Physical Activity and Lifestyle Toolkit

GP talking to patient


This toolkit has been designed by the RCGPs in partnership with Sport England, to be used by primary care professionals in the UK. Any health professional concerned about their own activity levels may find the toolkit useful. The toolkit is designed to have something for all clinicians. Quickly browse our quick reference section or explore certain resources in more detail.

Introduction

Physical activity and positive lifestyle changes have been known to be beneficial to health for centuries. With modern lifestyles changing the way we work, play and move from place to place, general activity levels have fallen sharply. There is now an urgent need to increase the fitness of the population to prevent and manage many health conditions that are a result of being inactive. The rise in type 2 diabetes may be the most obvious result of this change but our resources show benefits of increased physical activity across 33 conditions that are seen daily in the NHS (such as depression, CVD, some cancers, etc.) Changing health behaviour is not easy and the toolkit provides support and advice to help achieve this.

Physical activity medicine historically has not been taught in the majority of medical schools, so for some professionals this is new evidence. The evidence of the benefits is growing rapidly from scientific studies and the present workforce needs to understand this form of prevention and management of many medical conditions. On 5 November 2018, the government released the paper: Prevention is better than cure. The importance of prevention to reduce disease burden is critically important. This toolkit will help to ensuring health care professionals have the resources to provide preventative advice.

Moving medicine

This website along with the fact sheets forms the cornerstone of our toolkit. Moving Medicine is an exciting resource developed by the Faculty of Sport and Exercise Medicine (FSEM) as part of Sport England and Public Health England's (PHE) Moving Healthcare Professional programme. The website provides a platform and structure for clinicians to have conversations about physical activity with their patients. The platform provides evidence and a structure for giving advice depending on how much time the clinician has available. The information available is evidence based and has been through a peer review process. The peer review for each condition was performed by specialists in that field. The platform contains condition specific physical activity information. The RCGP alongside British Association of Sport and Exercise Medicine (BASEM) have led on the creation of the Primary Prevention resources that sit on the platform.

Condition specific resources for healthcare professionals

This series of factsheets have been created by Dr Brian Johnson and peer reviewed by the RCGP Physical Activity and Lifestyle team. They were made specifically for busy health professionals to provide all the information required to understand the health benefits of physical activity. Set out by disease areas, there are brief synopses of the scientific evidence, for prevention and management of conditions helped by physical activity. There are also further links into more reading, ideas for audit, key messages, NICE guidelines and further organisations who may be able to help: 

01. Guidelines [PDF]
02. Physical Activity and Cause Mortality [PDF]
03. Physical Activity and Cancer [PDF]
04. Physical Activity and Cardiovascular Health [PDF]
05. Physical Activity and Chronic Kidney Disease [PDF]
06. Physical Activity and Mental Health [PDF]
07. Physical Activity and Metabolic Health [PDF]
08. Physical Activity and Musculoskeletal Health [PDF]
09. Physical Activity and Neurological Disorders [PDF]
10. Physical Activity and Obesity [PDF]
11. Physical Activity and Respiratory Disease [PDF]
12A. Physical Activity and Sedentary Behaviour [PDF]
12B. Sedentary Behavior and Musculoskeletal Disorders [PDF]
13. Physical Activity and Surgery [PDF]
14. Physical Activity and Motivation to Change Health Behaviour [PDF]
15. Physical Activity and Starting to Get Active [PDF]
16. References [PDF]

Other useful resources for healthcare professionals

Physical activity educational documents

Condition specific organisations with physical activity materials

Supporting patients to change their behaviour

  • Motivational interviewing and behaviour change: Stephen Rollnick - Psychologist/Author and co-founder of Motivational interviewing; his own courses and publications.
  • Healthy Europe through Learning and Practice (HELP) has a module on behaviour change.
  • BMJ module on Motivational Interviewing - A one hour module on motivational interviewing.
  • Health professionals can access the National Physical Activity Clinical Champion Training provided through PHE and Sport England’s Moving Health Care Professional Programme. The training focuses on the evidence base for physical activity (both the prevention and treatment of conditions) and how to provide brief advice and support to patients in clinical practice. Contact the Moving Health Care Professional team at physicalactivity@phe.gov.uk to find out when sessions may be taking place in your area or if you would like to organise a training session for you and 19+ colleagues who are interested in embedding physical activity in clinical practice. Contact the team at physicalactivity@phe.gov.uk

