Tools for Practice


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


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


BOTTOM LINE
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
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):

  • 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.