VOL: 102, ISSUE: 20, PAGE NO: 21
Terry Hainsworth, BSc, RGN, is clinical editor, Nursing TimesFollowing the merger of NICE and the Health Development Agency, NICE has published its first public health guidance documents. These are on smoking cessation and physical activity and are both key documents for nurses in delivering the health promotion agenda as set out in Choosing Health: Making Healthy Choices Easier (Department of Health, 2004a), which makes it clear that health promotion should be part of the role of every nurse. This article looks at the benefits of physical activity and outlines the new guidance.
Following the merger of NICE and the Health Development Agency, NICE has published its first public health guidance documents. These are on smoking cessation and physical activity and are both key documents for nurses in delivering the health promotion agenda as set out in Choosing Health: Making Healthy Choices Easier (Department of Health, 2004a), which makes it clear that health promotion should be part of the role of every nurse. This article looks at the benefits of physical activity and outlines the new guidance.
Physical activity is any bodily movement produced by skeletal muscles resulting in energy expenditure beyond resting expenditure (Thompson et al, 2003). There is no clear data comparing how the amount of physical activity that people take has changed over time. But data from surveys suggests the amount may be falling. For example, the average distance walked by adults annually has fallen from 255 miles in 1975-1976 to 192 miles in 2003 (NICE, 2006).
Physical activity plays an important role in the prevention of obesity and several related diseases such as type 2 diabetes. Promotion of physical activity is therefore a vital element of health promotion work, with the chief medical officer (CMO) for England recommending that adults should achieve at least 30 minutes of moderate activity on five or more days of the week (DH, 2004a).
Physical activity guidance
The new guidance is on four common interventions (Table 1, p22) and makes six recommendations:
- Inactive adults should be identified and, unless inappropriate, should be advised to aim for 30 minutes of moderate activity five days each week;
- Advice on physical activity should take account of the individual's needs, preferences and circumstances. Written information about the benefits of activity and local opportunities should be given, goals agreed and follow-up arranged;
- Local promotion strategies should be monitored, especially regarding effectiveness of opportunistic advice at increasing activity levels of people from disadvantaged groups;
- The needs of hard to reach and disadvantaged communities, including minority ethnic groups, should be considered in the development of physical activity promotion services;
- Individuals should only be referred to exercise schemes that are part of a properly designed and controlled research study to determine effectiveness;
- Endorsement of pedometers, walking and cycling activities should only be for schemes that are part of properly designed and controlled research studies.
The health benefit of physical activity is seen throughout life. In children the effects are mainly the reduction of risk factors for disease, such as prevention of weight gain and achievement of high peak bone mass.
In adults physical activity is associated with a reduction in risk for:
- Cardiovascular disease;
- Type 2 diabetes;
Physical activity also promotes musculoskeletal health, and mental health and well-being. These effects are more marked in older adults, as conditions such as osteoporosis, circulatory diseases and depression can affect their independence (DH, 2004b).
The individuals who will benefit most from physical activity are those who are inactive (DH, 2004b).
Physical activity, at the level necessary to promote health, is associated with few risks. The greatest risks are associated with vigorous levels of exercise, contact sports and high-volume fitness training (DH, 2004b).
Most of the evidence on activity risk is regarding sports-related injuries. These vary according to the activity and many are thought to be avoidable (DH, 2004b). There is some evidence about risks such as sudden cardiac death and exercise-related MI suggesting that this is greatest in usually inactive individuals performing unaccustomed vigorous physical activity (Thompson et al, 2003).
Risks must be considered when recommending exercise and the principle of gradually increasing activity over time should be followed (DH, 2004b).
This guidance highlights the importance of an active lifestyle. Thompson et al (2003) suggest that health professionals should personally engage in exercise so that they are familiar with the issues involved and to set an example to their patients. This may increase the likelihood of recommending physical activity to patients. They also highlight that the promotion of physical activity should be incorporated into education and training (Thompson et al, 2003).
The NICE guidance is aimed specifically at primary care, and health visitors and nurses will play an important part in delivery of the recommendations.
There is already an established role in primary care for the prevention and management of coronary heart disease and other conditions related to physical inactivity, such as diabetes, as part of the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract.
Although not specific to acute care, the key messages in this guidance could be useful in other areas such as pre-operative counselling and care of older people. NICE has highlighted three guidelines that are related to this one:
- Hypertension (NICE, 2004a);
- Falls assessment (NICE, 2004b);
- Depression (NICE, 2004c).
In addition, Thompson et al (2003) suggest that the importance of physical activity on health risk means that a patient's habitual physical activity levels should be included when assessing patients.
These guidelines have highlighted areas where further research is required to provide evidence on which to base practice. These include identifying:
- Interventions that are most effective and cost-effective in increasing physical activity levels among people in lower socioeconomic and high-risk groups;
- Influencing factors for the effectiveness and cost-effectiveness of brief physical activity advice aimed at inactive adults;
- Influencing factors for the effectiveness and the cost-effectiveness of pedometer, walking and cycling schemes;
- Effectiveness and cost-effectiveness of exercise referral schemes on the long-term physical activity levels of previously inactive adults.
These research questions all relate to the interventions in the guidance. However, it is also recognised that there are other priorities for research in relation to the promotion of physical activity as a whole (NICE, 2006).
There is clear evidence of the role of physical activity in maintaining good health (DH, 2004b) but this needs to be supported by more evidence on effective interventions for promotion. The potential health gains from physical activity mean that its promotion needs to become a routine part of practice.
- This article has been double-blind peer-reviewed.
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