Health promotion of physical activity

Health promotion, or “the process of enabling people to increase control over their health and its determinants, and thereby improve their health” is expected to be an integral part of future Australian health policy. It has been suggested that a National Health Promotion and Prevention Agency be established to build the evidence base of effective health promotion and prevention strategies. The Preventative Health Taskforce report recently outlined specific strategies to reduce rates of obesity and tobacco and alcohol consumption. This issue of RESEARCH ROUNDup looks at promotion of physical activity (PA), exploring the effectiveness of interventions and the contributions of recent Australian research to the evidence about promoting physical activity in the primary care setting.


PA promotion in primary care
Australian research has indicated that primary care provides a suitable setting for the promotion of PA. 2 Addressing physical inactivity is perceived by healthcare providers as being integral to their role 8 and individuals are accepting of the appropriateness of PA promotion by their general practitioners. 9veral initiatives support the promotion of PA within primary care:  The SNAP framework for management of smoking, nutrition, alcohol and PA in general practice. 10 The Lifescripts initiative provides a framework for GPs to address lifestyle risk factors through assessment, tailored advice, activity prescriptions, referral and follow-up. 11 The Australian Better Health Initiative a joint state and territory initiative to promote good health and reduce the burden of chronic disease. 12spite these initiatives the draft National Primary Health Care Strategy 13 identifies the lack of a "systematic and integrated approach to preventive health care in the Australian primary health care setting" (p.52).

Issue 8 October 2009 L Isherwood E Kalucy R Katterl N Reinfeld-Kirkman
Is PA promotion in primary care effective?
A recent systematic review focusing on the promotion of PA in primary health care found good evidence that both brief and intensive interventions can achieve short-term increases in PA. 14 Components of successful PA promotion strategies included verbal or written advice, and systematic follow-up, to patients about PA.Few studies covered in the systematic review were delivered within routine service provision.Time and workload constraints, a lack of support at a practice level, and lack of access to referral services 10 are barriers to the sustainability of PA approaches.Divisions of General Practice can play an important role in addressing those barriers.In 2006-07 85% of Divisions conducted Lifescripts programs, mainly through GP education and practice support, but also through collaborating with other organisations. 15ile the impact of Lifescripts has not been fully evaluated, a recent study exploring PA screening approaches in general practice found that current methods for identifying patients who are insufficiently active were poor and that the Lifescripts PA assessment tool reduced this accuracy further. 16rticipants in studies on PA interventions have tended to be white, middle-class, well-educated, motivated, and living in urban areas. 17,18An example of adapting a PA intervention to make it more appropriate for local needs is the Indigenous Lifescripts initiative. 18Another initiative, Be Active Australia, has specific strategies focusing on Aboriginal and Torres Strait Islander peoples and also populations with special needs (eg.culturally and linguistically diverse communities). 3 CONTACT PHC RIS:

Australian PA Promotion Examples
The 10,000 Steps Rockhampton project is a multistrategy PA intervention which sought to translate evidence-based PA promotion strategies into a real-world community setting. 19GP participation in the intervention was high and there was a significant increase in the number of community residents counselled on PA in primary care.Overall the 10,000 Steps project successfully increased awareness of PA within the local community, but only modest changes in PA were noted, and only with females.
Another example of a successful local PA promotion initiative is the GP Exercise Referral Scheme within the Sutherland Division of General Practice. 20Patients are referred to the local leisure centre for a personalised exercise program.Evaluation of the scheme identified positive outcomes (increased levels of PA and changes to patient lifestyle risk factors) at three and six months.

Reflections on PA promotion
A recent study measured the cost effectiveness of different modalities in delivering a successful PA health promotion message. 21GP referral and GP-distributed prescriptions were found to be a cost effective intervention.However mass media and internet based approaches were also successful, and the cost-effect ratio of these interventions showed a comparable effect at a significantly lower cost.People of lower socio economic status are also less able to bear the costs of additional specialist or GP interventions, indicating that if we wish to gain a whole of population effect, our resources may best be focused on public health media campaigns, and resources on the internet.
Multi-dimensional action is therefore required across a variety of settings -health services, community, workplaces, schools -with interventions at individual, institutional and policy levels.Interventions to change individual behaviour need to be combined with healthy public policies and supportive environments. 22ommunity sporting organisations or events present an opportunity for social interaction as well as PA, which is likely to encourage the sustainability of PA. 23 Whilst the promotion of PA in primary care has been shown to have some success, such interventions are just one aspect of a coordinated approach which is needed to address declining levels of physical activity in Australia and the adverse impact that this has on the health of our nation.