Guidelines for preventive activities in general practice

Metabolic

Physical activity

      1. Physical activity

Metabolic | Physical activity

Screening age bar

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 70–74 75–79 ≥80
 

In 2020–21, 3 in 10 adults aged 18–64 years did not perform at least 150 minutes of physical activity per week, and 1 in 2 of those aged ≥65 years (47% of men and 52% of women) were insufficiently active, with little change over the previous decade.1 In 2011–12, 83% of children aged 2–5 years, 88% of children aged 5–12 years were insufficiently active for their age.1 In 2017–18, just over 1 in 10 (11%) of those aged 5–17 years were sufficiently active for their age, whereas just over 1 in 6 (16%) met the recommended muscle strengthening activity guidelines.2 Insufficient physical activity contributes 2.5% of the total burden of disease due to death or disability.1

The message that any physical activity is better than none is important.3 If a patient does not already engage in regular physical activity, they can be encouraged to start by doing some, and then gradually building up to the recommended amount.3 Advice, written physical activity materials and referral should be tailored to age, disability and level of risk.

Screening

Recommendation Grade How often References
General population: aged ≥18 years
Ask questions about the frequency, duration and intensity of physical activity and sedentary behaviour.
Recommended (strong) Every 2 years. 4,5
Children and adolescents: aged 3–18 years
Ask questions about the frequency (in each week), duration and intensity of physical activity and muscle strengthening activities (see Further information).
Recommended (strong) Every 2 years. 6,7

Preventive activities and advice

Recommendation Grade How often References
General population: aged ≥18 years
For substantial health benefits, it is recommended that adults should do:
  • at least 2.5–5 hours (150–300 minutes) of moderate-intensity aerobic physical activity, or
  • at least 1.25–2.5 hours (75–150 minutes) of vigorous-intensity aerobic physical activity, or
  • an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
For additional health benefits, it is recommended that adults should also:
  • do muscle strengthening activities at moderate or greater intensity that involve all major muscle groups on two or more days a week
  • limit the amount of time being sedentary; replacing sedentary time with physical activity of any intensity (including light intensity) provides health benefits.
Recommended (strong) N/A 3,8
People with disability, chronic conditions and people aged ≥65 years
To enhance functional capacity and prevent falls, adults with disability, chronic conditions and older adults (aged ≥65 years) should:
  • do varied multicomponent physical activity that emphasises functional balance and progressive strength training at a moderate or greater intensity on three or more days a week.  
Recommended (strong) N/A 3
Children (from birth to 2 years) should:
  • be physically active, particularly supervised floor-based play in safe environments
  • not spend time in front of screens.
Toddlers and preschoolers (2–5 years) should:
  • be physically active every day for at least three hours, spread throughout the day,
  • limit screen time to one hour per day.
Practice point N/A 8
Children and adolescents (5–17 years), including those with disability where possible, should:
  • do at least an average of 1 hour (60 minutes) per day of moderate- to vigorous-intensity, mostly aerobic, physical activity across the week
  • do vigorous-intensity aerobic activities, as well as those that strengthen muscle and bone (see Box 1) at least three days a week
  • limit sedentary time, particularly the amount of recreational screen time.  
Recommended (strong) N/A 3,8

Engaging in regular physical activity and avoiding long periods of sedentary behaviour can help maintain a healthy weight and avoid a range of chronic illnesses. 

Where possible, people should incorporate a variety of intensities of physical activity, as defined below:3,8

  • Light: Movement where people do not think about it (light gardening, getting dressed, stretching). The World Health Organization (WHO) defines light-intensity physical activity as between 1.5 and 3 metabolic equivalents of task (METs); that is, activities with an energy cost less than three times the energy expenditure at rest for that person. These activities can include slow walking, bathing or other incidental activities that do not result in a substantial increase in heart rate or breathing rate.3
  • Moderate: Putting in effort, but not strenuous activity (gentle bike riding, brisk walk). According to the WHO definition, on an absolute scale, ‘moderate intensity’ refers to physical activity that is performed at an intensity between three and less than six times the intensity of rest. On a scale of 0–10 relative to an individual’s personal capacity, moderate-intensity physical activity is usually rated a 5 or 6.3
  • Vigorous: out of breath and sweating (jogging, star jumps, sit-ups). On an absolute scale, the WHO definition of vigorous-intensity activity as physical activity that is performed at ≥6.0 METS. On a scale of 0–10 relative to an individual’s personal capacity, vigorous-intensity physical activity is usually rated a 7 or 8.3 

Assessment of physical activity involves questions about minutes of activity and being sedentary each day, and on how many days per week. Brief advice about increasing physical activity can be given in the consultation with the support of:

Assessment of physical activity should be supplemented by referral, especially for patients with risk factors or physical or social barriers to physical activity. This may include:

  • telephone counselling
  • local community-based programs
  • individual exercise physiology.

The choice of referral should be based on individualised shared decision making with the patient.

Box 1. Muscle strengthening activities for children and young people8
  • running
  • climbing
  • swinging on monkey bars
  • push-ups
  • sit-ups
  • lifting weights
  • yoga

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to Physical activity in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander peoples.

Make sure to ask people with disability about their levels of physical activity.

For recommendations about physical activity during pregnancy, please refer to the First antenatal visit and During pregnancy chapters.

For recommendations about physical activity for falls prevention, please refer to the Falls chapter.

 
 

To assist GPs and practice staff work with patients on the modifiable risk factors of smoking, nutrition, alcohol and physical activity:
Smoking, nutrition, alcohol, physical activity (SNAP) | RACGP 

A free digital tool to discuss physical activity and nutrition with patients and monitor their progress:
RACGP Healthy Habits app 

For exercise interventions to use with patients:
Handbook of non-drug interventions (HANDI)

  1. Australian Institute of Health and Welfare. (AIHW). Insufficient physical activity. AIHW, 2022 [Accessed 14 March 2023].
  2. Australian Institute of Health and Welfare (AIHW). Physical activity. AIHW, 2021 [Accessed 27 October 2023].
  3. World Health Organization (WHO). WHO guidelines on physical activity and sedentary behaviour. WHO, 2020 [Accessed 2 February 2024].
  4. Smith B, Bellew B, Milton K, Rocha G, Harris M. The primary and secondary healthcare domain and physical activity. In: Bellew B, Nau T, Smith B, Bauman A, editors. Getting Australia active III. A systems approach to physical activity for policy makers. The Australian Prevention Partnership Centre and The University of Sydney, 2020 [Accessed 2 February 2024].
  5. O’Connor EA, Evans CV, Rushkin MC, et al. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated systematic review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (U.S.), 2020 [Accessed 2 February 2024].
  6. Bauman A, Chau J, van der Ploeg H, Hardy L. Physical activity measures for children and adolescents – recommendations on population surveillance. An Evidence Check rapid review brokered by the Sax Institute. Sax Institute, 2010 [Accessed 2 February 2024].
  7. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54:1451–62. doi: 10.1136/bjsports-2020-102955.
  8. Australian Government Department of Health and Aged Care. Physical activity and exercise guidelines for all Australians. Department of Health and Aged Care, 2021 [Accessed 2 February 2024].
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