Your browser has 'Cookies' disabled, alert boxes will continue to appear without this feature.

Clinical guidelines

SNAP Guide

Physical activity

As defined in the most recent report106 supporting Australia’s physical activity and sedentary guidelines for adults, six terms apply to this section.

Physical activity – Any bodily movement produced by skeletal muscles that expends energy. This includes activities that use one or more large muscle groups for movement in the following domains:

  • Occupation (eg. paid and unpaid work)
  • Leisure (eg. organised activities such as sports, as well as exercise and recreational activities)
  • School (eg. physical education and active play during recess and lunch breaks)
  • Domestic (eg. house work, shopping and gardening)
  • Transport (eg. walking, cycling or skating to get to or from places).

Sedentary behaviours – Any waking activity that involves sitting or lying down, with little energy expenditure (ie. <1.5 metabolic equivalent), including in the following domains:

  • Occupational or educational (eg. sitting at work or school)
  • Leisure (eg. watching TV, reading, sewing, computer use, social networking)
  • Transport (eg. sitting in a car).

Metabolic equivalent (MET) – The unit used to define levels of activity, in multiples of resting metabolic rate. One MET is defined as energy expenditure at rest, usually equivalent to 3.5 mL of oxygen uptake per kilogram per minute.

Intensity –The rate of energy expenditure required for an activity, usually measured in METs. Physical activities are often divided into ‘light’, ‘moderate’ and ‘vigorous’ levels of intensity. Light activities include those that require standing up and moving around, with an energy expenditure of 1.6–2.9 METs. Moderate activities require some effort, but allow a conversation to be held (eg. brisk walking, gentle swimming, social tennis), with energy expenditure of 3.0–5.9 METs. Vigorous activities make you breathe harder or puff and pant, depending on fitness (eg. aerobics, jogging and some competitive sports), with energy expenditure equal to or greater than 6 METs.

Frequency – The number of times a behaviour (eg. walking, running, sitting) is carried out per day or per week.

Duration – The time spent in each session of a behaviour (eg. minutes of walking or sitting per session), or the total time spent in a behaviour in a specific period (eg. minutes of walking per week). Accumulation describes ‘collecting’ short bouts of a behaviour (eg. walking or sitting) to achieve a total amount of that behaviour over a specified time (eg. a day or a week).

3.5.1 Ask and assess

In assessing physical activity and sedentary behaviour, it is important to judge a patient’s level of activity against appropriate population recommendations. Australia’s physical activity and sedentary behaviour guidelines provide age-specific recommendations for both physical activity and sedentary behaviour. These are summarised in Table 15 in Section 3.5.2.

Table 14. Physical activity: when, how and who to assess

Who is at risk?

What should be done?

How often?

Average risk
Healthy adults, not otherwise at increased risk of chronic conditions.

Ask questions regarding current level of physical activity and sedentary behaviour and assess against current guidelines (II–A).70

Every two years (III–C)70

Increased risk
First-time mothers and teenage girls, older adults, office workers, Aboriginal or Torres Strait Islander peoples, people from low socioeconomic and non-English-speaking backgrounds, people with a chronic condition or other CVD or cancer45 risk factors, CVD or diabetes (including impaired glucose tolerance).

Ask questions regarding current level of physical activity and sedentary behaviour and assess against current guidelines. Assess readiness to be more active (III–C).70

Every visit (IV–D)107

Methods of assessment

The optimal method of assessing physical activity and sedentary behaviour in general practice is unclear. Options include taking a history, brief questionnaires or structured verbal questioning and the use of objective measures of physical activity, such as pedometers.

History-taking should include the type, intensity, frequency and duration of bouts of physical activity. In addition, physical activity in all domains (occupation, domestic, leisure and transport) should be assessed, as well as the extent of sedentary behaviours. History-taking should also address barriers to, and facilitators of, physical activity in order to facilitate behavioural change.

Brief questionnaires/questions are not recommended as they appear to be less effective than history-taking for identifying adults at risk of not meeting physical activity guidelines.108 A brief questionnaire tested in adolescents against an accelerometer determined physical activity levels had sub-optimal diagnostic performance with low sensitivity.109

Pedometers are an option for measuring steps per day, with 10,000 steps suggested as a reasonable target for healthy adults.110 This may be higher in children (13,000–15,000 for boys, 11,000–12,000 for girls) and adolescents (10,000–11,700),111 but somewhat lower in older adults (7000–10,000).112 However, these estimates may be higher than necessary to be equivalent to physical activity recommendations and health benefits appear to accrue at lower levels of steps per day.113 It should also be noted that pedometers do not measure non-ambulatory physical activity, such as cycling or swimming.

