About Prescription For Exercise

What is the Prescription for Exercise (P4E) initiative?

“Prescription for Exercise” (P4E) recognises that the promotion of physical activity is an essential component of high-quality health care and that being physically active is a clinical need; not just a lifestyle choice.

P4E is an initiative to promote and increase physical activity opportunities within primary and secondary health care. The P4E website is designed to help clinicians, and their patients, include physical activity when designing treatments plans to prevent and treat chronic disease.

In England, only 40% of adult men and 28% of adult women meet the Chief Medical Officer’s recommendations for health.  1 The Government’s national ambition for physical activity remains:

to have a year on year increase in the number of adults doing 150 minutes of exercise per week (in bouts of 10 minutes or more) and a year on year decrease in those who are inactive, defined as doing less than 30 minutes of exercise per week (in bouts of 10 minutes or more). 2 

The evidence over the past 10 years has now made inactivity perhaps the greatest threat to physical and mental health and a key-contributing factor to the rise of diabetes and many other long-term conditions. Equally, there is plenty of evidence showing that physical activity is as effective as many other therapies in treating long term conditions such as CHD, diabetes, osteoarthritis and COPD.

How might I use this website in practice?

Use or signpost your patient to this website. You may want to use the screening tools to find out whether your patient is active enough for health and then provide them with the correct supportive physical activity information. This website is full of helpful advice on choosing activity, getting started, types of activity, videos and more.

The ‘Condition Specific’ advice for physical activity focuses on inactive adults with, or at risk, of chronic disease aiming to do moderate activity. Note that advice on intense, vigorous activity for these patients is beyond the scope of our recommendations.

Physical activity: Do clinicians have a role?

There is no one single solution to increase physical activity but given that the average patient will visit their GP four 
times a year, with 78% of people visiting their GP at least once per year
, primary care can provide an ideal setting for a sustained, long lasting delivery for physical activity promotion. 3 Health care professionals are important influencers of patient behavior. One in four people in England say that they would be more active if they were advised to do so by a doctor or nurse. 4 Integrating positive physical activity messages when treating disease has been shown to be one of the ‘best investments’ for getting more people active. 5

Primary care professionals are experts in monitoring and, when needed, intervening for poor blood pressure, glucose, weight or cholesterol levels. There is no reason why we cannot apply this level of management to ‘physical inactivity’.

Inquiring about physical activity levels opens up dialogue on this matter and whether or not it evokes change, it at least, correctly informs the 75% of men and 67% of women that they are not doing enough for their health. 6

Who are the ‘Prescription for Exercise’ recommendations for?

The Condition Specific recommendations can be used for patients with chronic conditions who need to be more active for their health and well being.  The recommendations focus on ‘health enhancement’ rather than exercising for ‘physical performance’ which requires much higher intensity activity and can be unsafe for people with chronic conditions who are not regularly active and have not been initiated by exercise experts. The condition specific recommendation considers the patient’s current level of fitness by gradually aiming for relative moderate intensity activity.

 A simple clinical assessment covers points that the clinicians must go through before giving their patients advice. The disease specific cautions for activity are termed ‘safety considerations’. These are given alongside, rather than before, the recommendations. This approach reinforces that inactivity, rather than activity, carries a major risk to health and any caution should be managed rather than used to prevent someone from getting started. More information on these recommendations can be seen at the FAQ section.

What are the barriers for delivering physical activity advice in healthcare?

  • not having enough time during a consultation,   7
  • uncertainty of the benefits of exercise,   8
  • perception of a lack of evidence for the effectiveness of interventions   9

Many clinicians do not feel confident to discuss physical activity especially in patients who have, or are at risk, of chronic disease. The P4E resource is a free, easily accessible resource, which can be used to help the clinician feel more confident in recommending supportive physical activity advice related to specific chronic disease.

The website has an educational section for practitioners requiring more information on physical activity evidence including tips on delivering key messages during consultations.

Some highlights on this site:

  • Physical activity assessment and recommendation information for those with, or at risk of chronic disease.
  • UK Physical Activity guidelines
  • MSK exercise sheets for pain
  • Physical activity benefits (Patient Information Leaflets)
  • Advice on choosing local activities
  • Advice on getting started (brief intervention/advice leaflet)
  • Strength and flexibility Exercise sheets at home with videos
  • Educational section on the evidence for physical evidence
  •  

    References:

    1. The Health Survey for England 2006: CVD and risk factors adults, obesity and risk factors children, commissioned by the NHS Information Centre for health and social care.
    2. Moving more, living more. Dept of Health. Feb 2014.
    3. www.rcgp.org.uk/patient_information/what_is_general_practice. aspx
    4. The Health Survey for England 2008: CVD and risk factors adults, obesity and risk factors children, commissioned by the NHS information center for health and social care
    5. NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012;46:709-712
    6. The Health Survey for England: Healthy lifestyles: Knowledge, attitudes and behavior commissioned by NHS
    7. Wolff SH et al. A practice sponsored website to help patients pursue healthy behaviours: an ACORN study. Ann Family Med 2006; 4: 148-52
    8. Flocke SA et al. Evaluation of a community health promotion resource for primary care practices. Am J Prev Med 2006;30:243-51
    9. Eakin EG et al. Evaluating the population health impact of physical activity interventions in primary care – Are we asking the right questions? J Phys Activ Health 2005; 2:197-215

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