What is the protocol for Physical Activity (PA) prescription in General Practice (GP) in New Zealand (NZ)?

From the Guidelines

Physical activity prescription in New Zealand general practice should involve a comprehensive assessment of the patient's current activity levels, health conditions, and readiness for change, followed by a tailored exercise regimen that includes at least 30 minutes of moderate-intensity aerobic activity, such as brisk walking, five days per week, complemented by strength training twice weekly, as recommended by the World Health Organization 2020 guidelines on physical activity and sedentary behaviour 1. The process of physical activity prescription in New Zealand general practice typically begins with an assessment of the patient's current activity levels, health conditions, and readiness for change. This assessment is crucial in determining the most appropriate exercise regimen for the patient.

• The patient's risk should be assessed with a physical activity history and/or an exercise test to guide prognosis and prescription, as recommended by the American Heart Association and American College of Cardiology Foundation 1.
• The exercise regimen should include type, frequency, intensity, and duration recommendations, such as 30 minutes of moderate-intensity aerobic activity, like brisk walking, five days per week, complemented by strength training twice weekly.
• The Green Prescription (GRx) program is central to this approach, allowing healthcare providers to refer patients to funded support services where exercise specialists provide ongoing guidance and motivation through phone calls, face-to-face sessions, or group activities for up to 12 months.
• The effectiveness of physical activity prescriptions is enhanced when healthcare providers follow up regularly with patients, gradually increase exercise intensity, and address barriers to participation such as time constraints, access to facilities, or lack of confidence.
• Regular physical activity has proven physiological benefits, including improved insulin sensitivity, reduced inflammation, enhanced cardiovascular function, and increased endorphin release, making it an essential component of managing chronic conditions like diabetes, cardiovascular disease, and mental health issues 1.

From the Research

Physical Activity Prescription in General Practice in NZ

• Physical activity prescription in general practice in New Zealand is primarily facilitated through the Green Prescription program, a primary care physical activity scripting program 2.
• The Green Prescription program aims to increase population levels of physical activity in New Zealand, and general practitioners (GPs) counsel for physical activity and prescribe Green Prescriptions for both primary preventive and secondary management purposes 2.
• GPs view the Green Prescription program as beneficial for their patients with pre-existing conditions and/or weight problems, and also for promoting physical activity in currently healthy but low-active and sedentary individuals 2.

Barriers to Physical Activity Prescription

• Time constraints within the consultation are a significant barrier to GPs prescribing Green Prescriptions 2.
• Other barriers to physical activity include weather, physical environment, time, health, and psychological limitations 3.

Patient Attitudes and Experiences

• Patients who receive physical activity interventions value a personalized approach, continued structured external support, and focus on barriers and facilitators 3.
• Internal motivators, such as immediate or long-term psychological, health, or spiritual benefits, commitment, and guilt, also play a significant role in patients' attitudes towards physical activity 3.

Prevalence of Physical Activity Advice

• Approximately 13.3% of the New Zealand population reports receiving physical activity advice, while 3.0% reports receiving a Green Prescription from their general practitioner or practice nurse in the last year 4.
• Those more likely to receive physical activity advice are Maori or Pacific, overweight or obese, sedentary, or suffering from chronic disease 4.

Health Benefits of Physical Activity

• Regular physical activity has numerous health benefits, including reducing the risk of all-cause mortality, cardiovascular disease, and type 2 diabetes mellitus 5, 6.
• Exercise also has positive effects on brain function, cognition, and depressive symptoms, and can be used as a therapeutic intervention for many chronic diseases 5.