Strategies for Promoting Physical Activity in Clinical Practice

doi:10.1016/j.pcad.2014.10.003

Progress in Cardiovascular Diseases

Volume 57, Issue 4, January–February 2015, Pages 375-386

https://doi.org/10.1016/j.pcad.2014.10.003 Get rights and content

Abstract

The time has come for healthcare systems to take an active role in the promotion of physical activity (PA). The connection between PA and health has been clearly established and exercise should be viewed as a cost effective medication that is universally prescribed as a first line treatment for virtually every chronic disease. While there are potential risks associated with exercise, these can be minimized with a proper approach and are far outweighed by the benefits. Key to promoting PA in the clinical setting is the use of a PA Vital Sign in which every patient’s exercise habits are assessed and recorded in their medical record. Those not meeting the recommended 150 min per week of moderate intensity PA should be encouraged to increase their PA levels with a proper exercise prescription. We can improve compliance by assessing our patient’s barriers to being more active and employing new and evolving technology like accelerometers and smart phones applications, along with various websites and programs that have proven efficacy.

Section snippets

The connection between PA and health

Seminal observations from Jeremiah Morris in 1954 on PA and coronary heart disease (CHD) laid the groundwork for recognizing PA as a major determinant of health.1., 2. It is now readily apparent that the adoption of PA consistent with consensus guidelines provides benefit across a wide range of health outcomes. There is also overwhelming evidence to suggest that engaging in PA well below the current guidelines also provides substantive health benefit.3., 4., 5. Increasing PA is associated with

Conclusion

It is clear that physical inactivity is the major public health problem of our time. While obesity is most often publicized, its adverse effects on health are largely mitigated by engaging in regular PA. Inactivity is among the strongest risk factors for chronic disease and early mortality and therefore patients’ activity levels should be assessed at every visit using an EVS/PAVS. The recommended amount of 150 min per week of moderate PA (like a brisk walk) should be prescribed to all patients,

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Cited by (203)

