Physical Activity Promotion in Your Clinic

Original Editor - Wendy Walker

Top Contributors - Wendy Walker and Michelle Lee  

Introduction

As physiotherapists we frequently provide patients who come into our clinic with advice on how to improve their physical condition, usually in relation to a specific health problem which for which they seek treatment: low back pain, plantafasciitis, etc. We expect to advise our patients on how best to treat their condition with exercise, and how to prevent recurrance, but do we also look at the larger picture, ie. the general fitness level of each individual?

Physical inactivity [PA] is the 4th leading cause of global mortality[1].

Advising an increase in Physical Activity - Why Bother?

Historically, physiotherapy interventions, ranging from electrotherapy, manipulation through to exercise recommendation, have been centred on the restoration of function lost as a result of either injury, or of a muskuloskeletal or neurological condition. In recent years  physical inactivity has been shown to be one of the main risk factors for non-communicable diseases (NCDs), including cardiovascular disease, diabetes and cancer: see the page on Physical Activity and Non-Communicable Diseases for more information.

As therapists, we can influence the behaviour of people who walk into our clinic, and make them aware of the enormous benefits of physical activity: benefits to their health as well as to their mood and general well-being.

An alarming statistic: We are approximately 20% less active than people were in 1961. If this trend continues, by 2030 we will be 35% less active[2].

How much Physical Activity is enough to make a difference?

Physical activity [PA] does not have to be strenuous to be effective, as this infographic demonstrates:

PA infographic.jpg

WHO advises that a minimum of 30 minuntes of moderate intensity exercise on 5 or more days per week is sufficient to bring about significant health benefits[3]; this adds up to a total of 150 minutes of exercise per week.

Thirty minutes a day of moderate aerobic activity can be any of the following:
PA dog walking.jpg
  • a brisk walk
  • cycling (eg. to work)
  • a swim
  • vigorous gardening, housework or DIY
  • dancing
  • doing an exercise class
  • attending a gym
  • joining in with an exercise DVD
  • playing a sport

Identifying who needs to increase their PA levels

As a Physiotherapist, when taking a history from our patients we routinely ask about sports and hobbies in the Social History section, and this provides a perfect opportunity to ask just how much PA the person does in a typical week. It can be as simple as asking a couple of quick questions about their work and recreation:

  1. "Does your work involve any physical activity?" This includes handling of heavy objects and/or use of tools (e.g. plumber, cleaner, electrician, joiner, nurse, gardener, postal delivery worker etc.)
  2. "During the last week, [or during an average week] how many hours did you spend doing PA?" This includes walking (for leisure, or to work, to the shops), cycling, swimming, vigorous housework, gardening, participating in sports, etc.

Then add up the time spent doing PA, and if the weekly total is less than 150 minutes, then seize the opportunity to have a brief discussion about the benefits of exercise.

Providing Guidance on PA to a patient

Having identified that your patient is not currently sufficiently physically active, there are many ways you can advise and support this person to try and increase their PA levels:

  • Talk about the benefits of exercise, both general (reduction in cardiovascular disease etc.) and also in relation to the specific condition you are treating them for, if appropriate
  • Chat in general terms about different ways to increase PA, trying where possible to have a 2-way discussion with the person about their lifestyle and family commitments, and how they could incorporate more PA into a typical day.
  • Consider using the techniques of Motivational Interviewing, which are relatively straightforward to bring into the therapeutic relationship
  • Give out a leaflet on PA

Other Methods of Influencing within your Clinic

Use your walls!

It is quick and simple to put up some posters about PA and its benefits on the walls of your clinic room, or better still, the waiting room. Anything on the wall of the waiting room is likely to reach a larger audience as people who are just accompanying patients also see these.

Your Website

If your practice has a website, this is a very useful place to have some information about PA and its benefits.

You can then guide patients to this resource when you talk about PA in their treatment session.

You could post a link to relevent videos, such as:

Sign-post Local PA Resources

It is extremely useful to research the resources available in the area local to your clinic, as you can then guide people to specific activities which they may find attractive and useful, for instance:

  • Local gyms which have classes/groups which people can join
  • Parks/wild areas nearby which make for interesting areas to walk round
  • Any support groups for different populations (eg. older people, or people with Stroke, etc.) which offer exercise classes.
  • The Motivate2Move website, created by Wales Deanery, has a useful section on sedentary behaviour.

More radical suggestions...

Practice what you preach at work:

  • Have staff meetings as "walking meetings"
  • Run up and down a flight of stairs several times in between patient appointments
  • Put your coffee/tea into a vacuum mug and go for a short walk outside as you drink it

Practice what you preach at home:

  • Put on some loud lively music and dance
  • Keep a skipping rope in the lounge/TV room, so it is easy for you to grab it and skip during the adverts when watching TV
  • Run up and down stairs several times
  • Position a couple of small hand weights in your kitchen, and make use of them when waiting for the kettle/eggs/potatoes to boil

References

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  1. Lee I, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, for the Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. The Lancet. 2012;380(9838):219-229
  2. Ng SW, Popkin B (2012) Time Use and Physical Activity: a shift away from movement across the globe. Obesity Review 13(8):659-80.
  3. World Health Organization. Global recommendations on physical activity for health. Geneva, Switzerland: WHO Press; 2010