Background Regular physical activity is paramount for health and sustainable development. However, the prevalence of physical inactivity worldwide is an ongoing concern. Objective To explore the extent to which Brazilian physical therapists work in the promotion of physical activity in clinical practice. Method Cross-sectional study with a convenience sample of 463 physical therapists from all regions of Brazil. Responses to an online questionnaire were analyzed with descriptive statistics as frequency (n) and proportion (%). The Wilcoxon test with pairwise comparisons and continuity correction allowed checking for differences between the frequency in which physical therapists intervened in favor of physical activity according to their own physical activity routine. Results Physical therapists reported to always initiate conversations regarding physical inactivity (74.3%, n = 344) with patients/clients, propose interventions (50.3%, n = 233), indicate specific local services for physical activity (51.8%, n = 240), and formally assess a risk category for physical inactivity (34.3%, n = 159). Most (83.2%, n = 385) reported awareness of physical activity recommendations for adults and provided correct answers for days in a week recommended for strength training (90.5%, n = 419). Physical therapists provided less correct answers for the recommended number of minutes for moderate-intensity (57.5%, n = 266) and vigorous-intensity physical activity (44.7%, n = 207). Those who were more physically active tended to address the inactivity of their patients/clients (p = 0.012). Conclusion Physical activity promotion is partially integrated in the clinical practice of Brazilian physical therapists. However, there is a need for and an opportunity to strengthen educational approaches in physical therapy education platforms regarding the recommendations of physical activity across professional training.

Women in midlife (WiML) report a range of physical and psychological challenges, including the transition to perimenopause and menopause. Combined effects of work and life stressors alongside menopause symptoms in working women are reported to increase absenteeism, reduce productivity and work satisfaction and may result in women exiting the labour market earlier than intended. The aim of this study was to co-design and test a novel exercise programme delivered via smartphone app for working women in midlife. The findings aim to inform targeted support to facilitate exercise for working women in midlife, that could be offered virtually and at scale. A two-phase process was used to co-design and test a digital exercise programme for WiML, to be delivered via smartphone app. In phase one, participants (n = 12) joined four co-design workshops where collected data was mapped against the Behaviour Change Wheel (BCW). A tailored exercise programme was designed by an exercise physiologist and physiotherapist to meet user needs with a focus on increasing muscle strength. In phase two, a prototype app was developed to deliver the programme digitally. The app was tested for acceptability by a cohort of working women from the education and private sectors (n = 16) using the Theoretical Framework of Acceptability as a reference. Creating opportunities, both physical and social, were identified as the strongest enablers for improving engagement with strength training exercises for WiML, while automatic motivation was identified as a barrier. The app-based exercise programme was found to be low effort to engage with, but affective attitude towards the app was neutral and perceived effectiveness of the programme was low. A digital intervention was co-designed and tested by WiML. Findings suggest that combining a flexible programme of aerobic exercise, strength training and pelvic floor exercise via a smartphone application may be an acceptable way to support the health and wellbeing of working women in midlife. Optimisation of the app usability and functionality are needed prior to assessments of effectiveness. Digital workplace interventions are a potentially viable way to address disparities in midlife health and to support healthy ageing in women.

