Physical inactivity is a major global public health issue, significantly contributing to increased mortality and morbidity rates. According to the World Health Organisation (WHO), lack of physical activity ranks among the leading risk factors for non-communicable diseases, including cardiovascular disease, type 2 diabetes, obesity, and certain types of cancer. Despite substantial awareness campaigns and public health initiatives, physical inactivity remains widespread. Current data shows that one in four adults does not engage in sufficient physical activity, and this trend has not improved over the last two decades. This persistent issue underlines the urgent need for effective interventions to promote and sustain higher levels of physical activity among individuals across different age groups and demographics.
Recognising the growing impact of physical inactivity on public health, the WHO revised its physical activity guidelines in 2020. The updated recommendations state that adults should engage in 150–300 minutes of moderate-intensity activity per week, 75–150 minutes of vigorous-intensity activity per week, or a combination of moderate and vigorous activity spread throughout the week. These guidelines aim to reduce the risk of chronic diseases and improve overall well-being by encouraging regular engagement in physical movement. However, despite these clear guidelines, national physical activity programs have largely been ineffective in generating widespread behavioural changes, indicating that more targeted and individualised interventions are needed.
To address this issue, the World Health Assembly has set a goal of reducing global physical inactivity by 15% by the year 2030. This ambitious target requires collaborative efforts between governments, healthcare systems, community organisations, and individuals. While public health campaigns play an essential role in raising awareness, healthcare professionals, particularly those in primary care settings, have a unique opportunity to influence behavioural change at an individual level.
Primary Care in Promoting Physical Activity
Primary care providers are in an optimal position to encourage physical activity as part of routine healthcare consultations. The WHO recommends integrating physical activity counselling into primary healthcare to ensure that individuals receive consistent guidance on the benefits of movement and exercise. Studies indicate that 70–80% of adults visit their general practitioner at least once annually. This regular interaction with healthcare professionals presents a valuable opportunity to promote healthy behaviours and address barriers to physical activity.
Incorporating physical activity promotion into primary care involves providing patients with personalised advice based on their health status, lifestyle, and individual capabilities. Physicians, nurses, and other healthcare professionals can recommend specific exercises, suggest ways to integrate movement into daily routines, and refer patients to structured exercise programs when necessary. Additionally, primary care providers can help address common misconceptions about physical activity, such as concerns about safety, potential injuries, or the belief that only intense exercise provides health benefits.
Primary care consultations also allow healthcare professionals to assess patients’ readiness to engage in physical activity and provide motivational support. Behaviour changes techniques such as goal-setting, self-monitoring, and regular follow-ups can significantly enhance patients’ adherence to physical activity recommendations. By leveraging the frequent interactions between patients and healthcare providers, primary care can serve as a crucial platform for fostering long-term lifestyle modifications that improve overall health outcomes.
Effectiveness of Primary Care-Based Physical Activity Interventions
A systematic review and meta-analysis of 51 randomised controlled trials evaluated the effectiveness of primary care-based physical activity interventions. The findings demonstrated that interventions delivered by primary care professionals resulted in an average increase of 14 minutes per week in moderate-to-vigorous physical activity (MVPA). While this may seem like a small improvement, research shows that even modest increases in physical activity levels are associated with significant health benefits. A 14-minute weekly increase in MVPA corresponds to an 11% reduction in all-cause mortality, demonstrating the importance of small, sustained behavioural changes.
The analysis also found that patients in intervention groups were 33% more likely to meet recommended MVPA guidelines compared to those in control groups. This suggests that structured guidance and follow-up from primary care providers can positively influence patients’ engagement in physical activity. Furthermore, interventions that included multiple contacts, particularly those involving at least five follow-up sessions, were more effective in promoting sustained behavioural changes. These findings highlight the necessity of ongoing support and reinforcement in maintaining physical activity habits over time.