3.5.2 Advise and assist

Provide age-specific advice on meeting recommended levels of physical activity and avoiding exceeding recommended levels of sedentary behaviour (refer to Table 15). 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.

Table 15. Australia’s physical activity and sedentary behaviour guidelines for children, young people and adults

Age

Physical activity guidelines

Grade*

Sedentary behaviour guidelines

Grade*

Children (0–5 years)114

  • Physical activity, particularly supervised floor-based play in safe environments, should be encouraged from birth for healthy the development in infants (birth to one year).
  • Toddlers (1–3 years) and pre-schoolers (3–5 years) should be physically active at least three hours every day, spread throughout the day.

PP115

 

 

 

 

 

 

 

PP115

  • Children younger than two years should not spend any time watching television or using other electronic media (computers and other electronic games).
  • For children 2–5 years, sitting and watching television and the use of other electronic media should be limited to less than one hour per day.
  • Infants, toddlers and pre-schoolers (0–5 years) should not be sedentary, restrained, or kept inactive for more than one hour at a time, with the exception of sleeping.

PP115

Children (5–12 years)116

 

  • Children aged 5–12 years should accumulate at least 60 minutes of moderate to vigorous intensity physical activity every day.
  • Children’s physical activity should include a variety of aerobic activities, including some vigorous intensity activity.
  • Children should engage in activities that strengthen muscle and bone on at least three days per week.
  • Children should engage in more activity, up to several hours per day, to achieve additional health benefits.

I-A117

 

 

 

II-A117

 

 

 

 

II-A117

 

PP117

  • Children aged 5–12 years should reduce health risks by minimising the time they spend being sedentary every day.
  • Limit use of electronic media for entertainment (eg. television, seated electronic games and computer use) to no more than two hours a day – lower levels are associated with reduced health risks.
  • Break up long periods of sitting as often as possible.

PP118

Young people (13–17 years)119

 

  • Young people aged 13–17 years should accumulate at least 60 minutes of moderate to vigorous intensity physical activity every day.
  • Young people’s physical activity should include a variety of aerobic activities, including some vigorous intensity activity.
  • Young people should engage in activities that strengthen muscle and bone on at least three days per week.
  • Young people should engage in more activity, up to several hours per day, to achieve additional health benefits.

I-A117

 

 

 

II-A117

 

 

 

 

II-A117

 

 

 

 

PP117

  • Young people aged 13–17 years should reduce health risks by minimising the time they spend being sedentary every day.
  • Limit use of electronic media for entertainment (eg. television, seated electronic games and computer use) to no more than two hours a day – lower levels are associated with reduced health risks.
  • Break up long periods of sitting as often as possible.

PP118

Adults (18–64 years)120

 

  • Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing a small amount and gradually build up to the recommended amount.
  • Be active on most – preferably all – days of the week.
  • Accumulate 150–300 minutes (2.5–5 hours) of moderate-intensity physical activity, 75–150 minutes (1.25–2.5 hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.
  • Do muscle strengthening activities on at least two days each week.

III-A106

 

 

 

III-B106

 

III-A106

 

 

 

 

 

 

 

I-A/B106

  • Minimise the amount of time spent in prolonged sitting.
  • Break up long periods of sitting as often as possible.

III-C106

Older people (65 years and older)121

 

  • Do some form of physical activity, regardless of age, weight, health problems or abilities.
  • Be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility.
  • Accumulate at least 30 minutes of moderate intensity physical activity on most – preferably all – days.
  • Those who have stopped physical activity, or who are starting a new physical activity, should start at an easily-manageable level and gradually build up the recommended amount, type and frequency of activity.
  • Those 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.121

PP122

 

 

 

III-C122

 

 

 

 

 

III-C122

 

 

 

 

PP122

 

 

 

 

 

 

 

 

 

PP122

  • There are currently no recommendations focused on sedentary behaviour in older people. However, the prevalence of sedentary behaviour increases with age in older people and they have the potential to benefit from physical activity uptake and maintenance more than any other age group.122