Podcasts

Equally well

Centre for Mental Health, Kaleidoscope and Rethink Mental Illness are working together with support from the Royal College of GPs and the Royal College of Psychiatrists to create an Equally Well collaborative which will seek to promote and support collaborative action to improve physical health among people with a mental illness. We have produced a podcast to introduce you to the work of Equally Well:

 

 

Organisations

UK Organisations

  • Activity Alliance supports and enables organisations to support disabled individuals to be and stay active. Their work is centred on research and insight with disabled people as well as engagement with disability and sports organisations.
  • The British Association of Sport and Exercise Medicine (BASEM) has educational courses on sports medicine, musculoskeletal examination and exercise medicine, as well as national conferences on these subjects. Membership also provides free supply of the internationally recognised British Journal of Sport Medicine and provides the grounding for a career in sport, musculoskeletal and exercise medicine, suitable for any GP or allied health professional.
  • The British Association of Sport and Exercise Scientists (BASES)   produced the evidence behind the UK guidelines on physical activity.
  • The British Journal of Sport Medicine (BJSM) - The leading journal containing articles on sports and exercise medicine. A very useful education section with excellent orthopaedic medicine examination videos, case histories, information on exercise medicine and learning material. It also includes plenty of blogs and podcasts to listen to. 
  • British Society of Lifestyle Medicine is a multidisciplinary society aiming to prevent, improve, manage and treat lifestyle-related conditions. BSLM aims to establish Lifestyle Medicine as central to health and wellbeing by promoting the prevention of avoidable lifestyle-related diseases, by advocating treatment of diseases of the 21st century with a realistic approach and by influencing healthcare and health policy. Raising awareness of Lifestyle Medicine principles and providing leadership, education and support for healthcare practitioners is a primary objective
  • Exercise Works! The UK and international site for up to date, evidence-based physical activity news via its twitter account. A comprehensive set of Undergraduate resources for the Medical student curriculum are available from the curator of ‘Exercise Works!’ http://www.exercise-works.org/
  • The Faculty of Sport and Exercise Medicine (FSEM). The governing body of Sport and Exercise Medicine (SEM) in the UK, who oversees the curriculum for the higher speciality training.
  • Healthy Europe through Learning and Practice (HELP) has interesting learning modules on physical activity, healthy eating and behaviour change with patient materials. 
  • The National Centre for Sport and Exercise Medicine: Centre for research, education and clinical services in sport, exercise and physical activity from three hubs in England
  • Public Health England. PHE exists to protect and improve the nation’s health and wellbeing and reduce health inequalities. Their Everybody active, everyday framework for physical activity sets an evidence based approach to getting the nation active, including moving healthcare professionals. Reviews of the evidence for specific conditions and activities are also available on their website.
  • The Scottish Physical Activity Health Alliance has patient resources and professional support resources on physical activity. They include the Scots-PASQ a tool that can be used to ascertain how active a person is and how ready they are to change their behaviour.
  • Sport England has a vision that everyone in England feels able to take part in sport or activity, regardless of age, background or ability to deliver a range of outcomes including physical and mental wellbeing. A key focus of their work is supporting inactive people or those with or at risk of long term conditions to get active by developing collaborations, supporting innovation and providing advocacy and influence across a range of partners. This includes working in partnership with Public Health England on the Moving Health Care Professionals Programme (which includes the Moving Medicine resource), their work with the Richmond Group of Health Charities and investing in targeted interventions that reduce inequalities and improve the evidence base for how to tackle inactivity with specific audiences such as Get Healthy Get Active and Active Ageing. 
  • UK Active exists to improve the health of the nation by getting more people, more active, more often. 

