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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

7.5 Physical activity

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Ask about the patient's current level of physical activity and sedentary behaviour, and assess against current guidelines.

Provide age-specific advice on meeting recommended levels of sedentary behaviour and physical activity.

The message that any physical activity is better than none is important. If a patient does not already engage in regular physical activity, they can be encouraged to start by doing some, and then gradually build up to the recommended amount.135 Advice, written physical activity materials and referral should be tailored to age (refer to Table 7.5.1).

Table 7.5.1. Physical activity: Assessment, advice and referral
Age and risk groupWhat should be done?How often?
Children 0–5 years of age136 From birth, encourage physical activity, particularly supervised floor-based play in safe environments

Toddlers and pre-schoolers should be physically active every day for at least three hours, spread throughout the day (Practice Point)

Recommend children <2 years of age not spend time in front of screens. From two to five years of age recommend limiting screen time to one hour per day (Practice Point)
At times of child health surveillance or immunisation (Practice Point)
Children 5–17 years of age136 Ask questions regarding current level of activity and sedentary behaviour, and assess against current guidelines (II, A)

Recommend accumulating 60 minutes of a variety of moderate or vigorous aerobic physical activity per day (I, A) and muscle strengthening activity three days a week (II, A)

Recommend limiting or breaking up sitting time and use of screens to no more than two hours a day (Practice Point)
Opportunistically
Adults 18–64 years of age135 Ask questions regarding current level of activity and sedentary behaviour, and assess against current guidelines (II, A)

Recommend doing some activity on most days of the week. Accumulate 2.5–5 hours of moderate intensity physical activity, 1.25–2.5 hours of vigorous intensity physical activity, or a combination of these per week (III, A). Do muscle strengthening activities at least two days a week (I, A)

Avoid prolonged sitting and break up periods of sitting (III, C)
Every two years (III, C)
People ≥65 years of age137,138 Ask questions regarding current level of activity and sedentary behaviour, and assess against current guidelines (II, A)

Recommend some physical activity every day that improves fitness, strength, balance and flexibility (III, C)

Gradually increase amount and frequency (Practice Point)

Accumulate at least 30 minutes of moderate activity on most days (III, C; refer to Section 5.2. Physical activity)
Every two years
Increased risk
Those at higher risk include teenage girls, older adults, office workers, Aboriginal and Torres Strait Islander peoples, and people from low socioeconomic and non–English-speaking backgrounds)139–141

Those with or at high risk of a chronic condition or cancer (refer to Chapter 8. Prevention of vascular and metabolic disease, and Chapter 9. Cancer)142,143
Ask questions regarding current level of activity and sedentary behaviour and assess against current guidelines (III, C)

Provide brief interventions (refer to below) and age-appropriate written physical activity materials (III, C)

Refer to an exercise or physical activity professional or program if appropriate brief interventions within the general practice cannot be offered (I, D) or if preferred by the patient (Practice Point)

Programs with additional behaviour change support may be more beneficial (III, C)
At least two yearly and opportunistically (IV, D)
Table 7.5.2. Physical inactivity interventions
Assessment and interventionTechnique
Brief interventions to increase levels of physical activity Some of the components of interventions in general practice that have been shown to have short-term benefit in changing behaviour related to physical activity include:
  • at least two sessions of face-to-face provision of brief advice or counselling on exercise with supporting written materials
  • written prescription for exercise and/or supplementary advice or counselling by telephone
  • pedometer step target that is incremental and agreed with the patient142,144
Physical activity program Structured programs of physical activity education and exercise may be delivered as individual or group program and over several sessions.145,146

The National Heart Foundation of Australia program

Some local councils have information on local physical activity programs. Exercise physiologists are listed at www.essa.org.au

Non–face-to-face programs using telephone or internet have been demonstrated to be effective in adults >50 years of age143,147

It should be noted that there is limited research examining the effectiveness of exercise referral and none comparing exercise referrals to general practice-based physical activity interventions

Implementation

Physically inactive patients may be referred to physical activity programs or classes run by local community organisations. Those who have a chronic medical condition and complex needs may benefit from referral to an accredited exercise physiologist or physiotherapist. For more information, refer to the RACGP’s SNAP guide,2nd edn.82

References

  1. The Royal Australian College of General Practitioners. Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice. 2nd edn. East Melbourne, Vic: RACGP, 2015.
  2. Brown W, Bauman A, Bull F, et al. Development of evidence-based physical activity recommendations for adults (18–64 years). Canberra: Department of Health, 2012.
  3. Okely AD, Salmon J, Vella SA, et al. A systematic review to inform the Australian sedentary behaviour guidelines for children and young people. Canberra: Department of Health and Ageing, 2012.
  4. Sims J, Hill K, Hunt S et al. National physical activity recommendations for older Australians: Discussion document. Canberra: Department of Health and Ageing, 2006.
  5. Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R. Primary care – Relevant interventions to prevent falling in older adults: A systematic evidence review for the US Preventive Services Task Force. Ann Int Med 2010;153(12):815–25.
  6. Bauman A, Bellew B, Vita P, Brown W, Owen N. Getting Australia active: Towards better practice for the promotion of physical activity. Melbourne: National Public Health Partnership, 2002.
  7. LeFevre ML. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force recommendation statement. Ann Int Med 2014;161(8):587–93.
  8. Mammen G, Faulkner G. Physical activity and the prevention of depression. A systematic review of prospective studies. Am J Prev Med 2013;45(5):649–57.
  9. Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: Systematic review and meta-analysis of randomised controlled trials. BMJ 2012;344:e1389.
  10. Pavey TG, Anokye N, Taylor AH, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: A systematic review and economic evaluation. Health Technol Assess 2011;15(44):i–xii, 1–254.
  11. Kolt GS, Schofield GM, Kerse N, Garrett N, Ashton T, Patel A. Healthy Steps trial: Pedometer-based advice and physical activity for low-active older adults. Ann Fam Med 2012;10(3):206–12.
  12. Muller AM, Khoo S. Non face-to-face physical activity interventions in older adults: A systematic review. Int J Behav Nutr Phys Act 2014;11(35).
  13. Goode AD, Reeves MM, Eakin EG. Telephone-delivered interventions for physical activity and dietary behavior change: An unpdated systematic review. Am J Prev Med 2012;42(1):81–88.
  14. Pavey T, Taylor A, Hillsdon M, et al. Levels and predictors of exercise referral scheme uptake and adherence: A systematic review. J Epidemiol Community Health 2012;66(8):737–44.
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