Table 1.
Physical activity promotion features in 39 national guidelines
| Guideline | Physical activity recommendation | ||
|---|---|---|---|
| Gastrointestinal | |||
| 1 | NICE (2010) | Constipation in children and young people: diagnosis and management of idiopathic childhood constipation |
Advise daily physical activity tailored as a part of ongoing maintenance |
| 2 | NICE (2008) | Diagnosis and management of irritable bowel syndrome (IBS) in primary care |
Give information explaining the importance of self-help of IBS, including physical activity |
| 3 | NICE (2004) | Dyspepsia: management of dyspepsia in adults in primary care |
If no alarm signs and if not on drug with dyspeptic side effects, then offer simple lifestyle advice including weight reduction (ie, physical activity and diet) |
| 4 | Primary Care Society for Gastroenterology (2006) |
The management of adults with coeliac disease in primary care |
For osteoporosis risk and prevention recommend regular physical activity at annual review |
| 5 | British Society of Gastroenterology (2007) |
Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease |
All patients should be advised to undertake regular weight-bearing exercise (including walking, using stairs, housework and gardening) |
| Cardiovascular | |||
| 6 | NICE (2008, revised 2010) | Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease (CVD) |
People at high risk of or with CVD should be advised to exercise 30 min a day, of at least moderate intensity, at least 5 days a week, in line with national guidance for the general population. People who are unable to perform moderate-intensity physical activity at least 5 days a week because of comorbidity, medical conditions or personal circumstances should be encouraged to exercise at their maximum safe capacity. Recommended types of physical activity include those that can be incorporated into everyday life, such as brisk walking, using stairs and cycling. People should be advised that bouts of physical activity of 10 min or more accumulated throughout the day are as effective as longer sessions. Advice about physical activity should take into account the person's needs, preferences and circumstances. Goals should be agreed and the person should be provided with written information about the benefits of activity and local opportunities to be active |
| 7 | NICE (2008) | Identification and management of familial hypercholesterolaemia |
People at high risk of or with CVD should be advised to exercise 30 min a day, of at least moderate intensity, at least 5 days a week, in line with national guidance for the general population. People who are unable to perform moderate-intensity physical activity at least 5 days a week because of comorbidity, medical conditions or personal circumstances should be encouraged to exercise at their maximum safe capacity. Recommended types of physical activity include those that can be incorporated into everyday life, such as brisk walking, using stairs and cycling. People should be advised that bouts of physical activity of 10 min or more accumulated throughout the day are as effective as longer sessions. Advice about physical activity should take into account the person's needs, preferences and circumstances. Goals should be agreed and the person should be provided with written information about the benefits of activity and local opportunities to be active |
| 8 | NICE (2006) | Hypertension: management of hypertension in adults in primary care |
Ascertain patients' diet and exercise patterns because a healthy diet and regular exercise can reduce blood pressure. Offer appropriate guidance and written or audiovisual materials to promote lifestyle changes |
| 9 | NICE (2007) | Myocardial infarction (MI): secondary prevention in primary and secondary care for patients following an MI |
Patients should be advised to undertake regular physical activity sufficient to increase exercise capacity. Patients should be advised to be physically active for 20–30 min a day to the point of slight breathlessness. Patients who are not achieving this should be advised to increase their activity in a gradual step-by-step way, aiming to increase their exercise capacity. They should start at a level that is comfortable, and increase the duration and intensity as they gain fitness |
| 10 | NICE (2006, revised 2010) | Obesity: guidance on prevention, identification, assessment and management of overweight and obesity in adults and children |
Weight management programmes should include behaviour change strategies to increase physical activity and decrease inactivity. Interventions in children should address lifestyle within the family and social settings. If a child, family or adult are unwilling to change, give them information about the benefits of increased physical activity, losing weight and healthy eating. Ask about their related activity levels and beliefs |
| 11 | British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association (2005) |
Joint British Societies guidelines on the prevention of cardiovascular disease in clinical practice |
Discuss lifestyle targets to increase aerobic exercise |
| 12 | Guidelines (2010) | Consensus guideline for the management of symptomatic stable angina in primary care |
Before a patient is referred for assessment by secondary care, it is important to give lifestyle advice including physical activity |
