Ask

As pain affects an individual’s physical activity beliefs and behaviours, focusing on this can be a useful way to introduce the topic

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1

Ask permission

Ask permission to talk about either ‘physical activity’ or ‘something that can make a big difference to your future health and wellbeing’.

Spending a moment to set the scene and asking permission can open a constructive person-centred conversation around behaviour change. This keeps the individual actively engaged in the conversation and decision making.

2

Assess impact

How has their disease affected their physical activity levels and the things they enjoy?

Supporting behaviour change is hard work! This resource is designed to help you navigate this challenging task.

Most people are ambivalent about, rather than resistant to, increasing their physical activity levels. There are pros and cons to both maintaining the same physical activity levels as well as increasing them. Your challenge is to help an individual to consider and share their own ‘pros’ for increasing their physical activity levels and help them to develop these ideas into a workable plan that fits into their life.

Try to understand the individuals own perspective, agenda and priorities and do not assume they:[1]

  1. ought to change
  2. want to change
  3. are primarily motivated by their health
  4. either ARE or ARE NOT motivated to increase their activity levels
  5. will respond well to a tough approach from you
  6. must (or will) follow your advice

Learning skills such as motivational interviewing can help you avoid common pitfalls that sometimes make conversations about behaviour change unrewarding and ineffective.

References

  1. Mason P, Rollnick S. Health behaviour change : a guide for practitioners. 2nd ed. /. London: : Churchill Livingstone 2010.
3

Review activity

Physical activity calculator

The physical activity ‘vital sign’ is a simple way of assessing an individual’s physical activity level. It has been validated in a cohort of 1.73 million people in the USA against self report survey data[1,2] and is in use worldwide[3]. It serves as a screening tool for clinical staff to inform brief consultations in physical activity as per NICE recommendations[4]. As this tool does not assess strength and balance these should be asked about separately.

References

1. Sallis R, Franklin B, Joy L, et al. Strategies for promoting physical activity in clinical practice. Prog Cardiovasc Dis 2015;57:375–86. doi:10.1016/j.pcad.2014.10.003

2. Coleman KJ, Ngor E, Reynolds K, et al. Initial Validation of an Exercise ‘Vital Sign’ in Electronic Medical Records. Med Sci Sport Exerc 2012;44:2071–6. doi:10.1249/MSS.0b013e3182630ec1

3. Golightly YM, Allen KD, Ambrose KR, et al. Physical Activity as a Vital Sign: A Systematic Review. Prev Chronic Dis 2017;14:E123. doi:10.5888/pcd14.170030

4. NICE. Physical activity: brief advice for adults in primary care primary care. Natl Inst Heal care Excell Public Heal Guidel 44 2013;PH44.nice.org.uk/guidance/ph44

4

Explore benefits

What do they know about some of the benefits of physical activity in people with musculoskeletal pain?

As an individual is more likely to change if they can personally identify with the ‘pros’ for change, help them to identify how they might benefit from being more active. Find out what they know first so that you can add to their existing understanding by sharing some of the wide-ranging benefits of being more active.

Q1 On average, how many days each week do you do moderate or greater physical activity (like a brisk walk) ?

days

Q2 On those days, on average how many minutes do you do this physical activity for?

mins

Inactive. Only small increases in physical activity across the week can have large health benefits.

Insufficiently active. A good start, but there is still a lot to be gained by increasing physical activity levels.

Active. Well done. Maintaining this level of activity is really important.

Explain that just 30 minutes physical activity in one week can make a huge difference to their health.

Lower: 0.77
Relative Risk
Higher: 1
0
30
60
150
300
Minutes Per Week

Did you know?

The least active individuals stand to gain the most from a small increase in physical activity.

Large health gains are observed in individuals increasing their activity levels from very low amounts. For instance increasing from 10 to 20 minutes of moderate intensity activity per week has a significant effect on life expectancy despite the fact that they are still far below the recommended 150 minutes of moderate intensity.

Particular efforts should therefore be made to help very inactive individuals change their behaviour. Healthcare provides unique access to many of the least active members of the population so it is vital that each opportunity to positively influence behaviour is capitalised upon.

Reference

Department of Health. Start Active , Stay Active: a report on physical activity from the four home countries’ Chief Medical Officers. London: 2011.

NICE. Physical activity: brief advice for adults in primary care primary care. Natl Inst Heal care Excell Public Heal Guidel 44 2013;PH44.nice.org.uk/guidance/ph44

Muscle strengthening and balance activities should be done on at least two days per week

A recent rapid review by Public Health England for UK CMOs review of physical activity guidelines emphasises the importance of regular strength and balance activities throughout the life course.

This document highlights the three key transition points of benefit from regular strength and balance activities. At age 18-24 bone and muscle gains are maximised; from 40-50 years strength and balance activities slow the natural decline; finally from 65 years onward activity helps maintain independence and operate above key functional thresholds.

Reference

Department of Health. Start Active , Stay Active: a report on physical activity from the four home countries’ Chief Medical Officers. London: 2011.

Public Health England. Muscle and bone strengthening and balance activities for general health benefits: in adults and older adults. PHE publication gateway reference: 2018207. July 2018

Skelton DA, Mavroeidi A (2018) How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course and are there particular ages where MBSBA are important. Journal of Frailty, Sarcopenia and Falls 3(2): 74-84

Twice weekly strength sessions and specific balance and coordination training for the over-65s is also recommended

A recent rapid review by Public Health England for UK CMOs review of physical activity guidelines emphasises the importance of regular strength and balance activities throughout the life course.

This document highlights the three key transition points of benefit from regular strength and balance activities. At age 18-24 bone and muscle gains are maximised; from 40-50 years strength and balance activities slow the natural decline; finally from 65 years onward activity helps maintain independence and operate above key functional thresholds.

Reference

Department of Health. Start Active , Stay Active: a report on physical activity from the four home countries’ Chief Medical Officers. London: 2011.

Public Health England. Muscle and bone strengthening and balance activities for general health benefits: in adults and older adults. PHE publication gateway reference: 2018207. July 2018

Skelton DA, Mavroeidi A (2018) How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course and are there particular ages where MBSBA are important. Journal of Frailty, Sarcopenia and Falls 3(2): 74-84