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Physical Activity

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Introduction

When stretching, it is good to shut down the muscle through reciprocal inhibition. For example, when stretching psoas, flex your glutes so that psoas will be inhibited.

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What is "active enough"?

Good to accumulate in intervals; aim for 30-60 minutes/day.

Moderate Activity

Can talk while still walking

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Effective Physical Activity

Balance and neuromuscular training appear to reduce sports injuries (Hübscher et al, 2010).

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Barriers to Physical Activity

Barriers to PA Counselling (CFPC 2001)

time constraints
lakc of financial incentives
lack of standard protocols
lack of training and success in counselling role

There is a very inconsistent message being given in primary care

Patient's Barriers

lack of time
lack of energy
lack of motivation

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Supporting Physical Activity

Over 60% of obese pts don't get any recommendations from their GP (Sclamanna et al, 2000 Arch Int Med).

minimum intervention tools
minimal intervention counseling
other

Minimal Intervention Tools

brief and focused, saving time
handouts:
- Canada Physical Activity Guides
- Healthy Heart Kit from CFPC
  - engages people where they are at
- PACE (Provider-based Assessment and Counselling for Exercise)
- AIM (Americans in Motion)
limitations
- without background knowledge of counselling, can be hard
- tools don't explore reasons for not changing
- challenging to integrate into practice

Good Calls

be a role model (put up pictures of office staff doing things like snowshoeing)

Minimal Intervention Counseling

In a typical encounter, a GP has 2-4 minutes to play with

5 A's

Ask (to get pts to listen to you, listen to them)
- do you view inactivity as a problem?
- does being inactive concern you in any way?
- are you interested in becoming more active?
- are you ready to do something to accomplish right now?
Assess
- why do you want to become more active?
- how hard are you willing to work to fit increased activity into your life?
- are you ready to work now to gain benefits later?
Advise
- make specific recommendations
- encourage SMART goals
- remind patient to accept small gains
- advise the patient to identify barriers/temptations/confidence
Assist
- encourage and supprt success
- problem solve to address barriers and temptations
- make yourself available contingent upon change
  - if you meet goals, I'll see you more often
Arrange
- refer to community supports
- encourage patients to seek out active others