| 13 | Guidelines (2010) | Consensus guideline on reducing cardiovascular events and pancreatitis through the effective management of triglycerides |
The management of hypertriglyceridemia is multifaceted, including a combination of lifestyle changes (including physical activity), risk factor modification and drug therapy |
| Respiratory | |||
| 14 | NICE (2004, updated 2010) | Chronic obstructive pulmonary disease (COPD): management of COPD in adults in primary and secondary care |
Pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation. Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC grade 3 and above). Pulmonary rehabilitation is not suitable for patients who are unable to walk, have unstable angina or who have had a recent MI. The rehabilitation process should incorporate a programme of physical training, disease education, nutritional, psychological and behavioural intervention. Patients should be made aware of the benefits of pulmonary rehabilitation and the commitment required to gain these |
| 15 | The British Thoracic Society and Scottish Intercollegiate Guidelines Network (2008, revised 2009) |
British guideline on the management of asthma: a national clinical guideline |
Physical training improves indices of cardiopulmonary efficiency and should be seen as part of a general approach to improve lifestyle and rehabilitation in asthma, with appropriate precautions advised about exercise-induced asthma |
| Central nervous system | |||
| 16 | NICE (2007) | Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) (or encephalopathy): diagnosis and management of CFS/ME in adults and children |
Healthcare professionals should advise people with CFS/ME on the role of rest periods, how to introduce rest periods into their daily routine and the frequency and length appropriate for each person. This may include: limiting the length of rest periods to 30 min at a time. Introducing ‘low level’ physical and cognitive activities (depending on the severity of symptoms) |
| 17 | NICE (2006) | Dementia: supporting people with dementia and their carers in health and social care |
For the secondary prevention of dementia, vascular and other modifiable risk factors (eg, smoking, excessive alcohol consumption, obesity, diabetes, hypertension and raised cholesterol) should be reviewed in people with dementia, and if appropriate, treated (ie, includes physical activity from obesity, hypertension, diabetes and cholesterol guidelines, when appropriate) |
| 18 | NICE (2006) | Parkinson's disease: diagnosis and management in primary and secondary care |
Physiotherapy should be available to enhance aerobic capacity, improve movement initiation and functional independence |
| 19 | NICE (2009) | Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary and secondary care |
Physical health should be monitored at least once a year with focus on cardiovascular disease risk assessment in line with NICE lipid modification guideline as higher risk than general population (refer to guidelines numbers 6 and 7 above) |
| 20 | NICE (update 2009) | Depression: the treatment and management of depression in adults |
For people with persistent subthreshold depressive symptoms or mild-to-moderate depression, consider offering one or more of the following interventions, guided by the person's preference: individual guided self-help based on the principles of cognitive behavioural therapy (CBT), computerised cognitive behavioural therapy (CCBT), a structured group physical activity programme |
| 21 | NICE (2009) | Depression in adults with a chronic physical health problem: treatment and management |
Regarding sleep disturbance, recommend taking regular physical exercise where this is possible for the patient. For patients with persistent subthreshold depressive symptoms or mild-to-moderate depression and a chronic physical health problem, and for patients with subthreshold depressive symptoms that complicate the care of the chronic physical health problem, consider offering a structured group physical activity programme |
| 22 | NICE (2006) | Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care |
Should have annual physical review, usually in primary care, to assess lipid levels, plasma glucose levels, weight and blood pressure (see NICE guidelines above when appropriate) |
| Endocrine | |||
| 23 | NICE (2009) | Type II diabetes: the management of type II diabetes (update) |
Integrate increasing physical activity into a personalised diabetes management plan including other aspects of lifestyle modification. Measure blood pressure annually and offer and reinforce preventive lifestyle advice. Offer lifestyle advice (diet and exercise) at the same time for blood pressure control. Start metformin treatment in a person who is overweight or obese (tailoring the assessment of body weight associated risk according to ethnic group) and whose blood glucose is inadequately controlled by lifestyle interventions (nutrition and exercise) alone. Guidance recommends trial of 3 months lifestyle interventions to control and reduce blood glucose and HbA1c before commencing medication |
| 24 | Diabetes UK (2005) | Recommendations for the provision of services in primary care for people with diabetes |
