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26 Oct 2021

How can we support healthcare professionals to promote physical activity?

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Walking

Being active has proven health benefits, yet a large percentage of the UK population are physically inactive – and experience long-term health conditions as a result.

Healthcare professionals such as GPs, nurses and physiotherapists have significant community reach, and are trusted – and as such could have a big influence when it comes to promoting physical activity.

However, we don’t know a lot about how healthcare professionals (HCPs) are trained to promote active lifestyles.

A new project, funded by the NIHR ARC North East and North Cumbria and led by a team at Durham University, looked at the training that HCPs received around physical activity – to see where it might be improved.

Healthcare professionals are highly qualified, and undertake a huge amount of training. This research took an in-depth look at the content of any training that related to physical activity.

The research findings

Training content

Similarities in content were observed via continuing professional development and undergraduate resources for current and future HCPs. This included the importance of reducing sedentary behaviours, the cardiovascular, musculoskeletal, and psychosocial benefits of being physically active, alongside how physical activity aids the prevention and management of existing health conditions and non-communicable diseases. Training also included national physical activity guidelines for various population groups.

HCPs also received training on how to use various tools to assess, advise and prescribe physical activity to their patients.

Whilst assessment strategies included capability assessments, questionnaires, and health histories to assess patients’ frequency, intensity, duration, and type of current levels of physical activity, counselling strategies ensured that HCPs understood the NHS theme ‘Making Every Contact Count’ (MECC).

Making Every Contact Count is all about using the  interactions that people have with others to encourage positive changes in individual and population health behaviours.

Strategies such as the 5A’s framework (Ask, Assess, Advise, Assist, Arrange) were taught to ensure HCPs prescribe person-centred opportunities based on the patient’s interests. Opportunities included free-to-access campaigns such as ‘Park Run’ and ‘Walk4Life’.

As well as this, HCPs received training around behaviour change strategies that identified patients’ capabilities, motivations and opportunities to change their health behaviours.

One strategy was motivational interviewing. This involved employing reflective listening, asking open-ended questions, and linking activities to the patients’ personal ambitions. Other notable teachings included patient case studies, goal setting and social support strategies.

Training delivery

Training was predominantly delivered to HCPs via face-to-face and e-learning resources. Current HCPs received online e-learning as part of Public Health England’s ‘Moving Healthcare Professionals’ programme, alongside other resources such as online consultation guide ‘Moving Medicine’.

Peer-to-peer support complemented this training, with healthcare ‘Clinical Champions’ providing face-to-face coaching during protected learning times, enabling HCPs to learn from other professionals.

Undergraduate HCPs typically received physical activity training face-to-face via a spiral curriculum approach across existing teaching modules. Due to the challenges of a saturated curriculum, creative methods of incorporating training content included housing further resources on online web portals, blogs and podcasts, and problem-based learning tasks for students to complete.

Summary of the research conclusions

  • Despite similarities in training content, the curriculum across UK educators lacks standardisation.
  • Opportunities to expand the curriculum to support HCPs in understanding the socio-economic determinants behind how and why people are physically active/inactive could assist in understanding the patient story behind their current and future health behaviours.
  • Peer mentoring such as ‘Clinical Champions’ training can provide valuable spaces for sharing anecdotes and stories between HCPs. Exchanges of personal experiences between professionals can provide crucial learnings that goes above and beyond the competencies developed through e-learning.
  • E-learning supports HCPs learn at a time that complements existing job commitments, whilst undergraduate curriculum can utilise these virtual spaces to house further content, reduce curriculum pressures by blending online and face-to-face learning environments, and explore opportunities such as a flipped classroom approach (whereby students learn content at home and complete homework during class time).
  • HCPs should not be the only physical activity promoting workforce. Policymakers must do more to expand the breadth of credible physical activity messengers into other workforces. One key workforce identified is social workers.

You can download the full paper, here.

This project was led by Professor Brett Smith at Durham University. For more information, please email – brett.smith@durham.ac.uk