International organisations

 

Resources and guidance for patients

Disease specific resources for patients

  • Benefit From Activity website – The information for this patient site has been taken from the RCGP fact sheets with the medical jargon removed. With the same evidenced information. it means information is synergistic between health professional and public.
  • PACE UP ‐ A pedometer intervention to increase walking in adults and older adults. An exciting proven practical walking intervention for general practices to help our patients walk more. This
    intervention has been shown to reduce cardiac events and fractures in those who took part.
  • Cancer 
    • Cancer Research UK - Useful web site pages aimed at encouraging exercise as a way of reducing cancer risk.
    • Macmillan support materials - Information for those with cancer and after treatment. Ways to become active has links into activities near you.
    • Macmillan Cancer Support also has videos on the benefit of exercise after a cancer diagnosis.
      Search for Move More events on Macmillan’s website.  
  • Cardiac health
  • Chronic kidney disease
  • Chronic Obstructive Pulmonary Disease
  • Diabetes
    • Diabetes UK is a leading charity group with a wealth of diabetes information and resources both for patients and healthcare professionals.,
    • Diabetes UK - Information on exercise for diabetes and other advice on diabetes management.
  • Dementia
  • Disability
    • Activity Alliance - an organisation that supports and promotes activities for people with disabilities.
  • Fibromyalgia
    • NHS Choices self-help guidance on exercise for fibromyalgia 
  • Mental Health
  • Multiple Sclerosis
  • Musculoskeletal Health
    • Versus Arthritis - Advice on exercise to manage pain and arthritis
    • Versus Arthritis - Exercise sheets and videos for patients on:
      • Ankle sprain exercises
      • Back pain exercises
      • Knee pain exercises
      • Neck pain exercises
      • Osteoarthritis
      • Plantar fasciitis
      • Shoulder pain exercises
      • Elbow pain including tennis elbow
      • Keep moving conditions for home exercises
  • The Chartered Society of Physiotherapists has created a section of their website particularly for GP information on exercises for patients with free downloads and plenty of advice on a range of conditions including keeping health at work.
  • ShoulderDoc.co.uk - A website designed to provide information for patients and doctors on shoulder injuries.
  • Osteoporosis 
    •  The Royal Osteoporosis society has developed a series of recommendations for exercise and physical activity for osteoporosis and bone health
  • Pain and Exercise
  • Parkinson’s Disease and Exercise
  • Pregnancy and Exercise
  • Self Motivation for Exercise
    • This Girl Can is a national campaign developed by Sport England and partners to inspire women to move more and prove that judgement is a barrier which can be overcome.
  • Sitting and Exercise
    • Getting Started - Simple tips on increasing activity in your daily life.
    • Do you sit at a desk all day - The Chartered Society of Physiotherapists has a useful set of exercises on a free pdf download for desk workers or even use yourself!
    • Get Britain Standing - The campaign to grow awareness and educate on the dangers of sedentary behaviour.