BACKGROUND:Physiotherapists in primary care are well placed to provide health promotion interventions that target client metabolic risk factors. OBJECTIVE:To determine the effectiveness of health promotion interventions delivered by physiotherapists in primary care on metabolic outcomes for people with or at risk of metabolic syndrome. DATA SOURCES:AMED, CINAHL, Cochrane, Medline, PEDro, PsycInfo, SPORTDiscus (searched up to February 2024). ELIGIBILITY CRITERIA:Studies evaluating physiotherapist-delivered health promotion interventions for adults with at least one metabolic risk factor (abdominal obesity, hypertension, elevated triglycerides, reduced HDL-C or elevated glucose) delivered in primary care settings were included. STUDY APPRAISAL AND SYNTHESIS:Two reviewers extracted data, evaluated methodological quality using the Mixed Methods Appraisal Tool, and certainty of evidence using GRADE. Meta-analyses were conducted using a random effects model to calculate weighted mean differences (WMD) for outcomes on common scales, and standardised MD (SMD) for outcomes on different scales. RESULTS:Twenty-five studies (n = 3619 participants) were included. Moderate-high certainty evidence indicated that physiotherapist-delivered health promotion interventions reduced waist circumference (WMD -2.42 cm, 95%CI -4.31 to -0.53), diastolic blood pressure (WMD -2.34 mmHg, 95%CI -3.77 to -0.91), triglycerides (WMD -0.18 mmol/L, 95%CI -0.36 to 0.00) and fasting blood glucose (WMD -0.18 mmol/L, 95%CI -0.28 to -0.08), and increased physical activity (SMD 0.18, 95%CI 0.04 to 0.32) compared to usual care. CONCLUSION:Physiotherapy-led health promotion interventions in primary care can improve metabolic risk factors and physical activity levels for people with or at risk of metabolic syndrome by small but clinically significant amounts. SYSTEMATIC REVIEW REGISTRATION NUMBER:Systematic Review Registration Number PROSPERO CRD42022352725. CONTRIBUTION OF THE PAPER.

ABSTRACT Individual-level interventions are insufficient to create the enabling conditions for population-level shifts in physical activity. This is evidenced by a lack of progress tackling physical inactivity across the globe. A more integrative and holistic approach is needed that recognizes the different contexts within which physical activity takes place. The interactions that occur between individuals and wider policy, environmental, and structural factors are also worthy of attention. This article explores an attempt to apply systems thinking and co-design to a health care context. We argue that co-locating health care clinics within leisure facilities can make it easier for people, particularly those with a health condition, to engage in physical activity.

Objectives To determine the prevalence of metabolic syndrome in clients presenting for primary care physiotherapy within private practice settings, and the factors that may be associated with metabolic syndrome. The secondary aim was to determine client's attitudes towards lifestyle change. Design A cross-sectional study in which self-report and biometric data were collected. The study was conducted in physiotherapy private practices across metropolitan and regional areas, Australia. Participants 230 clients (mean age 54 (SD18) years, 64% women) presenting for physiotherapy participated. Main outcome measures Participant socio-demographic and lifestyle characteristics were collected. Metabolic syndrome presence was determined by the existence of three or more risk factors on physical examination and capillary blood sample: abdominal obesity, hypertension, elevated random blood glucose, elevated triglycerides and/or reduced HDL cholesterol. Results Thirty-seven percent of participants had metabolic syndrome, but none knew they had it. Metabolic syndrome was associated with older age and poorer socio-economic status and may have been associated with lower levels of physical activity but not diet. Of those identified as having hypertension and elevated triglycerides, many were undiagnosed (56% and 29% respectively). Conclusion Metabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy. Clients felt lifestyle change was important and they were willing to make changes. This study highlights the need for greater screening of metabolic risk factors in primary care and presents an opportunity for physiotherapists in private practice to identify risk and intervene to improve the overall health of their clients and contribute to chronic disease prevention.

ObjectivesTo determine the knowledge, attitudes, and current practice of primary care physiotherapists in recognising and managing clients with metabolic syndrome.DesignMixed-methods research design comprising an online survey and focus groups.ParticipantsAustralian and English physiotherapists (n=183) working in a primary care setting responded to the survey. Twelve physiotherapists participated in focus groups.ResultsMetabolic syndrome was not on physiotherapists radar. They did not screen for metabolic syndrome nor provide management for it in primary care. Although most physiotherapists had some awareness of metabolic syndrome, they were not knowledgeable. Physiotherapists reported a need to focus on their clients’ presenting condition, and there was uncertainty on whether metabolic syndrome management was within their scope of practice. Despite this, physiotherapists felt they had an important role to play in exercise and physical activity prescription for chronic disease management and were keen to further their knowledge and skills related to metabolic syndrome. Survey responses and focus group data were convergent.ConclusionPhysiotherapists working in primary care settings are well-placed to identify metabolic risk factors in their clients and provide physical activity interventions to enhance management but currently lack knowledge to embed this in clinical practice. Training and resources are required to enable physiotherapists to identify and manage metabolic syndrome within their practice.Contribution of Paper•Primary care physiotherapists have limited knowledge about metabolic syndrome and are not currently identifying and managing it in their practice.•Physiotherapists require education on the link between metabolic syndrome and musculoskeletal conditions, so they can promote healthy behaviours as an important component of management that may support a reduction in future chronic disease.

