GPs should play a greater role in getting the nation moving
NICE issues updated guidance for GPs, health visitors, midwives, pharmacists and practice nurses
The National Institute for Health and Care Excellence (NICE) is advising GPs and practice nurses to do more to identify adults who are not activei enough and to encourage them to get moving.
At present, we are not active enough as a nation - only 39% of men and 29% of women aged 16 and over are meeting the UK Chief Medical Officers' minimum recommendationsii for physical activity in adultsiii. Regular physical activity can significantly improve both physical and mental wellbeing and increase life expectancy. It can potentially prevent or alleviate conditions, such as stroke, heart disease, diabetes, obesity, colorectal cancer and breast canceriv that are estimated to cost the taxpayer more than one billion pounds a year in England alone. Physical activity can lower the risk of Alzheimer's diseasev, and it has also been shown to improve symptoms in those with depressionvi. The cost of inactivity to the wider economy (for instance through sickness absence or premature deaths) is estimated at more than six billion poundsvii.
Professor Mike Kelly, Director of Public Health at NICE said: “The cost of inactivity to people's health and wellbeing as well as to the wider economy is huge. Given the benefits, many healthcare professionals could do more to encourage people to be more active. This advice sets out simple ways for family doctors, practice nurses and others working in primary care, to consider levels of physical activity in every patient they see and to help people to improve their health by boosting their activity levels. This simple advice could have a big impact on improving lives and saving taxpayers' money.”
NICE is publishing this guidance to encourage people working in primary careviii to identify inactive adults during consultations and offer them brief adviceix.
The new guidance recommends that primary care practitioners should:
- Identify adults who are not currently meeting the UK Chief Medical Officers' physical activity guidelines. This could be done during a consultation or as part of a planned session on management of long-term conditions.
- Not rely on visual clues such as body weight to identify adults who are inactive, but use a questionnaire that has been shown to be accurate (such as the GP Physical Activity Questionnaire [GPPAQx]) to assess physical activity levels.
- Encourage adults who have been assessed as being inactive to do more physical activity, with the aim of meeting the UK physical activity guidelines. This advice should be tailored to the person's health status (for example whether they have a medical condition or a disability), the person's motivations and goals, current level of activity and ability, circumstances, preferences and the barriers preventing them from being physically active.
- Provide information about local opportunities to be physically active for people with a range of abilities, preferences and needs.
Professor Kelly added: “Most adults are simply not active enough. We know this can contribute to a great number of health problems which reduce people's quality of life and shorten lives. If family doctors and practice nurses follow this new guidance, it will help them deliver simple, sensible advice to people, and it will support patients to increase their physical activity levels and improve their lives.”
Professor Catherine Law, Professor of Public Health and Epidemiology, University College London Institute of Child Health, and Chair of the NICE Public Health Interventions Advisory Committee (PHIAC) said: “Promoting physical activity will improve physical and mental health and wellbeing. This updated guidance will help those working in primary care to promote physical activity in their everyday work.”
Dr Matt Kearney, General Practitioner in Runcorn, Primary Care and Public Health Advisor to NHS England, and member of the NICE Public Health Interventions Advisory Committee (PHIAC) which developed the guidance said: “As a practising GP, I see first-hand the effects of physical inactivity, and the lasting and serious damage it can have on people's health. This guidance offers practical advice to people working in busy clinics and will help us to give straight-forward advice to people who need to improve their levels of physical activity.”
The recommendations also say that commissioners of health services should:
- Ensure advice on physical activity is incorporated into the Care Pathwayxi of conditions such as cardiovascular disease, type 2 diabetes and stroke.
- Incorporate advice on physical activity into servicesxii for groups that are likely to be inactive, such as those aged 65 and over, those with a disability, and people from specific ethnic groups.
- Ensure assessment of physical activity and the delivery of, and follow up on, brief advice are built into local long-term disease management strategies. These strategies should also raise awareness of physical activity assessment as part of relevant Quality and Outcomes Framework (QOF) indicatorsxiii.
- Provide information and training for primary care providers. This should cover, for example, how physical activity promotion fits within their remit, how to undertake physical activity assessments, and the needs of specific groups.
Notes to Editors
References and explanation of terms
i. Physically inactive adults are those not meeting the Chief Medical Officers' current recommendations for physical activity. See reference point ii below.
ii. Adults (19-64 years) should be doing at least 150 minutes of moderate intensity activity over the week, in bouts of 10 minutes or more. Examples of moderate intensity activity could include vacuum cleaning, brisk walking or cycling, water aerobics, doubles tennis, pushing a lawn mower, hiking, rollerblading, volleyball or basketball. Older adults (65 years +) should aim to be active daily. Over a week, activity should add up to at least 150 minutes of moderate intensity activity in bouts of ten minutes or more. The full current UK physical activity guidance from the Chief Medical Office can be found at: https://www.gov.uk/government/publications/uk-physical-activity-guidelines
iii. Craig R, Mindell J, Hirani V (2009). Health survey for England, 2008, Health and Social Care Information Centre.
iv. Department of Health (2011) Start active, stay active: A report on physical activity for health from the four home countries´ Chief Medical Officers.
v. Scarmeas N, Luchsinger JA, Schupf N et al. (2009) Physical activity, diet, and risk of Alzheimer's disease. Journal of the American Medical Association 302 (6): 627-37.
