Tools for Practice Outils pour la pratique


#254 Should family physicians add “physical activity” to their prescription pads?


CLINICAL QUESTION
QUESTION CLINIQUE
 Do simple physical activity prescriptions increase physical activity levels?


BOTTOM LINE
RÉSULTAT FINAL
Physical activity prescriptions, combined with patient-specific goals and monitoring, may increase physical activity levels by up to ~1200 steps/day at ~1 year, with an additional 1 person becoming active for every 10 prescribed activity compared to general advice alone.



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EVIDENCE
DONNÉES PROBANTES
Focusing on randomized, controlled trials (RCTs) of physical activity prescriptions without additional counselling or referrals. RCTs generally include patient assessment and follow-up. Results statistically significant unless indicated. 
  • 347 patients with hypertension and/or type 2 diabetes, mean age 60, baseline ~4750 steps/day. Randomized to step count prescription (gradually increasing steps to an additional 3000/day) or control (verbal advice to be active for 30-60 mins/day). After 14 months:1 
    • Increase in steps/day: 1220 versus 30 (control). 
    • No difference in secondary outcomes (example blood pressure). 
  • 491 sedentary patients mean age 49. General practitioners discussed goals to increase activity (79% related to walking), then patient randomized to have goals written as prescription or not. Total time spent ~5 minutes. After 6 weeks:2 
    • No difference when analyzing all patients. 
      • When focusing on those who followed study protocol: Proportion who increased physical activity: 73% versus 63% (verbal only), Number Needed to Treat (NNT)=10. 
    • Physical activity duration: no difference. 
  • 88 people with transient ischemic attack, mean age=70, baseline ~7000 steps/day. Randomized to physical activity prescription (mostly walking) or control (general information). After 6 months:3 
    • 2489 more steps/day with prescription over control (not statistically different). 
    • Limitations: under powered. 
Other RCTs involved complex interventions not easily incorporated into primary care, such as referrals to exercise specialists or additional counselling.4,5  Context: 
  • Only 1 in 5 Canadians meet recommended 150 minutes of moderate-vigorous physical activity per week.6 
    • Mortality benefits may start with 15 minutes of moderate-vigorous physical activity/day and increase with additional activity.7 
  • Patient-specific goals, monitoring, and follow-up generally all part of physical activity prescribing.3 
    • Pedometers may assist with goal setting and monitoring.8 
  • Physical activity promotion in primary care is effective:9 NNT=12 for one sedentary person to meet recommended activity levels at 12 months. 
  • 2500-3000 steps are approximately equal to 30 minutes of moderate pace walking.1 


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Author(s)
Auteur(s)
  • Adrienne J Lindblad BSP ACPR PharmD
  • Srijan S. Raha BSC MSc
  • Victor Lun MD CCFP (SEM) FCFP Dip Sport Med

1. Dasgupta K, Rosenberg E, Joseph L, et al. Diabetes Obes Metab. 2017; 19:695-704.

2. Swinburn BA, Walter LG, Arroll B, et al. Am J Public Health. 1998; 88(2):288-91.

3. Morén C, Welmer AK, Hagströmer M, et al. J Neurol Phys Ther. 2016 Jul;40(3):176-83.

4. Pavey TG, Taylor AH, Fox KR, et al. BMJ. 2011 Nov 4; 343:d6462.

5. Onerup A, Arvidsson D, Blomqvist A, et al. Br J Sports Med. 2019 Mar; 53(6):383-8.

6. Chief Public Health Officer. Health Status of Canadians. 2016. Doi:Cat:978-0-660-05480-3.

7. Wen CP, Wai JPM, Tsai MK, et al. Lancet 2011 Oct; 378(9798):1244-53.

8. Turgeon RD, Korownyk C, Allan GM. Tools for Practice #5 online publication. Published July 14, 2009. Available at: https://gomainpro.ca/wp-content/uploads/tools-for-practice/1486404685_2016updatedtfp5motivatepedometer.pdf  Accessed October 18, 2019. 

9. Orrow G, Kinmonth AL, Sanderson S, et al. BMJ. 2012 Mar 26; 344:e1389. 

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.