS

A total of 319 GPs and 285 nurses' responders.

MEASUREMENTS

Data were analyzed under a classification tree analysis by four predictor variables: (i) Health professional (Nurses/GPs); (ii) Exercise prescription collaboration with all health professionals: physicians, nurses, psychologists, physical therapists, sports medicine physicians, sports scientists, nutritionists, and teachers (Yes/No); (iii) PA promotion collaboration with Sports Scientists (Yes/No); and (iv) The stage of change of PHC staff to PA promotion (0-4 Likert scale).

RESULTS

Regarding the predictor variable (i), responders without PA guidelines knowledge and positive attitude to collaborate with nurses in PA promotion are more GPs of female sex (nurses n=33 and GPs n=175) than male sex (nurses n=3 and GPs n=59) (p<.001). For the predictor variable (ii) only 9.30% of PHC staff with a positive attitude to collaborate with all health professionals in PA promotion and exercise prescription. For the predictor variable (iii) was shown low collaboration with sports physicians and sports scientists under a multidisciplinary PAP approach (26.50% responders). Finally, in the predictor variable (iv) Staff maintaining PAP for at least 6 months, self-considered active, and with PAP knowledge want to collaborate with Sports scientists (Yes=233; No=133).

CONCLUSIONS

Nurses and GPs are conscious of health-related PA benefits despite the lack of PAP knowledge and lack of willingness to collaborate with other health personnel, exercise professionals, and community resources available.

Managing fatigue transdiagnostically: a qualitative study among people with chronic conditions on optimizing daily activity

PURPOSE

To explore fatigue and physical activity behavior experiences and management, with an emphasis on activity pacing among adults with chronic conditions.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 15 adults with chronic conditions and the symptoms of chronic fatigue who had either received or not received fatigue management advice. Interviews were audio-recorded and transcribed verbatim, then analyzed using reflexive thematic analysis.

RESULTS

Participants reported barriers to fatigue management such as overactivity, mental health issues, and workplace challenges. Additionally, they highlighted rest, restful activities, and supportive social environment as facilitators of effective fatigue management, along with the importance of nutrition and physical activity. In some cases, there were conflicting experiences with social environment and physical activity. Activity pacing was identified as a promising solution and participants recommended several strategies for future consideration.

CONCLUSIONS

Participants identified fatigue as a significant denominator in daily living and recognized the importance of activity pacing in fatigue management. Through reflective processes, they uncovered crucial factors for effective fatigue management, highlighting a multidimensional, interdisciplinary, and tailored approach to activity pacing as a promising solution. Further research should explore clinicians' perspectives of a multidimensional fatigue management approach to further support optimal intervention design.

The role of community pharmacists and pharmacies in physical activity promotion: an interdisciplinary e-Delphi study

BACKGROUND

Physical activity has a key role in the prevention and control of noncommunicable diseases. Community pharmacists are an accessible source to provide brief advice to people on how to be more physically active. Nonetheless, there is a limited understanding of stakeholders' perspectives on their role in promoting physical activity, to inform policy and practice. The present study addresses this gap.

AIM

To determine consensus from different health professionals on the role of pharmacists and pharmacies in brief physical activity counselling in Portugal.

METHOD

This cross-sectional study used a two-round e-Delphi panel. The questionnaire was organised into four domains of physical activity promotion and comprised 37 items. Interdisciplinary experts rated their level of agreement using a 5-point Likert scale. Consensus was set at the outset as 75% or more of participants scoring 4 or 5 (consensus "in") or 1 or 2 (consensus "out").

RESULTS

Forty-two health professionals involved in promoting physical activity in the ambulatory setting in Portugal were selected through purposive quota sampling. Eighteen out of 37 items were consensual in the first round and five more achieved consensus after the second round (62.2%). Physical activity promotion was seen as the role of all healthcare workforce and pharmacies were considered as suitable spaces for service provision, regardless of remuneration.

CONCLUSION

This study endorses a set of roles for physical activity promotion in community pharmacy from an interdisciplinary perspective. Consensually established perspectives can inform policy making and practice, streamlining the coordination of pharmacies with the national health service.

Efficacy of Physical Activity Promoting Interventions in Physical Therapy and Exercise Therapy for Persons With Noncommunicable Diseases: An Overview of Systematic Reviews

OBJECTIVE

The objective of this study was to synthesize the evidence from systematic reviews on the efficacy of physical therapy and exercise therapy, including interventional elements explicitly aiming at physical activity promotion (PAP) in patients with noncommunicable diseases (NCDs).

METHODS

PubMed, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews were searched from inception to February 28, 2023. Two independent reviewers screened the literature to identify systematic reviews that evaluated the effects of physical therapy and exercise therapy, including PAP interventions. Patient-reported and device-based measures of physical activity (PA) outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of the included systematic reviews was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We assessed primary study overlap by calculating the corrected covered area and conducted the evidence synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Fourteen systematic reviews were included in the present overview, including patients with a variety of NCDs. Most included systematic reviews had critically low (n = 5) to low (n = 7) methodological quality. Most meta-analyses (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions, but not all pooled estimates were clinically relevant. Only three of the systematic reviews with meta-analysis included an assessment of the certainty of the evidence. The evidence from systematic reviews without meta-analysis was inconclusive.

CONCLUSIONS

The results of the present overview suggest that PAP interventions in physical therapy or exercise therapy may be effective in improving PA for patients with NCDs in the short and long term. The results should be interpreted with caution due to the limited certainty of evidence and critically low-to-low methodological quality of the included systematic reviews. Both high-quality primary studies and systematic reviews are required to confirm these results.

IMPACT

There is limited evidence that PAP interventions in physical therapy and exercise therapy may be effective in improving PA for patients with NCDs.