vi. Rimer J, Dwan K, Lawlor DA et al. (2012) Exercise for depression. Cochrane Database Systematic Review 11 7: CD004366.
vii. Ossa D, Hutton J (2002). The economic burden of physical inactivity in England. London: MEDTAP International.
viii. Primary care practitioners refer to anyone working in primary care whose remit includes offering lifestyle advice. Examples include: exercise professionals, GPs, health trainers, health visitors, mental health professionals, midwives, pharmacists, physiotherapists and practice nurses.
ix. The term ‘brief advice' is used in this guidance to mean verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion.
x. The general practice physical activity questionnaire (GPPAQ) is an example of a validated questionnaire for assessing someone's (aged 16-74) current level of physical activity. The index can be cross-referred to Read Codes and can be used to determine whether brief advice might be appropriate. Read Codes is the standard clinical terminology system used in general practice in the UK.
xi. A care pathway is an agreed treatment plan for an illness or condition.
xii. Examples of these primary care services may include mental health services for adults and older people, services for people with learning disabilities, and services for people with drug and alcohol problems. There are a number of former PCTs and NHS foundation trusts offering these specific services. For example: http://www.shsc.nhs.uk/our-services
xiii. The QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them financially for how well they care for patients. The QOF contains groups of indicators, against which practices score points according to their level of achievement.
About the guidance
1. The guidance can be found from 00:01hrs BST on Wednesday 29 May 2013 at http://www.nice.org.uk/PH44
2. The Public Health Interventions Advisory Committee (PHIAC) has developed this updated guidance in consultation with stakeholders. Further details on the Public Health Interventions Advisory Committee (PHIAC)
3. The Public Health Interventions Advisory Committee (PHIAC) considers that the recommended approaches are cost effective. The economic analysis showed that, compared with a cohort not exposed to brief advice (ie usual care), the incremental cost-effectiveness ratio (ICER) for brief advice was £1,730. The ICER is a measure of the additional cost per additional unit of health gain produced by one intervention compared to another.
4. The recommendations have been made within the context of other national and local strategies and interventions to increase or maintain physical activity levels in the population. These might include addressing barriers to activity, for example, through changes to the physical environment or other measures to support an active lifestyle.
5. Physical activity levels vary according to income, gender, age, ethnicity, socioeconomic status and disability. People tend to be less physically active as they get older and levels of physical activity are generally lower among women than men. Physical activity levels are also lower among certain minority ethnic groups, among people from lower socioeconomic groups and among people with disabilities (Department of Health 2011).
6. Inactivity costs the NHS an estimated at £1.06 billion based on national cases of CHD, stroke, diabetes, colorectal cancer and breast cancer (all conditions which are potentially preventable or manageable through physical activity). This is a conservative estimate, given the exclusion of other health problems that physical activity can help manage and prevent. Examples include osteoporosis, falls and hypertension. Allender S, Foster C, Scarborough P et al. (2007). The burden of physical activity-related ill health in the UK. Journal of Epidemiology and Community Health 61: 344-348.
7. The total cost of inactivity further increases when considering the wider economic costs. These include sickness absence, estimated at £5.5 billion per year, and the premature death of productive people of working age from ‘lifestyle-related' diseases, estimated at £1 billion per year. Ossa D, Hutton J (2002). The economic burden of physical inactivity in England. London: MEDTAP International
8. In 2008, the Be active, be healthy plan (Department of Health 2009a) estimated that the average cost of physical inactivity for every primary care trust (PCT) in England was £5 million.
9. This guidance is a partial update of NICE public health guidance 2 (2006), Four commonly used methods to increase physical activity.
10. NICE public health guidance applies to England. It is not subject to a mandatory requirement regarding funding, but the NHS, local authorities and the wider public, private and voluntary community sectors in England should take it into account.
Related NICE guidance
11. Walking and cycling. NICE public health guidance 41 (2012)
12. Preventing type 2 diabetes: risk identification and interventions for high risk individuals. NICE public health guidance 38 (2012)
13. Obesity: working with local communities. NICE public health guidance
14. Preventing type 2 diabetes - population and community interventions. NICE public health guidance 35 (2011)
15. Weight management before, during and after pregnancy. NICE public health guidance 27 (2010)
16. Prevention of cardiovascular disease. NICE public health guidance 25 (2010)
17. Mental wellbeing and older people. NICE public health guidance 16 (2008)
18. Identifying and supporting people most at risk of dying prematurely. NICE public health guidance 15 (2008)
19. Promoting physical activity in the workplace. NICE public health guidance 13 (2008)
20. Community engagement. NICE public health guidance 9 (2008)
21. Physical activity and the environment. NICE public health guidance 8 (2008)
22. Behaviour change. NICE public health guidance 6 (2007)
23. Four commonly used methods to increase physical activity. NICE public health guidance 2 (2006)
24. Obesity. NICE clinical guideline 43 (2006)
25. Falls. NICE clinical guideline 21 (2004)
26. BMI and waist circumference - black, Asian and minority ethnic groups. NICE public health guidance (publication expected June 2013)
27. Overweight and obese adults: lifestyle weight management. NICE public health guidance (publication expected May 2014)
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This page was last updated: 29 May 2013