Brief physical activity interventions in primary care: A systematic review
The prevalence of physical inactivity remains high in developed countries and contributes to significant health and economic burden. The World Health Organisation global recommendations on physical activity (PA) for health suggest PA should be promoted within primary care. Brief advice from a general practitioner can be beneficial and cost effective, but less is known about how often such advice is given and to whom. The aim of this systematic review was to examine the extent to which brief PA interventions are delivered in primary care and explore factors associated with both the delivery and patient receptivity.
CINAHL, Embase, Medline, and PsychINFO were searched from January 2012 until July 2018 (PROSPERO: CRD42018103812). Inclusion criteria were: qualitative or quantitative studies reporting on level of delivery of brief PA interventions in primary care and/or views towards brief PA interventions. Studies in the context of disease management or survivorship were excluded.
Searches found 8756 original results, with 42 articles for inclusion (37 surveys and 5 qualitative studies). Nineteen studies collected data from the general population, 16 collected healthcare professional data and 7 collected healthcare professional and patient data. Thirty-seven studies reported data on the delivery of brief PA interventions. The proportion of healthcare professionals who assessed level of patient PA ranged from 8% to 81%, with delivery of PA advice ranging from 15% to 96%. The proportion of patients who received PA advice ranged from 7.7% to 76%. Delivery of PA advice tended to be higher in certain countries (e.g. USA) and among certain healthcare professional groups (e.g. nurses). Few consistent findings emerged for factors associated with the delivery of brief PA interventions. Nine studies reported a significant positive association with patient Body Mass Index (BMI) and the delivery of brief PA interventions. Nineteen quantitative studies examined healthcare professional attitudes towards delivering brief PA interventions. Main themes included: professional role; perceived effectiveness and importance of brief PA interventions; feasibility and time constraints; healthcare professional self-efficacy and; knowledge and need for further training. Practitioners considered a perceived lack of patient motivation and receptivity towards PA to be a key barrier. Data from qualitative studies suggest that patients value brief PA advice when it is clearly linked to contextual factors, such as their presenting health complaint or potential to reduce medication.
Delivery of brief PA interventions within primary care varies widely, and healthcare professionals have identified a number of barriers. Addressing these barriers within training programmes could improve the consistency with which advice is given. More research is needed to better understand when patients are most likely to be receptive to PA interventions within primary care. This could help optimise the effectiveness of interventions and encourage healthcare professionals to feel confident about discussing PA with their patients.