Other Physical Activity resources for patients

  • Walk4life - A useful walk site for the UK with a simple ordnance search map to look for walks anywhere in the UK and a useful widget device (puts their website direct on your own website). The widget can be loaded onto business websites, public companies’ websites etc. Individuals who sign up free can put their own walks on and monitor their own fitness via the website. 
  • Walk Unlimited -The home site of the organisation behind Walk4life and Benefit from Activity. They have several useful websites on healthy lifestyle and a site of ‘Dr maps’ with examples of maps which have been created for GP surgeries, hospitals or businesses. Why not get walking maps around your health establishment for yourself, staff and patients
  • Walking for Health - England’s network of walking schemes
  • Let’s Walk Cymru - Wales network of walking schemes
  • Paths for All - Scotland’s network of walking schemes
  • Walk NI - Northern Ireland’s network of walks and groups
  • Couch to 5k -The starting course from sedentary through to running with a 9 week course of training podcasts.
  • The Daily Mile  - Encourages school children to become active
  • Parkrun - Organise free weekly 5km runs around the UK in parkland
  • Sustrans - The cycle charity promoting cycling as a healthier, cleaner and cheaper mode of transport with plenty of advice and cycle routes available by a postcode search. Has the National Cycle Network on their site to access for routes near you.
  • The Activity Alliance - Organisation that supports and promotes sport for people with disabilities. Helps you find activities to suit the individual if you are disabled.
  • 10 Today. 10 Today is an exercise programme launched by a host of experts and led by older people, for older people. It provides a series of easy and accessible 10-minute broadcasts, which can be done almost anywhere and at any time, in a group or alone, standing up or sitting down, and which can be adapted to different fitness levels. 10 Today aims to increase physical activity amongst older people across the country, helping to improve physical and mental wellbeing. Watch the workouts.
     
Use online search tools for activities near you:
  • There is a national search tool for England on the NHS Choices website. Visit NHS Choices and enter your postcode. NHS Choices also has suggested exercise videos and podcasts such as the popular ‘Couch to 5K’ 
  • In Scotland you can visit NHS Inform 
  • In Wales you can use the Sport Wales website to search for activities near you.
  • In Northern Ireland visit Sport Northern Ireland to search for activities near you 
  • Active Partnerships coordinates and support the delivery of regional physical activity and sport opportunities.
  • BBC Get Inspired for people looking to get into more physical activity and sport.

National guidance and reports

NICE guidelines 

Many NICE guidelines related to the medical conditions listed below have some physical activity lifestyle interventions present within them. They are listed but for ease the relevant bullet points have been extracted and placed on the physical activity fact sheets. There are some additional physical activity-specific NICE guidelines that are also listed below.

NICE guidelines not on the fact sheets:

  • Weight management: lifestyle services for overweight or obese adults. PH53 - This guideline covers multi-component lifestyle weight management services including programmes, courses, clubs or groups provided by the public, private and voluntary sector. The aim is to help people lose weight and become more physically active to reduce the risk of diseases associated with obesity. This includes coronary heart disease, stroke, type 2 diabetes and various cancers.
  • Weight management before, during and after pregnancy. PH 27 - This guideline covers how to assess and monitor body weight and how to prevent someone from becoming overweight or obese before, during and after pregnancy. The aim is help all women who have a baby to achieve and maintain a healthy weight by adopting a balanced diet and being physically active.
  • Behaviour changes: general approaches. PH6  - This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.
  • Physical activity and the environment. NG90 - This guideline covers how to improve the physical environment to encourage and support physical activity. The aim is to increase the general population’s physical activity levels. The recommendations in this guideline should be read alongside NICE's guideline on physical activity: walking and cycling.
  • Physical activity: walking and cycling. PH41 This guideline covers encouraging people to increase the amount they walk or cycle for travel or recreation purposes.
  • Physical activity for children and young people. PH17 - This guideline covers promoting physical activity for children and young people aged under 18 at home, preschool, school and in the community. It includes raising awareness of the benefits of physical activity, listening to what children and young people want, planning and providing spaces and facilities, and helping families build physical activity into their daily lives.
  • Physical activity in the workplace. PH13 - This guideline covers how to encourage employees to be physically active. The aim is to increase the working population’s physical activity levels.
  • Physical activity: exercise referral schemes. PH54 - This guideline covers exercise referral schemes for people aged 19 and older, in particular, those who are inactive or sedentary. The aim is to encourage people to be physically active.
  • Physical activity: for NHS staff, patients and carers. QS84 This quality standard covers encouraging physical activity in people of all ages who are in contact with the NHS, including staff, patients and carers. It describes high-quality care in priority areas for improvement.
  • Read Codes Do not use visual cues (for instance body weight) to asses physical activity levels. Use validated tools such as GPPAQ to assess activity levels. Record results of the physical activity assessment using Read codes.
    GPPAQ documents and Read codes    