If the screening test is negative and the person has no symptoms of diabetes, they should be given advice on how to reduce their risk of going on to develop diabetes and supported to lose weight and increase their physical activity levels. People aged <40 with diabetes who are asymptomatic and who are overweight (body mass index (BMI) 25–30 kg/m2) or obese (BMI >30 kg/m2) should be advised to increase their physical activity levels, adopt a balanced diet and aim to reduce their calorie intake. Insulin should be considered in those who are not obese. People aged >40 with diabetes who are asymptomatic should initially be treated with diet, weight control and increased physical activity. They should be advised to increase their physical activity levels, adopt a balanced diet and, if they are overweight or obese, aim to reduce their calorie intake. If blood glucose control is not achieved within 3 months, treatment with oral hypoglycaemic agents should be commenced. Insulin treatment should be considered if blood glucose control is not achieved with diet, increased physical activity and combined drug therapy. Oral and written information about diabetes and its management should be provided in appropriate languages and media at each point of the care pathway as part of a structured education programme, meeting nationally agreed criteria |
| Urology | |||
| 25 | NICE (2010) | The management of lower urinary tract symptoms (LUTS) in men |
Offer men with LUTS suggestive of overactive bladder supervised bladder training, advice on fluid intake and lifestyle advice (ie, including physical activity) |
| 26 | NICE (2006) | Urinary incontinence (UI): the management of UI in women |
Women with UI or overactive bladder syndrome who have a BMI greater than 30 should be advised to lose weight (ie, including physical activity) |
| 27 | NICE (2008) | Chronic kidney disease (CKD): early identification and management of CKD in adults in primary and secondary care |
Encourage people with CKD to take exercise, achieve a healthy weight and stop smoking |
| 28 | British Society for Sexual Medicine (2009) |
Guidelines of the management of erectile dysfunction (ED) |
Lifestyle modifications can greatly reduce the risk of ED, and should accompany any specific pharmacotherapy or psychological therapy. The potential advantages of lifestyle changes may be particularly pronounced in those with psychogenic ED, but patients with serious medical illnesses such as diabetes may also benefit from these changes, for example, weight loss (ie, diet and physical activity) |
| 29 | British Association of Urological Surgeons (2004) | Primary care management of male LUTS | Not all patients require treatment, and primary care management should include reassurance, watchful waiting, advice on lifestyle (ie, including physical activity) and a review of their current medication |
| Obstetrics and gynaecology | |||
| 30 | PCOS UK (2006) | Diagnosis and management of polycystic ovary syndrome (PCOS) |
An increase in physical activity is essential, preferably as part of the daily routine. 30 min/day of brisk exercise is encouraged to maintain health, but to lose weight, or sustain weight loss, 60–90 min/day is recommended. Concurrent behavioural therapy improves the chances of success of any method of weight loss |
| 31 | Royal College of Obstetricians and Gynaecologists (2007) |
Long-term consequences of PCOS | Women diagnosed with PCOS should be advised regarding weight loss through diet and exercise |
| 32 | Royal College of Obstetricians and Gynaecologists (2007) |
Management of premenstrual syndrome | General advice about exercise, diet and stress reduction should be considered before starting treatment |
| 33 | National Association for Premenstrual Syndrome (2003) |
Treatment guidelines for premenstrual syndrome |
All sufferers benefit from simple advice related to dietary changes, exercise, relaxation, stress avoidance and lifestyle modification |
| Musculoskeletal | |||
| 34 | NICE (2008) | Osteoarthritis: the care and management of osteoarthritis in adults |
Exercise should be a core treatment for people with osteoarthritis, irrespective of age, comorbidity, pain severity or disability. Exercise should include local muscle strengthening and general aerobic fitness |
| 35 | NICE (2009) | Low back pain: early management of persistent non-specific low back pain |
Advise people to stay physically active and exercise |
| 36 | SIGN (2003) | Management of osteoporosis | Everyone with osteoporosis will benefit from a good calcium intake and weight-bearing exercise. All healthcare professionals should encourage regular exercise, such as walking, to promote good bone and general health. High intensity strength training is recommended as part of a management strategy for osteoporosis. Low impact weight-bearing exercise is recommended as part of a management strategy for osteoporosis |
| Other | |||
| 37 | British Lymphology Society (2009) | Strategy for lymphoedema care | Maintenance therapy includes a programme of exercise and movement to maximise lymph drainage |
| 39 | NICE (2004) | Falls: the assessment and prevention of falls in older people |
Strength and balance training is recommended. Those most likely to benefit are older community-dwelling people with a history of recurrent falls and/or balance and gait deficit. A muscle-strengthening and balance programme should be offered. This should be individually prescribed and monitored by an appropriately trained professional |