ABSTRACTPrimary AimTo describe the features of implementation in the setting of primary care (PC) for physical activity (PA) interventions that improved total and moderate to vigorous PA (MVPA).Secondary AimTo assess the scalability potential of effective PC PA interventions.MethodA comprehensive search was conducted across multiple electronic databases to identify relevant studies published between 2012 and 2023. Implementation‐related features were extracted, and the scalability potential of effective PC PA interventions was assessed using the Intervention Scalability Tool (ISAT) as a framework.ResultsTwenty‐six studies met the inclusion criteria after screening. Analysis of the implementation‐related features revealed that effective PC PA interventions showed promising reach with a mean participation rate of 43%. Effective PC PA interventions that increased PA were mostly delivered by nurses and were underpinned by the behavioural change techniques (BCTs) of goal setting, feedback and self‐monitoring. The scalability assessment revealed that remote‐based interventions and those delivered by nurses had moderate to high scores in the scalability domains of fidelity, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability.ConclusionPC PA interventions, whether delivered remotely or face‐to‐face, show promise for increasing PA, especially when incorporating BCTs like goal setting and feedback. Using the ISAT, most interventions displayed promise for implementation at scale, but further examination is needed concerning the delivery setting, implementation infrastructure and sustainability of these interventions. Remote‐based (automated PA advice and mailed instructions) PA interventions and those delivered in contact with a nurse showed high scalability potential. Further work that examines the acceptability and effectiveness of other healthcare professionals in intervention delivery would be worthwhile, and more work is needed to assess the utility and effectiveness of remote‐based PA interventions in PC.

Background: Physical activity (PA) contributes to the prevention and management of many health conditions. Primary care practitioners have an important role to play in supporting people to be physically active. Aim: This study had the following three aims: 1) to explore GPs‘ awareness and knowledge of the PA guidelines; 2) to assess GPs’ confidence in promoting PA; and 3) to explore factors that influence PA promotion among GPs. Design & setting: Cross-sectional survey, using secondary analysis. Method: UK-based GPs were invited to take part in an online survey in January 2021. Demographic questions were followed by nine multiple choice questions. Categorical data were analysed using descriptive statistics, and open-ended data were analysed using content analysis and inductive coding. Results: In total, 839 GPs based in England completed the survey. Most GP responders (98.9%) believed that PA was important, yet only 35.7% reported being at least ‘somewhat familiar’ with current PA guidance. Despite this, 74.1% of GPs reported feeling confident raising the topic of PA with their patients. Barriers included lack of time, perceptions of patient attitude and risk, language issues, and COVID-19. Key facilitators were identified and ‘Couch to 5k’ and the ‘parkrun practice’ initiatives were the most widely used support tools. Conclusion: GPs value PA yet well-known barriers exist to embedding promotion into primary care. As primary care reconfigures, there is an opportunity to embed PA into systems, services, and processes.

Cardiovascular diseases (CVD) are prevalent and lead to high morbidity and mortality globally. Physiotherapists regularly interact with patients with or at risk of CVDs (pwCVDs). This study aimed to assess the nature of existing evidence, interventional approaches used, and the population groups included in physiotherapy-led health promotion (PLHP) for pwCVDs. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until June 2023. Two reviewers independently screened the titles, abstracts, and full text and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 4992 records were identified, of which 20 full-text articles were included in the review. The studies had varied populations, including those with stroke, coronary artery diseases, peripheral artery diseases, hypertension, diabetes, and multiple CVD risk factors. The interventions ranged from exercise and physical activity programmes, dietary interventions, education, and counselling sessions with various supplementary approaches. Most interventions were short-term, with less than 12 months of follow-up. Interventions were personalised and patient-centred to promote adherence and health behaviour change. Among the included studies, 60% employed experimental designs, with the remainder using quasi-experimental designs. Although a wide range of PLHP strategies have been used for pwCVDs, exercise and physical activity were employed in 85% of the included studies. Other components of health promotion, such as sleep, smoking, and alcohol abuse, should be investigated within PLHP.

