Brief Interventions in Primary Care
Brief interventions involve opportunistic advice, discussion, negotiation, or encouragement. They are commonly used in many areas of health promotion, and are delivered by a range of primary and community care professionals. The interventions vary from basic advice to more extended, individually-focused attempts to identify and change factors that influence activity levels. The Public Health Interventions Advisory Committee (PHIAC) determined there is sufficient evidence to recommend the use of brief interventions in primary care.
Recommendation 1
Primary care practitioners should take the opportunity, whenever possible, to identify inactive adults and advise them to aim for 30 minutes of moderate activity on 5 days of the week (or more)*. They should use their judgment to determine when this would be inappropriate (for example, because of medical conditions or personal circumstances). They should use a validated tool, such as the Department of Health's forthcoming general practitioner physical activity questionnaire (GPPAQ), to identify inactive individuals.
* The practitioner may be a general practitioner (GP) or another professional with specific responsibility for providing encouragement or advice. This will depend on local conditions, professional interest, and resources. Health trainers are likely to have a role in offering brief advice. "Inactive" is used as shorthand for those failing to reach the Chief Medical Officer for England's (CMO's) recommendation. "Advise" is used as shorthand for "encourage, advise, discuss, negotiate"—see definition of brief interventions above.
Recommendation 2
When providing physical activity advice, primary care practitioners should take into account the individual's needs, preferences, and circumstances. They should agree goals with them. They should also provide written information about the benefits of activity and the local opportunities to be active. They should follow them up at appropriate intervals over a 3- to 6-month period.
Recommendation 3
Local policy makers, commissioners, and managers, together with primary care practitioners, should monitor the effectiveness of local strategies and systems to promote physical activity. They should focus, in particular, on whether or not opportunistic advice is helping to increase the physical activity levels of people from disadvantaged groups, including those with disabilities (and thereby tackling health inequalities). They should also assess how effective professionals from a range of disciplines are at raising long-term physical activity levels among these groups.
Recommendation 4
Local policy makers, commissioners, and managers, together with primary care practitioners, should pay particular attention to the needs of hard to reach and disadvantaged communities, including minority ethnic groups, when developing service infrastructures to promote physical activity.
Exercise Referral Schemes
An exercise referral scheme directs someone to a service offering an assessment of need, development of a tailored physical activity programme, monitoring of progress, and a follow-up. The Fitness Industry Association estimates that there are around 600 schemes in England. They involve participation by a number of professionals and may require the individual to go to an exercise facility such as a leisure centre.
The PHIAC determined that there was insufficient evidence to recommend the use of exercise referral schemes to promote physical activity, other than as part of research studies where their effectiveness can be evaluated.
Recommendation 5
Practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness (For further information, see the "Description of the Implementation Strategy" field). Measures should include intermediate outcomes such as knowledge, attitudes and skills, as well as measures of physical activity levels. Individuals should only be referred to schemes that are part of such a study.
Pedometers, Walking and Cycling Schemes
Pedometers are a common aid to increasing physical activity through walking. Much of the research about pedometers has involved comparing the validity and reliability of different models. This guidance focuses on how effective they are at increasing people's physical activity levels.
In the context of this guidance, walking and cycling schemes are defined as organised walks or rides. Public health practitioners have increasingly become involved in these types of project in recent years.
PHIAC determined that there was insufficient evidence to recommend the use of pedometers and walking and cycling schemes to promote physical activity, other than as part of research studies where effectiveness can be evaluated. However, professionals should continue to promote walking and cycling (along with other forms of physical activity, which could include gardening, household activities and recreational activities) as a means of incorporating regular physical activity into people's daily lives (see Recommendation 1).
Recommendation 6
Practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness (For further information, see the "Description of the Implementation Strategy" field). Measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels.
