Table 1.
Factors affecting the likelihood of physical activity assessment being performed and/or depth of assessment.
| Illustrative quotes | |
|---|---|
| Factors increasing the likelihood and/or depth of assessment | |
| Clinical context | |
| If physical activity is immediately relevant to patient's presentation (contributing either to the cause or to treatment) | ‘If somebody's got diabetes … then you know it's [physical activity is] part of the treatment … to do with control of blood sugar.’ (GP9) |
| Presence of target chronic diseases | |
| Overweight/obesity | ‘If they are obese or diabetic or have any heart problems … I feel that it's important to investigate what sort of physical activity they engage in so that if it's something that's neglected in their lifestyle that's obviously something that one has to encourage them to do.’ (GP15) |
| Metabolic syndrome | |
| Cardiovascular disease and/or presence of cardiovascular risk factors | |
| Lung problems | |
| Diabetes mellitus or pre-diabetic | |
| Depression, mood disorders | |
| Osteoporosis | ‘If people have medical problems that … are specifically related or … very closely linked to a lack of appropriate physical exercise then that would be … the sort of patient that you'd spend a lot more time questioning … and going through their … physical exercise.’ (GP2) |
| Arthritis | |
| Other musculoskeletal problems including injuries | |
| Multiple sclerosis | |
| Occurrence of a health scare | ‘Those middle-aged guys who suddenly have a little health scare, they are actually ripe for change … so I … certainly do assessments on those guys in particular.’ (GP7) |
| Use of enhanced primary care itemsa | ‘Our practice has got really into the management plans and care plans and health assessments … [physical activity] does get assessed in the course of an annual health check for the oldies.’ (GP7) |
| Being raised by patient as an issue | |
| Patient appearing unfit | ‘If I see people look like they've been sitting on the couch for too long I try and get them going.’ (GP12) |
| Factors decreasing the likelihood and/or depth of assessment | |
| Patient perceived as not ready to change physical activity levels | ‘I guess it comes back to the motivation of people and when they feed back that their motivation is low then … it goes down to the bottom of the list.’ (GP5) |
| Younger age | ‘I probably don't bring up exercise with younger people unless there's an issue that I link it with.’ (GP9) |
| Older age | ‘I probably don't do it enough in the elderly.’ (GP8) |
| Being of normal body weight | ‘If they're not obese, then I don't tend to worry so much about physical activity.’ (GP7) |
a
These are specific government reimbursed general practice activities for health assessments in preventive care and for chronic disease management.