PP122

*Level of evidence and strength of recommendation

Several interventions for improving physical activity in sedentary adults have been shown to be effective in primary care,123 resulting in a higher likelihood of achieving recommended levels of physical activity, or increasing physical activity (odds ratio 1.42 [95% confidence interval, 1.17–1.73], number needed to treat for one additional sedentary adult to meet guideline recommended levels of physical activity = 12). Most interventions included written materials and two or more sessions of physical activity advice or counselling, delivered face-to-face. Other intervention components included the use of written exercise prescriptions and supplementary advice or counselling by telephone. Exercise prescription has demonstrated effectiveness and using pedometers as part of exercise prescription may have additional benefits.124

Interventions targeting sedentary behaviour have not been tested in the general practice setting, but evidence suggests substantial reductions are possible when it is done in workplaces (eg. through use of sit–stand desks).125 Advice about reducing sedentary time at work should therefore be considered in relevant patients.

The health risks of moderate intensity physical activity are low. However, there are certain conditions that place patients at higher risk and require clinical assessment and supervision, including:

  • unstable angina
  • recent complicated myocardial infarction (within three months)
  • untreated heart failure or cardiomyopathy
  • resting heart rate >100
  • symptoms such as chest discomfort or shortness of breath on low exertion
  • severe aortic stenosis
  • uncontrolled diabetes
  • hypertension
  • unstable respiratory disease.

Sedentary individuals should be discouraged from undertaking sudden vigorous physical activity in favour of starting with moderate activity to reduce any transient increased risk of cardiovascular events.126

3.5.3 Arrange

Patients may be referred to cardiac rehabilitation or physical activity programs, or classes run by local community organisations. Some patient groups may particularly benefit from referral to group programs such as those for socioeconomically disadvantaged women.127

Examples of exercise programs for referring your patients:

  • Heartmoves is the Heart Foundation’s gentle physical activity program run by accredited exercise professionals and suitable for people with stable long-term health conditions such as heart disease, diabetes or obesity. Visit www.heartmoves.org.au for more information.
  • Heartline (1300 36 27 87) is a telephone service staffed by trained healthcare professionals who provide information on CVD management, nutrition and healthy eating, blood pressure, smoking cessation and physical activity. Information on relevant support programs and information booklets on a range of topics is also available.
  • HEAL program is a lifestyle modification program designed to improve nutrition and physical activity and promote self-management for people who are overweight or obese with, or who are at risk of developing, a chronic disease. Visit www.essa.org.au/for-gps/heal-program

Information on local physical activity programs may also be available from your local council. State government departments of sport or recreation have databases of local sport and recreation organisations in each state/territory:

These should be included in a practice directory (refer to Section 4.5.4)

Refer to Chapter 5 for information on other exercise programs and resources.

Patients who are insufficiently active and who have a chronic medical condition and complex needs may benefit from referral to an accredited exercise physiologist or physiotherapist. For referral to an exercise physiologist, you can use the ‘find an exercise physiologist’ feature of the Exercise and Sports Science Australia (ESSA) website (www.essa.org.au).

It should be noted that there is limited research examining the effectiveness of exercise referral. Moreover, adherence to such referrals is frequently poor (<50%).128 For a summary of the evidence and physical activity recommendations for multiple conditions, refer to ESSA’s position statements at www.essa.org.au/for-media/position-statements

Patients who are insufficiently active and who have a chronic medical condition and complex needs may also benefit from a GP Management Plan and Team Care Arrangement under Medicare’s CDM GP services (formerly Enhanced Primary Care). Refer to Chapter 4 and Chapter 5 for more information about what is available under Medicare, including links to MBS templates.

Factsheets are a good way for general practice teams to provide their patients with information related to physical activity and various conditions. Examples of exercise factsheets are available at http://exerciseismedicine.org.au/public/factsheets

Follow-up

Patients should be reviewed at 3–6 month intervals, determined by the general practice team in line with the MBS. The practice information system should generate reminders or lists of patients overdue for follow-up (refer to Section 4.5.1).

Many patients find it difficult to sustain changes in physical activity, especially if it is not a regular part of their daily activity. Evidence from randomised controlled trials on techniques for improving adherence to physical activity promotion advice in primary care is limited. However, a systematic review of interventions to improve adherence to exercise for chronic musculoskeletal pain in adults suggests:129

  • the type of exercise prescribed (eg. aerobic versus resistance exercise) does not influence levels of exercise; therefore, patient preference should be considered in an attempt to motivate and initiate a new exercise program
  • interventions such as supervised or individualised exercise therapy may enhance adherence
  • incorporating specific adherence-enhancing strategies within an exercise program, such as positive reinforcement, goal-setting, feedback, development of problem-solving skills to overcome barriers to adherence and self-monitoring through use of an exercise plan, contract, and/or logbook, may have a positive impact on adherence.