Tips to make your practice an Active Practice

  • Display physical activity guidelines infographics in a prominent place in your waiting rooms. Use the infographics as handouts in your consulting rooms. The CMO fact sheets and infographics are available to download in different formats for printing, display or on monitors.
  • Print physical activity guidelines on your FP10 prescriptions’ ‘right hand side’. Target different age groups and or different disease groups or everyone. Set it for two to three months and repeat it two to three times a year to catch people’s attention.
  • Send exercise advice invitations to targeted disease groups e.g.: the hypertensive patients on your register. Personalise these invitations with names, details of their condition and why activity could help them manage this. You could also include details of activities happening near the surgery etc to encourage patient engagement. 
  • Be aware of local walks and cycle routes in your waiting rooms and what your local gyms can offer. Display any information that may make patients aware.
  • Display activity messages on your website.
  • Add the walk4life widget to your website. It is free and easy to set up. Walk4life is a useful site for the UK with a simple ordnance search map to look for walks anywhere in the UK. The’ widget’ can be loaded onto business websites, public companies websites etc (tell your patients). Individuals who sign up can put their own walks on and monitor their own fitness. 
  • If you have a health video channel in your waiting room, run the YouTube videos of ‘Let’s make our day harder’ and ’23-and-a-half-hours’. 

Videos to show in waiting rooms:

  • No excuses’ - A short YouTube video to help get over some of the common excuses.
  • 23-and-a-half-hours’ - A superb cartoon video expressing the benefits of exercise. It is only 9 minutes long and has had millions of hits.
  • Let’s make our day harder’  another cartoon video about avoiding being so sedentary.

The RCGP Active Practice Charter:

The RCGP Active Practice Charter is a fun, easy way to make some simple but impactful changes in your workplace that will demonstrate to your patients and staff that you mean it when you say that movement is the best medicine. Becoming an Active Practice is simple - all you need to do is sign up and demonstrate you have taken steps in the practice to:

  Support a reduction in sedentary behaviour in staff
  Support a reduction in sedentary behaviour in patient
  Support an increase in physical activity in staff
  Support an increase in physical activity in patient
  Partner with a local physical activity provider, to support the practice in getting more people active.

Learn more about this initiative and register to become an Active Practice in the RCGP Active Practice website 

 

The RCGP Active Practice Charter podcast:

Resources for commissioners

NICE Guideline PH44 – recommendation 3. Incorporating brief advice in commissioning

  • When commissioning services to prevent or treat conditions such as cardiovascular disease, type 2 diabetes and stroke or to improve mental health, ensure brief advice on physical activity is incorporated into the care pathway.
  • Ensure brief advice on physical activity is incorporated into services for groups that are particularly likely to be inactive. This includes people aged 65 years and over, people with a disability and people from certain minority ethnic groups. 
    • Include physical activity assessment and brief advice as part of a strategy for addressing domain 2 of the public health outcomes framework Proportion of physically active and inactive adults indicator.  
    • Ensure assessment of physical activity and the delivery of, and follow up on, brief advice  (see Nice Guidance PH44 - recommendations 1–2) are built into local long-term disease management strategies. Highlight physical activity as an independent modifiable risk factor for many conditions (see box 1). Strategies should also raise awareness of physical activity assessment as part of relevant quality and outcomes framework (QOF) indicators.

From the UK Faculty of Sport and Exercise Medicine you can download documents on the application of exercise medicine ‘A Fresh Approach’ and ‘A Fresh Approach in Practice’, which outline the benefits of sport and exercise services to patients and the NHS.   

 

Nutrition and Diet

General healthy eating:

For patients:

  • British Dietetic Association – The Association of UK Dietitians have produced a series of Food Fact Sheets to download and print for your patients. They cover healthy eating and lifestyle as well as diet advice for specific medical conditions. 

Alcohol:

Smoking:

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