Physical Activity

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When stretching, it is good to shut down the muscle through reciprocal inhibition. For example, when stretching psoas, flex your glutes so that psoas will be inhibited.

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What is "active enough"?

Good to accumulate in intervals; aim for 30-60 minutes/day.


Moderate Activity

Can talk while still walking

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Effective Physical Activity

Balance and neuromuscular training appear to reduce sports injuries (Hübscher et al, 2010).

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Barriers to Physical Activity

Barriers to PA Counselling (CFPC 2001)

There is a very inconsistent message being given in primary care


Patient's Barriers

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Supporting Physical Activity

Over 60% of obese pts don't get any recommendations from their GP (Sclamanna et al, 2000 Arch Int Med).

  • minimum intervention tools
  • minimal intervention counseling
  • other

Minimal Intervention Tools

  • brief and focused, saving time
  • handouts:
    • Canada Physical Activity Guides
    • Healthy Heart Kit from CFPC
      • engages people where they are at
    • PACE (Provider-based Assessment and Counselling for Exercise)
    • AIM (Americans in Motion)
  • limitations
    • without background knowledge of counselling, can be hard
    • tools don't explore reasons for not changing
    • challenging to integrate into practice

Good Calls

  • be a role model (put up pictures of office staff doing things like snowshoeing)

Minimal Intervention Counseling


In a typical encounter, a GP has 2-4 minutes to play with

5 A's

  • Ask (to get pts to listen to you, listen to them)
    • do you view inactivity as a problem?
    • does being inactive concern you in any way?
    • are you interested in becoming more active?
    • are you ready to do something to accomplish right now?
  • Assess
    • why do you want to become more active?
    • how hard are you willing to work to fit increased activity into your life?
    • are you ready to work now to gain benefits later?
  • Advise
    • make specific recommendations
    • encourage SMART goals
    • remind patient to accept small gains
    • advise the patient to identify barriers/temptations/confidence
  • Assist
    • encourage and supprt success
    • problem solve to address barriers and temptations
    • make yourself available contingent upon change
      • if you meet goals, I'll see you more often
  • Arrange
    • refer to community supports
    • encourage patients to seek out active others


Relationship within family medicine allows for follow-up

Be comfortable repeating yourself endlessly



  • remind me why you wanted to change


  • what are the dangers you face?


  • what are the pro's


  • what are the barriers and temptations you encounter?




There is a balance: have the positives of change outweigh the negatives


Pedometer use increases physical activity and may promote weight loss (Bravata et al. 2007)


Good Ideas

Switch from 'prescribing' to 'goal-setting'

1) Make sensitive recommendations for increased activity

  • Vallis: GPs have given up; it doesn't matter what they do; behaviour change is not possible

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Resources and References

Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health. A systematic review. JAMA 2007;298(19):2296-2304.


Canadian Society for Exercise Physiology

Hübscher M et al. 2010. Neuromuscular training for sports injury prevention: a systematic review. 42(3):413-21.

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