References

  1. United States Department of Health and Human Services. Physical activity guidelines advisory committee report. Washington DC: US DHHS; 2008.
  2. Guidelines for preventive activities in general practice, 8th edn. Melbourne: The Royal Australian College of General Practitioners; 2013.
  3. Brown W, Bauman A, Bull F, Burton N. Development of evidence-based physical activity recommendations for adults (18–64 years). Report prepared for the Australian Government Department of Health, August 2012.
  4. 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.
  5. Winzenberg T, Shaw KA. Screening for physical inactivity in general practice - a test of diagnostic accuracy. Aust Fam Physician 2011;40(1–2):57–61.
  6. Ridgers ND, Timperio A, Crawford D, Salmon J. Validity of a brief self-report instrument for assessing compliance with physical activity guidelines amongst adolescents. J Sci Med Sport 2012;15(2):136–41.
  7. Tudor-Locke C, Craig CL, Brown WJ, et al. How many steps/day are enough? For adults. Int J Behav Nutr Phys Act 2011;8:79.
  8. Tudor-Locke C, Craig CL, Beets MW, et al. How many steps/day are enough? For children and adolescents. Int J Behav Nutr Phys Act 2011;8:78.
  9. Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011;8:80.
  10. Schmidt MD, Cleland VJ, Shaw K, Dwyer T, Venn AJ. Cardiometabolic risk in younger and older adults across an index of ambulatory activity. Am J Prev Med 2009;37(4):278–84.
  11. Department of Health and Ageing. National physical activity recommendations for children 0-5 years. Canberra: Department of Health and Ageing; 2012.
  12. Okely AD, Salmon J, Trost SG, Hinkley T. Discussion paper for the development of physical activity recommendations for children under five years. Canberra: Department of Health and Ageing; 2008.
  13. Department of Health and Ageing. National physical activity and sedentary behaviour guidelines for children (5–12 years). Canberra: Department of Health and Ageing; 2012.
  14. Okely AD, Salmon J, Vella SA, et al. A Systematic Review to update the Australian Physical Activity Guidelines for Children and Young People. Report prepared for the Australian Government Department of Health and Ageing, June 2012.
  15. Okely AD, Salmon J, Vella SA, et al. A Systematic Review to Inform the Australian Sedentary Behaviour Guidelines for Children and Young People. Report prepared for the Australian Government Department of Health and Ageing, June 2012.
  16. Department of Health and Ageing. National physical activity and sedentary behaviour guidelines for young people (13–17 years). Canberra: Department of Health and Ageing; 2012.
  17. Department of Health and Ageing. National physical activity and sedentary behaviour guidelines for adults (18–64 years). Canberra: Department of Health and Ageing; 2012.
  18. Department of Health and Ageing. National Physical activity recommendations for older Australians (65 years and older). Canberra: Department of Health and Ageing; 2012. http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#chba[Accessed 16 January 2015].
  19. Sims J, Hill K, Hunt S, et al. National physical activity recommendations for older Australians: Discussion document. Canberra: Australian Government Department of Health and Ageing; 2006.
  20. 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.
  21. 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.
  22. Prince SA, Saunders TJ, Gresty K, Reid RD. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev 2014.
  23. American College of Sports Medicine, American Heart Association. Exercise and acute cardiovascular events: placing the risks into perspective. Med Sci Sports Exerc 2007;39(5):886–97.
  24. Cleland V, Granados A, Crawford D, Winzenberg T, Ball K. Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis. Obes Rev 2013;14(3):197–212.
  25. 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.
  26. Jordan JL, Holden MA, Mason EE, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev 2010(1):CD005956.

 

Advertisement loading...

Advertisement

The Royal Australian College of General Practitioners

Contact Us

General Inquiries

General Enquiries

Opening hours 8:00 am-8:00 pm AEST

1800 4RACGP

1800 472 247 | +61 (3) 8699 0300 (international)

Payments

Payments

Pay invoices online

RACGP automated payment service: 1800 198 586

Follow us on

Follow RACGP on Twitter Follow RACGP on Facebook Follow RACGP on LinkedIn


Healthy Profession. Healthy Australia Logo

The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807
RACGP House, 100 Wellington Parade, East Melbourne, Victoria 3002 Australia

Terms and conditions | Privacy statement
Sponsor conditions | Delegate conditions