1 Recommendations

The Public Health Interventions Advisory Committee (PHIAC) considers that the recommended approaches are cost effective.

The evidence statements underpinning the recommendations are listed in The evidence. See also supporting evidence for the evidence reviews and economic modelling report.

For the research recommendations and gaps in research, see Recommendations for research and Gaps in the evidence respectively.

Background

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. (See Physical activity and the environment, NICE public health guidance 8 [2008] and Walking and cycling, NICE public health guidance 41 [2012]).

The availability of local opportunities to be active will influence whether brief advice has an impact on people's physical activity levels.

Brief advice

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.

Box 1 Physical activity: definition and current UK recommendations

Definition

Physical activity includes everyday activity such as walking and cycling to get from A to B, work-related activity, housework, DIY and gardening. It also includes recreational activities such as working out in a gym, dancing, or playing active games, as well as organised and competitive sport. (See the Chief Medical Officers' [CMOs'] report.)

National recommendations

The CMOs' current recommendations for physical activity (see UK physical activity guidelines) state that:

  • All adults aged 19 years and over should aim to be active daily.

  • Over a week, this should add up to at least 150 minutes (2.5 hours) of moderate intensity1 physical activity in bouts of 10 minutes or more.

  • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity2 activity spread across the week or combinations of moderate and vigorous intensity activity.

  • All adults should also undertake physical activity to improve muscle strength on at least 2 days a week.

  • They should minimise the amount of time spent being sedentary (sitting) for extended periods.

  • Older adults (65 years and over) who are at risk of falls should incorporate physical activity to improve balance and coordination on at least 2 days a week.

  • Individual physical and mental capabilities should be considered when interpreting the guidelines, but the key issue is that some activity is better than no activity.

1 Moderate-intensity physical activity leads to faster breathing, increased heart rate and feeling warmer. Moderate-intensity physical activity could include walking at 3–4 mph, and household tasks such as vacuum cleaning or mowing the lawn.

2 Vigorous-intensity physical activity leads to very hard breathing, shortness of breath, rapid heartbeat and should leave a person unable to maintain a conversation comfortably. Vigorous-intensity activity could include running at 6–8 mph, cycling at 12–14 mph or swimming slow crawl (50 yards per minute).

Box 2 Benefits of physical activity

  • Prevents and helps to manage conditions such as coronary heart disease, type 2 diabetes, stroke, mental health problems, musculoskeletal conditions and some cancers.

  • Has a positive effect on wellbeing, mood, sense of achievement, relaxation and release from daily stress.

Whose health will benefit?

Adults aged 19 and older who are inactive ('inactive' refers to those who are not currently meeting the UK physical activity guidelines).

Recommendations 1 and 2

Who should take action?

Primary care practitioners – that is 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.

Recommendation 1 Identifying adults who are inactive

  • Identify adults who are not currently meeting the UK physical activity guidelines (see box 1). This could be done, for example:

    • when the opportunity arises during a consultation with a primary care practitioner or while people are waiting

    • as part of a planned session on management of long-term conditions.

  • Use professional judgement to determine when this assessment would be most appropriate, for example, when someone is presenting with a condition that could be alleviated by physical activity. When assessing activity levels, remain sensitive to people's overall circumstances. If it is not appropriate during the current consultation, carry out an assessment at the next available opportunity.

  • Do not rely on visual cues (for example, body weight). Use validated tools such as GPPAQ[1] to assess physical activity levels.

  • For people who are not meeting the UK guidelines, identify the most appropriate time to discuss physical activity with them. This might be during the current consultation or in a later consultation, and might involve referral to another member of the primary care team. If they agree to a future consultation, make sure it occurs at the earliest opportunity. Ensure the person at least leaves the initial consultation aware of the health benefits of physical activity (see box 2).

  • Record the outcomes of the physical activity assessment. Use Read Codes[2] if appropriate.

  • Encourage people who are assessed as meeting the UK physical activity guidelines (see box 1) to maintain this level of activity.

Recommendation 2 Delivering and following up on brief advice

  • Advise adults who have been assessed as being inactive to do more physical activity, with the aim of achieving the UK physical activity guidelines. Emphasise the benefits of physical activity. (See box 1.)

  • When delivering brief advice, tailor it to the person's:

    • motivations and goals (see NICE guidance on Behaviour change: the principles for effective interventions [public health guidance 6])

    • current level of activity and ability

    • circumstances, preferences and barriers to being physically active

    • health status (for example whether they have a medical condition or a disability).

  • Provide information about local opportunities to be physically active for people with a range of abilities, preferences and needs.

  • Consider giving a written outline of the advice and goals that have been discussed.

  • Record the outcomes of the discussion.

  • Follow up when there is another appointment or opportunity. The follow-up could consist of a conversation about what physical activity someone has been doing, progress towards their goals or towards achieving the UK physical activity guidelines (see box 1).

Recommendations 3–5

Who should take action?

Commissioners of health services, including primary care and public health services.

Recommendation 3 Incorporating brief advice in commissioning

  • When commissioning services to prevent or treat conditions such as cardiovascular disease, type 2 diabetes and stroke or to improve mental health, ensure brief advice on physical activity is incorporated into the care pathway.

  • Ensure brief advice on physical activity is incorporated into services for groups that are particularly likely to be inactive. This includes people aged 65 years and over, people with a disability and people from certain minority ethnic groups.

  • Include physical activity assessment and brief advice as part of a strategy for addressing domain 2 of the public health outcomes framework Proportion of physically active and inactive adults indicator.

  • Ensure assessment of physical activity and the delivery of, and follow up on, brief advice (see recommendations 1–2) are built into local long-term disease management strategies. Highlight physical activity as an independent modifiable risk factor for many conditions (see box 1). Strategies should also raise awareness of physical activity assessment as part of relevant quality and outcomes framework (QOF) indicators.

Recommendation 4 Systems to support brief advice

  • Ensure systems such as Read Codes are being used to identify opportunities to assess people's physical activity levels and deliver brief advice.

  • Ensure resources (for example, standard documents and forms) and systems are available to assess, record and follow up on the provision of brief advice.

  • Ensure information about local opportunities to be active (including non-sporting activities) is available and up to date. This could include online maps and route finding for walking or adapted cycling.

Recommendation 5 Providing information and training

Provide information and training for primary care practitioners. This should cover:

  • how physical activity promotion fits within their remit and how it can help prevent and manage a range of health conditions (see box 2)

  • the definition of physical activity: what constitutes moderate and vigorous physical activity, and what intensity, duration and frequency of physical activity is needed to achieve the UK physical activity guidelines (see box 1)

  • groups more likely to be inactive (see recommendation 3)

  • misconceptions about who needs to increase their physical activity (based, for example, on visual cues such as body weight)

  • how to undertake physical activity assessments

  • local opportunities for physical activity

  • the needs of specific groups, such as people with disabilities, including local opportunities for them to be physically active

  • delivery of brief advice including, for example, the skills to motivate people to change (see NICE guidance on Behaviour change: the principles for effective interventions [public health guidance 6]).



[1] 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. See guidance on using GPPAQ.

[2] Read Codes is the standard clinical terminology system used in general practice in the UK.

  • National Institute for Health and Care Excellence (NICE)