ARTICLE BY DR ASHLEY RIDOUT
Five things all healthcare professionals should know about the risk of physical activity for people living with long term conditions
INTRODUCTION
Healthcare professionals and people living with long-term conditions report valid concerns about the risks of increasing activity levels, including fear of exacerbating symptoms or causing an adverse event. A recent Moving Medicine consensus statement on risk addressed these pervasive barriers to increasing physical activity.(1)
The statement provides clear messages for healthcare professionals to help them advise people living with one or more long-term conditions about the potential medical risks of becoming more active. It specifically addresses the lack of confidence, and knowledge, that healthcare professionals report as barriers to discussing and promoting physical activity in this group.
This article discusses the five core รขโฌหimpact statementsรขโฌโข, whilst eight symptom-based statements are available in the published manuscript.(1)
THE BENEFITS OUTWEIGH THE RISKS
Being physically active is safer than becoming or remaining inactive. This remains true for people living with symptoms from multiple medical conditions, provided red flag symptoms are observed and activity levels are built up gradually. Increasing activity levels should be encouraged for all adults, especially those with long-term conditions, who are less likely to meet physical activity level recommendations. Inactive people have the most to gain as even a slight increase in their activity level or reduction in sedentary behaviour conveys a tangible benefit.
THE RISK OF ADVERSE EVENTS IS VERY LOW, BUT THATรขโฌโขS NOT HOW PEOPLE FEEL
Members of the public and healthcare professionals are concerned about the risk of acute cardiovascular events and death, but the actual risk of this is very low in both the general population and in people with long-term medical conditions. Risk is higher when a previously sedentary person suddenly undertakes unaccustomed vigorous-intensity activity. The risk of serious adverse events is further diminished by increasing activity levels gradually and according to symptomatic tolerance. Well informed conversations with healthcare professionals can further reduce this risk, providing education and reassurance to people concerned about adverse outcomes.
ITรขโฌโขS NOT AS EASY AS JUST TELLING SOMEONE TO MOVE MORE
Traditional, didactic instruction is unlikely to engage and motivate a person for successful behaviour change. Instead, understanding what matters to the individual and helping them build and strengthen their own reasons for change is much more likely to empower lasting change. A common language and approach across healthcare contacts over time provide a powerful way to enable individuals to build self-efficacy and achieve lasting behavioural change. Advice should consider the concerns of individuals and their carers, individual preferences, symptoms and functional capacity, social support, and psychosocial factors.
EVERYONE HAS THEIR OWN STARTING POINT
Dependent on their functional status, comorbidities, and readiness for change, everyone has their own baseline. Their current baseline may be very different to their historical activity levels or achievements. It is beneficial to help people identify this and counsel them about the importance of building up gradually, according to their symptoms and tolerance, to minimise their risk of adverse events.
RED FLAG SYMPTOMS
Since healthcare professionals are the target audience for this consensus statement, an element of clinical judgement is assumed. Healthcare professionals should manage individuals with unstable symptoms related to activity as they would be at any other time. To make it easier to give people advice around risk, รขโฌหred flagรขโฌโข advice is presented as symptoms rather than condition-specific contraindications. For example, people should be advised to stop and seek medical review if they notice a dramatic increase in breathlessness, new or worsening chest pain and/or increasing GTN requirement, a sudden onset of rapid palpitations or irregular heartbeat, dizziness, a reduction in exercise capacity or sudden change in vision. The conversation should include a discussion around what differentiates these red flag symptoms from a normal physiological response to physical activity. Furthermore, exploring when and how an individual would seek help in an emergency will build their confidence and ensure a timely and appropriate response.
CONCLUSION
In keeping with advice from the World Health Organisation (2), this consensus statement recommends that people with stable symptoms of long-term medical conditions do not require formal pre-participation screening. In conjunction with the symptom-based supporting statements, the headline statements described above provide healthcare professionals with the knowledge and confidence to evoke and address concerns around risk. Effectively addressing concerns is a vital component of clinical advice to empower people with symptomatic long-term conditions to increase their activity levels and embrace lasting behavioural change.
Looking to the future, person-centred, cohesive and collaborative messaging about risk from both the healthcare and physical activity sectors is essential, working toward the common goal of enabling all people to reap the benefits of incorporating regular physical activity into their daily routines.
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References:
1. Reid H, Ridout AJ, Tomaz SA, et al. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med 2022;56:427รขโฌโ38. doi:10.1136/bjsports-2021-104281
2. WHO guidelines on Physical Activity and Sedentary Behaviour. Geneva: 2020. https://www.who.int/activities/developing-new-guidelines-on-physical-activity-and-sedentary-behaviour-for-youth-adults-and-sub-populations