Strengths and Limitations
One of the key strengths of the systematic review was its inclusion of approximately 16,000 participants from diverse geographic regions. This broad representation enhances the generalisability of the findings, making them applicable to a wide range of populations. Additionally, the review incorporated a comprehensive search strategy that included both published and grey literature, ensuring that relevant studies were not overlooked. The absence of publication bias further strengthens the reliability of the conclusions drawn from the analysis.
However, several limitations must be considered. A significant number of trials relied on self-reported physical activity data, which is prone to overestimation and recall bias. Device-based measurements, such as accelerometers, provide more accurate assessments of physical activity levels, but they were less frequently used in the included trials. Another limitation was the potential underestimation of intervention effects due to the inclusion of brief physical activity advice in some control groups. This may have reduced the apparent difference between intervention and control groups, leading to a more conservative estimate of the true impact of primary care-based interventions.
Furthermore, 14 trials within the review were identified as having a high risk of bias. However, sensitivity analyses showed that the removal of these studies did not significantly alter the overall findings, reinforcing the robustness of the results. Another challenge was the substantial heterogeneity in the data, primarily due to variations in how physical activity was measured across different studies. Standardising measurement methods in future research could enhance the comparability of findings and provide more definitive conclusions.
Comparisons with Other Studies
Previous reviews on primary care-delivered physical activity interventions have reported mixed results. Some studies found small-to-moderate effects, while others lacked sufficient evidence to support significant conclusions. A review conducted by Oloo et al. reported a standardised mean difference (SMD) of 0.11, but its findings were limited by reliance on self-reported data and the inclusion of only 14 trials. Another review by Goryakin et al. suggested that increased patient-provider interactions led to better outcomes, a finding consistent with the systematic review discussed earlier.
These comparisons highlight the variability in the effectiveness of primary care interventions. While some interventions yield significant benefits, others may require modifications to enhance their impact. The differences in findings across studies highlight the need for further research to identify the most effective strategies for integrating physical activity promotion into routine primary care practice.
Implications for Healthcare Practice and Future Research
The findings from the systematic review and related studies reinforce the idea that all movement contributes to improved health outcomes. While MVPA is commonly highlighted in public health guidelines, light-intensity physical activity also provides substantial health benefits. This insight is particularly relevant for populations such as older adults, pregnant women, and individuals with disabilities, who may have limitations in engaging in high-intensity exercise.
Despite the demonstrated benefits of physical activity, some healthcare professionals hesitate to promote MVPA due to a lack of expertise or concerns about patient safety. Addressing this gap requires improved training and education for healthcare providers to equip them with the knowledge and confidence to incorporate physical activity counselling into routine practice. The Global Action Plan for Physical Activity highlights the importance of building healthcare professionals’ capacity to support physical activity promotion effectively.
Primary care interventions not only contribute to increased physical activity levels but also have additional health benefits. Research indicates that patients who participated in physical activity interventions experienced, on average, a 1 kg reduction in body weight. This suggests that even small increases in activity levels can have meaningful effects on weight management and overall health.
Future research should focus on optimising intervention strategies to maximise their effectiveness. Key areas of investigation include determining the ideal frequency and duration of interventions, evaluating different types of physical activity programs, and increasing the use of device-based measurements for more accurate data collection. Additionally, exploring the long-term sustainability of primary care-based interventions will be critical in ensuring lasting health benefits.
Conclusion
Integrating physical activity promotion into primary care settings represents a powerful strategy for addressing global inactivity. By leveraging the influence of healthcare professionals, providing ongoing support, and implementing evidence-based interventions, meaningful progress can be made toward achieving the World Health Assembly’s goal of reducing physical inactivity by 15% by 2030. Encouraging even small increases in movement can lead to substantial improvements in health and quality of life, reinforcing the message that every step counts.
References
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Oloo, M. O., Wamukoya, E. K., & Wanzala, M. (2020). Efficacy of physical activity counselling interventions delivered in primary care: a systematic review and meta-analysis. Eur J Phys Educ Sport Sci, 6, 65–141.
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