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New NICE guidance on promoting physical activity using brief advice

This month the National Institute for Health and Clinical Excellence (NICE) published their new evidence-based clinical guideline on "Physical advice: brief advice for adults in primary care".  NICE state "The guidance is for ... anyone ... whose remit includes offering lifestyle advice. Examples include: exercise professionals, GPs, health trainers, health visitors, mental health professionals, midwives, pharmacists, practice nurses, physiotherapists.  It may also be of interest to others with a role in encouraging physical activity and members of the public." 

The guidance includes recommendations on:  * identifying adults adults who are inactive;  * delivering and following up on brief advice;  * systems to support brief advice;  * information and training to support brief advice. 

Full details are available as a downloadable 63 page PDF document and also in web format.  The authors point out "The recommendations have been made within the context of other national and local strategies and interventions to increase or maintain physical activity levels in the population.  These might include addressing barriers to activity, for example, through changes to the physical environment or other measures to support an active lifestyle. (See "Physical activity and the environment", NICE public health guidance 8 [2008] and "Walking and cycling", NICE public health guidance 41 [2012]).  The availability of local opportunities to be active will influence whether brief advice has an impact on people's physical activity levels. The term 'brief advice' is used in this guidance to mean verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion."

NICE's definition states: "Physical activity includes everyday activity such as walking and cycling to get from A to B, work-related activity, housework, DIY and gardening. It also includes recreational activities such as working out in a gym, dancing, or playing active games, as well as

  • All adults aged 19 years and over should aim to be active daily.

  • Over a week, this should add up to at least 150 minutes (2.5 hours) of moderate intensity1 physical activity in bouts of 10 minutes or more.

  • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity2 activity spread across the week or combinations of moderate and vigorous intensity activity.

  • All adults should also undertake physical activity to improve muscle strength on at least 2 days a week.

  • They should minimise the amount of time spent being sedentary (sitting) for extended periods.

  • Older adults (65 years and over) who are at risk of falls should incorporate physical activity to improve balance and coordination on at least 2 days a week.

  • Individual physical and mental capabilities should be considered when interpreting the guidelines, but the key issue is that some activity is better than no activity.

1 Moderate-intensity physical activity leads to faster breathing, increased heart rate and feeling warmer. Moderate-intensity physical activity could include walking at 3-4 mph, and household tasks such as vacuum cleaning or mowing the lawn.

2 Vigorous-intensity physical activity leads to very hard breathing, shortness of breath, rapid heartbeat and should leave a person unable to maintain a conversation comfortably. Vigorous-intensity activity could include running at 6-8 mph, cycling at 12-14 mph or swimming slow crawl (50 yards per minute).

If you are involved with encouraging people (including yourself) to exercise more, then this NICE guidance is worth glancing at.  Mental health professionals should definitely know about these important issues ... they are highly relevant for our work.  There are many other relevant resources on this website - see, for example, the "Good knowledge" page on "Exercise" with it's questionnaires, handouts and links. 

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