Prescribing Exercise in Clinical Practice
- 198 Downloads
There is solid evidence that physical activity is essential to improve health as well as quality of life, and there is an urgent need to find effective strategies to implement this knowledge into health care delivery as well as to develop more effective strategies for the promotion of physical activity. A systematic literature review of methods of promoting physical activity from randomized controlled studies with at least 6 months follow-up published 2007 showed that advice or counseling on physical activity given by health care professionals (15 studies) leads to an increase in physical activity of 12% to 50%. Studies on theory-based behavioral interventions (21 studies) demonstrated a 10% to 15% increase in physical activity compared to usual care. More recent studies performed within the health care system indicate that “physical activity on prescription” can be a feasible and effective way to increase patients’ physical activity levels. There is a great and urgent need to spread this new evidence-based knowledge as well as experiences and pedagogic skills to counteract the epidemic of a sedentary lifestyle. However, there are still major gaps in our knowledge about long-term effectiveness of various methods of promoting physical activity and about how to implement current knowledge into clinical practice. A focus on translational research and studies on implementation is needed.
KeywordsPhysical activity Exercise Promotion Prescription Health care
The author is grateful for the assistance of Jonas Lindblom at the Swedish Council on Technology Assessment in Health Care with literature search and of Karin Björklund-Jonsson, Annika Larsson and Viktor Grahn with the manuscript.
Mai-Lis Hellénius’ institution has received research grants from the Swedish Heart and Lung Foundation, the Stockholm County Council, the Swedish National Institute of Public Health, the Tornspiran Foundation, the Karolinska Institute Foundation, the Swedish National Center for Research in Sports, and the Capio Foundation.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Global recommendations on physical activity for health.WHO Library Cataloguing-in-Publication Data. NLM classification: QT 255. World Health Organization. 2010. These are the latest global recommendations on physical activity and health, with guidelines and practical messages for individuals as well as the public. It is an important resource for all engaged in promotion of physical activity. Google Scholar
- 2.• Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009;43:1–2. This is an important commentary on the role of physical inactivity and low fitness as public health problems. Data from the United States show that low fitness constitutes the largest attributable factor for all causes of death in both men and women. PubMedGoogle Scholar
- 15.• Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer. Med Sci Sports Exerc. 2009;41:998–1005. This prospective study demonstrates an inverse and independent association between sedentary behavior and health. It is of great clinical relevance considering the high prevalence of physical inactivity in modern societies. PubMedCrossRefGoogle Scholar
- 16.• Warren TY, Barry V, Hooker SP, Sui X, Church TS, Blair SN. Sedentary Behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc. 2010;42:879–85. This prospective study demonstrates an inverse and independent association between sedentary behavior and health. It is of great clinical relevance considering the high prevalence of physical inactivity in modern societies. PubMedCrossRefGoogle Scholar
- 17.• Dunstan DW, Barr ELM, Healy GN, Salmon J, Shaw JE, Balkau B, et al. Television Viewing Time and Mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121:384–91. This prospective study demonstrates an inverse and independent association between sedentary behavior and health. It is of great clinical relevance considering the high prevalence of physical inactivity in modern societies. PubMedCrossRefGoogle Scholar
- 25.Swedish Council on Technology Assessment in Health Care (SBU). Metoder för att främja fysisk aktivitet. [Methods of promoting physical activity.] En systematisk litteraturöversikt [A systematic literature survey]. English Summary. Swedish Council on Technology Assessment in Health Care Stockholm, 2007.Google Scholar
- 42.Lisspers J, Sundin O, Hofman-Bang C, Nordlander R, Nygren A, Ryden L, et al. Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study. J Psychosom Res. 1999;46:143–54.PubMedCrossRefGoogle Scholar
- 61.Hellénius ML, de Faire U, Berglund B, Hamsten A, Krakau I. Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis. 1993;103:81–91.PubMedCrossRefGoogle Scholar
- 62.• Physical Activity in the Prevention and Treatment of Disease. Professional Associations for Physical Activity, Sweden. Swedish National Institute of Public Health. Report 2010:14. 2010./www.fhi.se/Publikationer/Alla-publikationer/Physical-Activity-in-the-Prevention-and-Treatment-of-Desease/. This is a comprehensive guide on prescription of physical activity for health care professionals. It contains more than 600 pages and 47 chapters with evidence-based recommendations on how to give advice on physical activity for different kinds of health problems or diseases. It is also available on the Internet.
- 63.Blair S, Diehl P, Massarini M, Sarto P, Sallis R, Searle J. Exercise is medicine. A quick guide to exercise prescription. Technogym Medical Scientific Department 2010.Google Scholar
- 65.Elley CR, Garrett S, Rose SB, O’Dea D, Lawton BA, Moyes SA, et al. Cost-effectiveness of exercise on prescription with telephone support among women in general practice over 2 years. Br J Sports Med. 2010 Nov 16. [Epub ahead of print].Google Scholar
- 71.Kallings LV, Sierra Johnson J, Fisher RM, de Faire U, Stahle A, Hemmingsson E, et al. Beneficial effects of individualized physical activity on prescription on body composition and cardiometabolic risk factors: results from a randomized controlled trial. Eur J Cardiovasc Prev Rehabil. 2009;16:80–4.PubMedCrossRefGoogle Scholar
- 72.Be Active Your Way: A Guide for Adults. Based on the 2008 Physical Activity Guidelines for Americans. ODPHP Publication No. U0037. Office of Disease Prevention & Health Promotion, US Department of Health and Human Services, October 2008. www.health.gov/paguidelines/pdf/adultguide.