Lifestyle in NICE guidance – Part 1 – Brief advice: physical activity

Lots of people think lifestyle medicine is fringe, or alternative. I want to present how lifestyle interventions are mainstream and today is the start of a blog series on NICE guidance which covers aspects of lifestyle. NICE is evidence-based guidance, advice and information services for health, public health and social care professionals across the UK.

The first guidance to be covered today is entitled ‘Physical activity: brief advice for adults in primary care’.

I thought this was a timely guidance to discuss given the start of #weareundefeatable campaign this week, which although doesn’t require input from GPs, it is a great motivation to start talking to our patients about movement.

Background:

The majority of adults and many children in England do not meet the Chief Medical Officer’s (CMO) recommendations for physical activity. In 2008, based on self-reporting, 39% of men and 29% of women aged 16 and over met the CMO recommendations on minimum physical activity levels (The Health and Social Care Information Centre 2011).

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).

Inactivity costs the NHS an estimated at £1.06 billion based on national cases of coronary heart disease, stroke, diabetes, colorectal cancer and breast cancer (all conditions that 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 et al. 2007).

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 and Hutton 2002). 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.

Key Definitions in the guidelines

Brief advice

Brief advice refers to 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 such as motivational interviewing.

Physical activity

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.

 

Current physical activity guidelines for adults (updated September 2019 version):

 

Screenshot_20190908_204553.jpg

Screenshot_20190908_204536.jpg

Screenshot_20190908_204523.jpg

Screenshot_20190908_204723.jpg

 

Source for above infographics: https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report

Recommendations in the guidance are:

Identify adults who are inactive

  • Opportunistically whilst in consultation or whilst waiting for an appointment.
  • Planned follow-ups managing 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.
    • Ensure the person at least leaves the initial consultation aware of the health benefits of physical activity.
      • I feel it’s vital to ask permission to discuss weight with a patient and be respectful of their choice to delay this if not ready or in the right frame of mind. Written information or signposting them to a website is useful if giving patient advice they can reflect upon in their own time whilst fulfilling these guidelines.
    • Use validated tools to assess physical activity levels (e.g. The general practice physical activity questionnaire (GPPAQ)), rather than replying on visual cues such as BMI/body weight.
    • Encourage people who are meeting physical activity guidelines to maintain this level of activity.

Delivering and following up on brief advice

Personally, I use the ‘Ask-Assess-Advise’ structure for discussing physical activity with patients. An example framework for this is available in the guidance, and feel free to contact me if you’d like more information on this structure.

  • Advise adults assessed as inactive to increase their physical activity, ultimately aiming to achieve UK physical activity guidelines.
    • Personally, I feel giving a patient small, achievable goals to start if inactive rather than overwhelming them with the guidelines is more effective. This way they are more likely to build momentum in achieving specific and attainable goals than feeling like the goal is insurmountable.
  • Tailor brief advice to the patient’s:
    • Motivations and goals
    • Current level of activity and ability
    • Circumstances, preferences and barriers to being physically active
    • Health status
  • Provide information about local opportunities to be physically active for people with a range of abilities, preferences and needs.
    • This is something you could task to a social prescriber (if you have one in your practice), after engaging your patient in the conversation with their permission to discuss their case with your colleague.
  • Consider giving a written outline of the advice and goals that have been discussed.
  • Record the outcomes of the discussion
    • This facilitates following up on this discussion at a future appointment.
    • Follow-up discussions can include what physical activity a patient has been undertaking, progress towards their goals or towards the physical activity guidelines.

The full guidance includes recommendations for how to incorporate brief advice in commissioning and systems to support brief advice (such as read codes being developed and resources easily available). I wanted to keep this blog as practical as possible for a health care professional, but if you want to see the full list of recommendations follow the link here:

https://www.nice.org.uk/guidance/ph44

All references used in the guidelines are also available through this link.

Hope you found this useful.

Emma x

 

1 thought on “Lifestyle in NICE guidance – Part 1 – Brief advice: physical activity”

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s