Associations of animal source foods, cardiovascular disease history, and health behaviors from the national health and nutrition examination survey: 2013–2016
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Some individuals adopt vegetarian or plant-based diets to improve their health. Observational evidence suggests diets composed of higher amounts of animal-source foods (ASFs) are associated with increased risk for disease and early mortality. In many of these studies, those who ate fewer animal-source foods reported fewer disease risk factors and unhealthy behaviors, which could indicate bias.
This study aims to examine the relationships between ASF consumption, health behaviors, and cardiovascular disease (CVD) prevalence in a population-representative sample of U.S. civilians controlling for confounders.
Respondent data were collected from the National Health and Nutrition Examination Survey (NHANES) 2013–2016 collection years. Collected data included demographics, ASF intake, healthy lifestyle variables, body mass index, and blood lipids.
There was a higher proportion of those with CVD history who consumed red meat (61.3%; C.I. 41.7%–77.8%), but the proportion was lower for white (23.3%; C.I. 12.6%–39.0%) and processed meat (15.4%; C.I. 6.5%–32.3%). When adjusted for sex, the odds of CVD history increased for red meat compared to processed meat consumption (OR 2.95; C.I. 1.14–7.66). Unhealthy lifestyle increased the odds of CVD history by nearly 8-fold (OR 7.8; C.I. 3.44–17.7). Individual factors including age, smoking history, body mass index, and blood lipids, and demographic factors, including education level, race, and income, were also associated with increased odds for CVD history. ROC analysis revealed 77.2% AUC for CVD history classified by individual factors (BMI ≥30 kg/m**2, ≤ 30 min moderate physical activity, smoker, fiber intake ≤25 g, dental visit more than two years ago, and age above 60 years). Three or more factors moderately predicted CVD history when optimized for sensitivity (73.4%) and specificity (71%). Adjusted for sex, the relationship between CVD and moderate physical activity became stronger possibly reflecting lifestyle changes. Despite evidence of lifestyle changes, modifiable risk factors persisted in the CVD group. CVD diagnosis in males was substantially delayed compared to females concerning the sex-specific age cutoff associated with higher risk. The healthy lifestyle group was characterized by earlier CVD diagnosis and fewer overall risk factors compared to the unhealthy lifestyle group.
CVD history was strongly associated with demographic, lifestyle, and dietary factors. Future research should focus on multidimensional models for disease risk stratification and prevention, including individual, behavioral, and sociodemographic factors.
Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community
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The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.
Self-perception of primary health-care staff about physical activity on prescription: A qualitative semi-structured interview
2023, Semergen
This study aimed to analyze the self-perception at primary health-care (PHC) nurses and general practitioners (GPs) toward PAP implementation in PHC centers.
Two semi-structured group interviews were performed separately, with five GPs and nurses working in the PHC system in the region of Madrid (Spain). An expert psychologist guided each semi-structured session. The interviews were transcribed verbatim and consensually analyzed using a content analysis.
Half of the PHC staff considered themselves physically active and were convinced that physically active staff behavior could facilitate PAP with patients. Both GPs and nurses showed a lack of knowledge of exercise prescription but were interested in PAP and motivational training courses, as well as leadership or to collaborate under a multidisciplinary or interdisciplinary PAP approach. Some of the most relevant self-perceived PAP barriers were a confident method to measure sedentary and physical activity levels. Besides lack of staff awareness, time of consultation, and improving local community relationships and PAP policies strategies.
There are some common self-perceptions, barriers, and facilitators among PHC nurses and GPs for PAP implementation. Following a socio-ecologic approach, this organizational data provides further insight to design a future cost-effective policy strategy to improve patient health and health-care system sustainability.
Este estudio tiene como objetivo analizar la autopercepción de las enfermeras y médicos de Atención Primaria para implementar la promoción y prescripción de ejercicio físico en sus centros.
Dos entrevistas grupales semiestructuradas, con cinco enfermeras y cinco médicos que se encontraban trabajando en ese momento en el Sistema de Salud de la Comunidad de Madrid (España), fueron desarrolladas de forma independiente. Un psicólogo experto guio cada una de las sesiones. Las entrevistas grabadas, fueron transcritas y analizado su contenido de forma consensuada.
La mitad de los profesionales sanitarios entrevistados se consideraron a sí mismos físicamente activos y convencidos de que dicho comportamiento podría facilitar la promoción y prescripción de ejercicio físico hacía sus pacientes. Ambos grupos mostraron una falta de conocimiento para prescribir ejercicio físico, pero se sentían interesados en adquirir la formación mediante cursos, así como de recibir formación para entrevistar de forma motivacional a sus pacientes. También mostraron liderazgo o colaboración para implementar la promoción y prescripción de ejercicio físico bajo un enfoque multi o interdisciplinar con otros profesionales. Algunas de las barreras sugeridas por ambos profesionales fue la falta de un método seguro para comprobar los niveles de actividad física y sedentarismo de sus pacientes. Además, de la falta de concienciación de sus compañeros de profesión, el limitado tiempo de consulta que poseen con cada paciente, y mejorar la colaboración con otros recursos comunitarios y desarrollar estrategias políticas adecuadas.
Existen autopercepciones, barreras y facilitadores comunes entre los médicos y enfermeras de Atención Primaria para implementar la promoción y prescripción de ejercicio físico. Siguiendo un enfoque socio-ecológico, los datos de la dimensión de organización del Sistema Sanitario obtenidos podrían servir para diseñar en el futuro una estrategia costo-efectiva para mejorar la salud del paciente y la sostenibilidad del Sistema Nacional de Salud mediante la promoción y prescripción de ejercicio físico.
The effect of rhythmic movement on physical and cognitive functions among cognitively healthy older adults: A systematic review and meta-analysis
2023, Archives of Gerontology and Geriatrics
To explore the effects of rhythmic movement interventions on the physical and cognitive functions among cognitively healthy older adults.
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An association was found between rhythmic movement and improved physical function (mobility, cardiopulmonary endurance, muscle strength, flexibility, and balance), global cognitive function, and quality of life (QOL). The physical function outcomes suggested additional significant benefits when using control groups with no exercise than when using control groups with exercise. No significant improvement was found in executive function.
Regular rhythmic movement likely improves physical function, global cognitive function, and QOL in healthy older adults. The effect of rhythmic movement on the physical function in older adults is similar to that of routine exercise. Further studies on cognitive function of healthy older adults using larger samples of populations with more balanced sex ratios with long-term follow-up are particularly encouraged.
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The prescription of exercise for individuals with and without cardiovascular disease (CVD) should be scientifically-based yet adapted to the patient. This scientific statement reviews the clinical and physiologic basis for the prescription of exercise, with specific reference to the volume of physical activity (PA) and level of cardiorespiratory fitness (CRF) that confer significant and optimal cardioprotective benefits. Recommendations are provided regarding the appropriate intensity, frequency, and duration of training; the concept of MET-minutes per week; critical components of the exercise session (warm-up, conditioning phase, cool-down); methodologies for establishing the training intensity, including oxygen uptake reserve (V̇O₂R), target heart rate derivation and rating perceived exertion; minimum and goal intensities for exercise training; and, types of training activities, including resistance training, adjunctive lifestyle PA, marathon/triathlon training, and high-intensity interval training. In addition, we discuss the rationale for and value of exercise training programs for patients with peripheral artery disease, diabetes mellitus, and heart failure.
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Strategies for Promoting Physical Activity in Clinical Practice