Muscle weakness is a key component of age-related conditions such as sarcopenia and frailty. Resistance training is highly effective at preventing and treating muscle weakness; however, few adults meet recommended levels. Retirement may be a key life-stage to promote resistance training. We carried out a virtual focus group study to explore motivators and barriers to resistance training around the time of retirement, with the aim of determining strategies and messages to increase its uptake. The five focus groups (n = 30) were recorded, transcribed and thematically analysed. We found that resistance training was positively viewed when associated with immediate and long-term health and wellbeing benefits and had a social dimension; but there was a lack of understanding as to what constitutes resistance training, the required intensity level for effects; the role of pain; and the consequences of muscle weakness.

Background: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. Aim: The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. Methods: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. Results: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people’s views and needs are heard and validated by health professionals. Conclusions: More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.

Background/aims: Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation. Methods A cross-sectional study was undertaken of community-dwelling older adults (n=86, 75 ± 6 years) discharged from rehabilitation in the previous 12 months. Basic functional independence was assessed using the Functional Independence Measure and complex functional independence was assessed using the Frenchay Activities Index. Multiple regression analyses were conducted to assess any association between predetermined factors and function. Results Functional Independence Measure scores and physical activity levels after being discharged accounted for 50% of the variance in basic function (R 2 =0.50, F=40.75, P<0.001). Frenchay Activities Index scores, physical activity, age, sex and migrant status accounted for 68% of variance in complex function (R 2 =0.68, F=29.75, P<0.001). Conclusions Clinicians are encouraged to implement strategies to improve function at discharge from rehabilitation and to promote physical activity among older people at risk of poor function following rehabilitation.

The incidence of falling, due to aging. is related to both personal and environmental factors. There is a clear need to understand the nature of the major risk factors and design features of a safe and navigable living environment for potential fallers. The aim of this scoping review was to identify studies that have examined the effectiveness of environments, which promote physical activity and have an impact on falls prevention. Selected studies were identified and categorized into four main topics: built environment, environment modifications, enriched environments, and task constraints. The results of this analysis showed that there are a limited number of studies aiming to enhance dynamic postural stability and fall prevention through designing more functional environments. This scoping review study suggests that the design of interventions and the evaluation of an environment to support fall prevention are topics for future research.

The incidence of falling, due to aging, is related to both personal and environmental factors. There is a clear need to understand the nature of the major risk factors and design features of a safe and navigable living environment for potential fallers. The aim of this scoping review was to identify studies that have examined the effectiveness of environments, which promote physical activity and have an impact on falls prevention. Selected studies were identified and categorized into four main topics: built environment, environment modifications, enriched environments, and task constraints. The results of this analysis showed that there are a limited number of studies aiming to enhance dynamic postural stability and fall prevention through designing more functional environments. This scoping review study suggests that the design of interventions and the evaluation of an environment to support fall prevention are topics for future research.

