Progressing the role and evidence-base for ‘Exercise as Medicine’ in UK primary care settings
In 2011, the Chief Medical Officers in the UK issued guidance on the recommended levels of physical activity for adults.1 The guidance aims to tackle the well-established links between sedentary lifestyle, chronic disease and mortality and estimated economic cost to the NHS of £450m annually and findings that nearly half of all adults in the UK never do any moderate level physical activity.2 In response, there have been growing calls for healthcare professionals to help tackle the problem of physical inactivity, with primary care professionals seen as ideally placed to lead the fight and to “question patients about their physical activity and exercise habits at every meeting.”3
When surveyed, 92% and 99% of GPs and practice nurses agreed that promoting physical activity was an important part of their role.4 However, this agreement may be at odds with what is happening in clinical practice, with other reports highlighting that opportunistic brief interventions to increase physical activity occur in only a quarter of appropriate instances.5 Barriers include clinicians’ time constraints, a lack of knowledge of what detailed advice to give, and a lack of available tools/resources to support the brief intervention.4
There is a clear “knowledge-to-action” gap between UK recommendations for physical activity and professionals’ uptake it in primary care settings. Existing initiatives, such as “exercise on prescription” schemes often overly generalise the intervention, hampered by a lack of evidence-based information around which physical activity interventions work and to whom they should be targeted. There is also a lack of knowledge translation tools to effectively support the delivery of this information.
This project will be part of on going work seeking to reduce this knowledge-to-action gap. We are currently completing a funded evidence synthesis assessing the quality of evidence for physical activity interventions in the prevention and treatment of 20 chronic health conditions.6 However, our synthesis has highlighted the lack of disease specific head-to-head evaluations, allowing for more clear recommendations about the types of activity to recommend for a certain disease type. One of the next key steps will therefore be to conduct a complex evidence synthesis of direct and indirect comparisons. This information will then be used to construct a “formulary” of evidence based, disease specific physical activity interventions for patients and practitioners. To support the translation of knowledge, the formulary may also benefit from a patient/clinician decision tool (The “Evidence of Effects” page) that we are also developing in another, parallel NIHR funded project. The potential implementation of the formulary can then be explored in end-users.
The selected student will work in a priority clinical area to primary care, as well as develop methodological experience in complex systematic reviews, questionnaire/survey and qualitative data collection.
The research team
The project will be linked to the Centre for Evidence-Based Medicine (http://www.cebm.net/) within the Department of Primary Care Health Sciences (https://www.phc.ox.ac.uk/). Dr David Nunan (https://www.phc.ox.ac.uk/team/david-nunan), a departmental lecturer and senior researcher, and Dr Kamal Mahtani (https://www.phc.ox.ac.uk/team/kamal-mahtani), an academic GP, between them have extensive experience in clinical exercise science, complex systematic reviews and qualitative research methodology, with a strong emphasis on evidence-into-practice and mixed-methods research. There may also be opportunities to link this work with the RCGP Physical Activity and Lifestyle Clinical Priority, a 3-year programme to promote the uptake of evidence-based physical activity and lifestyle interventions in primary care.
Who should apply?
Candidates will be expected to be familiar with the basics of evidence synthesis, and quantitative and qualitative research methodology as applied to healthcare settings and to hold a good undergraduate degree and a Masters degree in a relevant subject (such as clinical exercise science, public health, evidence-based health care, communications science, behavioural science). The overarching topic for study has been identified but specific questions and research methodology should be identified by the candidate, who should offer a preliminary literature review as part of the application.
- Department of Health. Start Active, Stay Active: A report on physical activity from the four home countries’ Chief Medical Officers. Accessed on 15.11.2016 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf London: DoH; 2011.
- Public Health England. Physical inactivity: economic costs to NHS clinical commissioning groups. Accessed 15.11.2016 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524234/Physical_inactivity_costs_to_CCGs.pdf London: DoH; 2016
- Academy of Medical Royal Colleges. Exercise—the miracle cure. Accessed 02.02.2016. http://www.aomrc.org.uk/publications/reports-guidance/exercise-the-miracle-cure-0215/ London; Academy of Medical Royal Colleges: 2015.
- Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med 2012;46:625-31.
- National Institute for Health and Care Excellence. Physical activity: exercise referral schemes. NICE guidelines PH54. Accessed on 15.11.2016: https://www.nice.org.uk/guidance/ph54.
- Nunan D, Mahtani KR, Roberts N, Heneghan C. Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews. Syst Rev 2013;2:56.