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Clinical guidelines

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people Second edition

Physical activity

Author Dr David Peiris
Expert reviewer Dr Ben Ewald


Physical activity is any bodily movement produced by skeletal muscles that results in energy expenditure.74 This definition importantly recognises that physical activity is not restricted to structured exercise programs. Lack of physical activity is an independent risk factor for a range of diseases, in particular cardiovascular disease (CVD), diabetes, some cancers and osteoporosis.75 Non-vigorous (light or moderate) physical activity reduces the risk of all-cause mortality, with the greatest benefits apparent in moving from no activity to low levels of activity. Two and a half hours per week of moderate physical activity* (equivalent to 30 minutes daily of moderate intensity activity on 5 days a week) compared with no activity is associated with a reduction in mortality risk of 19%, while 7 hours per week of moderate activity compared with no activity reduces mortality risk by 24%.76 Being based on self reported data, this may be an underestimate of the true mortality benefit from physical activity. Other studies using objective measures of physical activity expenditure have shown up to a 69% reduction in mortality in the upper tertile of activity when compared with the lower tertile.77 

By contrast with most other risk factors, physical inactivity is equally and highly prevalent among Aboriginal and Torres Strait Islander people when compared with non-Indigenous people. Based on 2004–05 National Health Survey and National Aboriginal and Torres Strait Islander Health Survey data, no exercise or low levels of exercise was reported by 75% of those aged 15 years and over in the 2 weeks prior to interview.78,79 


There is evidence that interventions to increase physical activity can lead to significant risk reductions in vascular disease and diabetes.80,81 Further, a health benefit accrues to people who increase their physical activity levels, even in the absence of weight reduction. Secondary prevention interventions for people with diabetes and both postacute and stable CVD are also effective.82 Targeted interventions involving professional guidance and continued support can lead to moderate short and midterm increases in self reported physical activity, achievement of a predetermined level of physical activity and improved cardiorespiratory fitness.83,84 

The specific components of successful interventions are difficult to discern owing to large heterogeneity in the types of interventions previously studied. When translating clinical trial based interventions into real world settings there appears to be a substantial reduction in the effectiveness of those interventions.85 A World Health Organization systematic review of 67 studies examining 29 primary care based strategies concluded that the most effective interventions need to be moderately intensive and include three key components:86

  • at least one session involving a health risk appraisal with a healthcare professional, with brief negotiation or discussion to decide on reasonable, attainable goals, and a follow up consultation with trained personnel
  • support with targeted information
  • linked and/or coordinated with other stakeholders such as community sports organisations, ongoing mass media physical activity campaigns and integration with social support measures (eg. buddy system, contracts for exercise, group activities).87 

Use of pedometers has been shown to lead to an absolute short term increase in physical activity of around 2000–2500 steps per day, reductions in blood pressure and mild reductions in body mass index.88 Long term effects are not known.

Environmental policies targeting the built environment, in particular increased access to public transport, increased recreational space opportunities, reduction in environmental barriers to physical activity and point-of-decision prompts to increase use of stairs have been shown to be effective.86,87 Facilities for sporting and recreational activities are lacking in many remote Aboriginal and Torres Strait Islander communities and surveys have reported that the need for such facilities is ranked as a high priority among community members.89 Health promotion strategies in the school and workplace are also effective in increasing physical activity,86,87 but have not been well studied in Aboriginal and Torres Strait Islander community settings.

* Moderate physical activity is activity at a level that causes your heart to beat faster and some shortness of breath, but you can still talk comfortably. Vigorous physical activity is activity at a level that causes your heart to beat a lot faster and shortness of breath, which makes talking difficult between deep breaths (ie. physical activity at a heart rate of 70–85% of maximum heart rate [MHR]). MHR is calculated as 220 minus age.

Table 1.4. Australian physical activity guidelines: Recommendations by age group
Age groupRecommendation
Under 2 years For children under 1 year supervised floor based play in safe environments should be encouraged from birth
For children under 2 years no time watching television or using other electronic media
2–5 years Toddlers and preschoolers should be physically active every day for at least 3 hours, spread throughout the day
Watching television and the use of other electronic media (DVDs, computer and other electronic games) should be limited to less than 1 hour per day
5–12 years At least 60 minutes (and up to several hours) of moderate to vigorous physical activity every day
No more than 2 hours per day using electronic media for entertainment (eg. computer games, TV, internet), particularly during daylight hours
12–18 years At least 60 minutes of moderate to vigorous physical activity every day
No more than 2 hours per day using electronic media for entertainment (eg. computer games, TV, internet)
18–54 years The following 4 steps are recommended:
  • Think of movement as an opportunity, not an inconvenience
  • Be active every day in as many ways as you can
  • Put together at least 30 minutes of moderate physical activity on most, preferably all days. 30 minutes can be accumulated throughout the day in 10–15 minute sessions or done in one session
  • If you can, also enjoy some regular vigorous activity for extra health and fitness
55 years and over Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities
Older people should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility
Older people should accumulate at least 30 minutes of moderate physical activity on most, preferably all days. Sedentary people may need to gradually build up to 30 minutes or more
Older people who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up the recommended amount, type and frequency of activity
Older people who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to
Source: Department of Health and Ageing 201092
Recommendations: Physical activity
Preventive intervention typeWho is at risk?What should be done?How often?Level/strength of evidence
Screening All people Assess current level of physical activity Opportunistic and as part of an annual health assessment IB86,87,90
Behavioural   All people For patients who are insufficiently active give targeted advice and written information. This should include the following:
  • determine existing preferred physical activities and invite patients to propose new activities
  • ask the patient the amount/frequency of activity they feel is achievable and set exercise goals aiming to achieve National Physical Activity Guideline recommendations (see Table 1.4)
  • record these goals and provide patients with a written copy
  • consider cognitive behavioural support and follow up
  • consider additional social support (eg. buddy system, involvement in a group activity, referral for coaching)
People with diabetes For sedentary people, a gradual introduction and initial low intensity of physical activity with slow progressions in volume and intensity is recommended
Those on insulin should be given individualised advice on avoiding hypoglycaemia when exercising (eg. adjustment of carbohydrate intake, reduction of insulin dose, and choice of injection site)
Consider referral to an exercise physiologist for coaching if facilities are available
Opportunistic and as a part of an annual diabetes assessment GPP91
People with cardiovascular disease   Those with recent acute coronary syndrome event or revascularisation surgery (CABG, PCI) should be advised to participate in a short period (up to 12 weeks) of supervised exercise rehabilitation Opportunistic    IA82
Those who are well compensated and clinically stable should commence an initial low intensity of physical activity with slow progressions in volume and intensity
Consider referral to an exercise physiologist for coaching if facilities are available
Environmental All people Refer to appropriate community based physical activity programs and encourage use of public facilities that promote activity (eg. advocate for increased availability of sports and recreational facilities in remote communities) Opportunistic and as part of an annual health assessment IB88,90


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