BackgroundIn 2017 Public Health England and Sport England commissioned a Consultant-led Sport and Exercise Medicine (SEM) pilot to test the feasibility and acceptability of embedding physical activity interventions in secondary care clinical pathways. The aim of this paper is to report qualitative findings exploring the experience of healthcare professionals (HCPs) and patients involved in the Active Hospital pilot.MethodsQualitative data was collected by semi-structured interviews with Active Hospital pilot SEM Consultants, and staff and patients involved in three clinical pathways. Interviews with SEM Consultants explored the experience of developing and implementing the pilot. Interviews with staff and patients explored the experience of delivering and receiving Active Hospital interventions. Data were analysed thematically.ResultsInterviews identified the importance of the Active Hospital pilot being Consultant-led for the following reasons; i) having trusting relationships with decision makers, ii) having sufficient influence to effect change, iii) identifying champions within the system, and iv) being adaptable to change and ensuring the programme fits within the wider strategic frameworks. HCPs emphasised the importance of the Active Hospital interventions fitting easily within existing work practices, the need for staff training and to tailor interventions for individual patient needs. The Active Hospital pilot was well received by patients, however a lack of dedicated resource and capacity to deliver the intervention was highlighted as a challenge by both patients and HCPs.ConclusionThe SEM Consultants' ability to navigate the political climate of a large National Health Service (NHS) Trust with competing agendas and limited resource was valuable. The interventions were well received and a valued addition to usual clinical care. However, implementation and ongoing delivery of the pilot encountered challenges including lack of capacity within the system and delays with recruiting to the delivery teams in each pathway.

This 'Active at Home' booklet has been produced to provide practical guidance to older adults on home-based activities to maintain their strength and balance. It follows concerns that low levels of physical activity in older adults will lead to reduced fitness resulting in loss of independence and need for care in the future. Developed by Public Health England, Sheffield Hallam University (SHU), the National Centre for Sport and Exercise Medicine (NCSEM) and Sport England.

Background Physical inactivity affects every system in the body and is associated with many chronic diseases. This impacts on the lives of individuals and has substantial social and economic implications. A large proportion of the UK population is insufficiently active and system-wide approaches to promoting physical activity are required. There are over 55,000 physiotherapists in the United Kingdom, yet little is known about physical activity promotion in this domain of healthcare. The overarching research aim is to explore physical activity promotion in physiotherapy practice and to understand the factors that influence current practice. Method This programme of research is underpinned by a philosophical position of pragmatism. Within this methodological framework, a systematic scoping review was first undertaken to assess the state of the existing global evidence. Following this, a mixed methods study, was completed using a sequential explanatory design. Phase 1 involved a national, cross-sectional survey of UK physiotherapists. Phase 2 involved a qualitative, explanatory follow-up which aimed to further explain the quantitative findings. Findings Thirty-one studies were included in the systematic scoping review. Findings from Phase 1 of the mixed methods study indicated that respondents (n=514) initiate conversations with patients about physical activity but lack a systematic approach. Physical activity status was not routinely assessed, signposting to other services was inconsistent, and knowledge of the physical activity guidelines was poor. These findings were further explained in Phase 2; participants (n=12) highlighted a lack of understanding of key concepts which underpinned the inconsistent approach to physical activity promotion. Phase 2 also identified that physiotherapists focus on short-term restoration of function over longer-term promotion of health. Conclusion Physical inactivity is a major public health issue, and physiotherapists have the potential to contribute to tackling inactivity. However, the current approaches identified within this programme of research were inconsistent and unsystematic. Changes in demography necessitate holistic physiotherapy approaches that promote long-term health and wellbeing. Recommendations are made to improve physiotherapy practice in line with the aspiration of orientating healthcare toward prevention.

Objective: Physical inactivity is a major public health issue and healthcare professionals are encouraged to promote physical activity during routine patient contacts in order to reduce non-communicable diseases and enhance individuals' quality of life. Little is known about physical activity promotion in physiotherapy practice in the UK. The aim of this study was to better understand physiotherapists' experience of physical activity promotion in clinical practice. Design: A qualitative study was undertaken comprising 12 telephone interviews with participants using a quota sampling approach. The qualitative data was analysed using a thematic analysis approach and written up according to COREQ guidelines. Findings: Four themes were identified (1) Current physiotherapy practice (2) Barriers to, and facilitators of physical activity promotion, (3) Exercise or physical activity? and (4) Functional restoration versus general wellbeing. Conclusions: Physiotherapists use routine clinical contacts to discuss physical activity. However, brief interventions are not consistently used and no common framework to guide physical activity promotion was identified. Approaches appear to be inconsistent and informal and focus largely on short-term restoration of function rather than health promotion. There is scope to improve practice in line with current guidance to maximise potential impact on inactivity.