Abstract

Section snippets

The connection between PA and health

Conclusion

Lancet

Ann Epidemiol

Lancet

Am J Prev Med

Prev Med

Prev Med

Lancet

Mayo Clin Proc

Lancet

Prog Cardiovasc Dis

Prog Cardiovasc Dis

Prog Cardiovasc Dis

Mayo Clin Proc

Am J Med

Am J Cardiol

Am J Prev Med

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association

Circulation

Health benefits of physical activity: the evidence

CMAJ

Mortality trends in the general population: the importance of cardiorespiratory fitness

J Psychopharmacol

Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men

JAMA

Obesity, abdominal obesity, and insulin resistance

Clin Cornerstone

Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men

JAMA

Global Strategy on diet, physical activity and health

Economic burden of physical inactivity: healthcare costs associated with cardiovascular disease

Eur J Cardiovasc Prev Rehabil

Physical activity behavior change: issues in adoption and maintenance

Health Psychol

Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial

Arch Intern Med

The economic burden of physical inactivity in Canada

CMAJ

Physical activity, cardiovascular disease, and medical expenditures in U.S. adults

Ann Behav Med

Statin therapy for primary prevention of cardiovascular disease

JAMA

Updated projections of global mortality and burden of disease, 2002–2030: data sources, methods and results

World Health Report 2002: reducing risks, promoting healthy life

Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study

Circulation

Changes in physical fitness predict improvements in modifiable cardiovascular risk factors independently of body weight loss in subjects with type 2 diabetes participating in the Italian Diabetes and Exercise Study (IDES)

Diabetes Care

Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues

Med Sci Sports Exerc

Putting the benefits and risks of aerobic exercise in perspective

Curr Sports Med Rep

Exercise and acute cardiovascular events. Placing the risks into perspective. A Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology

Circulation

Clinical and angiographic characteristics of exertion-related acute myocardial infarction

JAMA

Sudden death in young competitive athletes: clinical, demographic, and pathological profiles

JAMA

Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion

N Engl J Med

Association of episodic physical and sexual activity with triggering of acute cardiac events. Systemic review and meta-analysis

JAMA