• Put patients at ease by letting them know you are having lifestyle conversations with all your patients.

• Gently gauge your patient’s interest in having the conversation to assess if they are ready for change.

• Focus on the positives from the patient’s point of view to foster a constructive, two-way conversation.

• If patients are not interested, invite them to make a follow-up appointment when they are ready to chat.

BMC Family Practice

Insights

• Be mindful of linking patient’s current health concern with their health behaviour, it may make them resistant.

• Build well received, collaborative conversations by inviting patient’s views using a question and answer format.

Albury C, Hall A, Syed A, Ziebland S, Stokoe E, Roberts N, Webb H, & Aveyard P (2019). Communication practices for delivering health behaviour change conversations in primary care: a systematic review and thematic synthesis. BMC Family Practice, 20: 111. Link to journal article

Assess if your patient is ready to commit to healthy changes with some simple questions. Patients are more receptive to change when they feel their clinician has listened with empathy.

• Would you like your health to be different, and, if so, how?

• How do you feel about improving your physical activity?

• Could you manage some small regular exercise activity, starting today?

The Physician and Sportsmedicine

Insight

• Evidence supports the view that today ‘Physicians have a responsibility to assess physical activity habits in their patients, inform them of the risk of being inactive, and provide a proper exercise prescription.’

Sallis R (2015). Exercise is medicine: a call to action for physicians to assess and prescribe exercise. The Physician and Sportsmedicine, 43(1), 22-26. Link to journal article

Identify your patient’s barriers and enablers to physical activity within their environments, to support a conversation about potential strategies and improve their potential for success.

Potential barriers to physical activity might include:

• Limited time, fatigue, family obligations or other competing priorities

• A lack of safe paths or open spaces for activity away from traffic

• Gyms or sports clubs which are too far away or too costly to join

• Feeling self-conscious about being active in a public space

• Cultural expectations regarding the type of activity and its location

• Safety issues, especially for women exercising alone in public spaces

Potential enablers of physical activity include:

• Simple and easy to use self-tracking tools like Healthy Habits to foster motivation

• Friends and family to exercise with together, or to provide support and childcare

• Virtual support groups to challenge, motivate and encourage adherence to goals

The American Journal of Medicine

Insights

• Research supports a multilevel approach to physical activity counselling that considers the socioecological levels, which drive differences in physical activity behaviour by geography, sex, age, and ethnic groups.

• A multilevel approach can help to reduce barriers. This involves a holistic focus on assessing physical activity levels, providing advice on increasing physical activity, reaching agreement on goals, connecting patients with resources, and arranging for follow-ups.

AuYoung M, Linke SE, Pagoto S, et al. (2016). Integrating physical activity in primary care practice. The American Journal of Medicine, 129, 1022-1029. Link to journal article

• Encourage patients that even a small increase in physical activity will help to improve their glycaemic control.

• Make change more achievable by reiterating the importance of starting small and working up to bigger goals.

• Patients may have unrealistic expectations about how much physical activity they need to do to. Reassure them by letting them know that even a small increase in their physical activity levels can improve their health.

RACGP HANDI Interventions

Insight

• Exercise improves glycaemic control in people with type 2 diabetes, even without weight loss.

Royal Australian College of General Practitioners (2014). Handbook of non-drug interventions. Exercise: type 2 diabetes. Link to handbook

Public Health England

Insights

• An additional 10 minutes of brisk walking a day is seen as achievable by adults who are currently ‘inactive’. (Adults doing less than 30 minutes of physical activity per week, where the greatest health risks persist.)

• For currently inactive adults, evidence shows the following benefits from 10 minutes of brisk walking for 7 days: increased physical fitness, improved mood, healthier weight and a 15% reduction in risk of early death.

• Being active helps to better manage many common conditions, including diabetes, depression and arthritis.

Brannan M, Varney J, Timpson C, Foster C, & Murphy M (2017). 10 minutes brisk walking each day in mid-life for health benefits and towards achieving physical activity recommendations: evidence summary. London: Public Health England. Link to journal article

Canadian Medical Association Journal

Insight

• The least physically active people gain the most by becoming even a little more active on most days.

Warburton DER, Nicol, CW, & Bredin SSD (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal, 174(6), 801-809. Link to journal article

Journal of Family Medicine and Primary Care

Insight

• Brief 2 minute interventions can improve patients’ physical activity, even if sedentary or with chronic disease.

Babwah T, Roopchan, […], & Dwarika K (2018). Exercise prescriptions given by GPs to sedentary patients attending chronic disease clinics in health centres – the effect of a very brief intervention to change exercise behaviour. Journal of Family Medicine and Primary Care, 7(6), 1446-1451. Link to journal article

• Get an idea of your patient’s current activity level and suggest and agree on small changes to their existing levels.

• Know your patient’s motivations, and work together to set achievable goals. Do they want to run 5 kilometres? Climb stairs more easily? Pick up grandkids without pain?

The Healthy Habits app is a simple and easy way to get your patients started:

• It guides patients to set small, achievable physical activity and nutrition goals

• Your patient can choose their own goals and increase their goals over time

• The app gives your patients simple tips and tricks to help them stay on track

The Healthy Habits app allows patients to link their data to your dashboard:

• You will be able to see how your patients have been tracking

• Discuss behaviours and revise goals at their next appointment

Annals of Family Medicine

Insights

Clinicians reported using 5 key strategies to support patient behaviour change.

1. Emphasising and encouraging patient ownership

2. Partnering with patients to identify small steps

3. Frequent follow-up visits to cheer successes

4. Listening and problem solving together

5. Showing caring and concern for patients

Greene J, Hibbard JH, Alvarez C, & Overton V (2016). Supporting patient behaviour change: approaches used by primary care clinicians whose patients have an increase in activation levels. Annals of Family Medicine, 14(2), 148-154. Link to journal article

Frontiers in Public Health

Insight

• Self-tracking apps, which track activities like exercise, eating and heart rate, help users to better understand their health and make improvements in their behaviours.

Sullivan AN and Lachman ME (2017). Behaviour change with fitness technology in sedentary adults: a review of the evidence for increasing physical activity. Frontiers in Public Health 4:289. Link to journal article

Journal of the National Comprehensive Cancer Network

Insight

• A recent study shows that activity trackers, such as pedometers and smartphone apps, are linked to improved step counts and exercise engagement for cancer survivors.

Schaffer K et al. (2019). Systematic review of randomized controlled trials of exercise interventions using digital activity trackers in patients with cancer, Journal of the National Comprehensive Cancer Network (2019). Link to journal article