Tailored Physical Activity and Exercise Approach Determined in Collaboration With Patients

All participants emphasized a positive attitude toward tailoring physical activity for patient health, needs, and intrapersonal barriers. Tailoring was believed to be best practice when providing physical activity and exercise advice.

“They can barely make the appointments with us, let alone join a gym, so I just try to adapt it based on what is in their capacity” (P2, 39-year-old female, GP).

This approach is reported to be determined in collaboration with the patient and often involves a multistage process and behavioral change techniques such as motivational interviewing:

“You identify what their values are, and if being healthy is important to them, but they’ve neglected it, then you keep chipping away, and you plant that seed, and then when you help them realize that being healthy is something important to them, then what’s some steps they can take to move towards that?” (P1, 39-year-old male, clinical psychologist).

“I think, to be a good doctor, you need to think of the whole patient and not just medications. It’s also their mental health and their lifestyle” (P8, 38-year-old female, GP).

Some health professionals acknowledged that, sometimes, logistics relating to a patient’s personal situation is the most important factor, rather than the type of physical activity program on offer:

“It’s how it can be fit into their current circumstances and commitments” (P3, 26-year-old female, clinical psychologist).

“I ask the patient what they’re likely to engage in. There’s not much point telling them to do something that they’re unlikely to want to do or if it’s not accessible for them” (P6, 57-year-old female, GP).

Barriers to Recommending Physical Activity and ERSs

Limited consult duration inhibited ability to recommend physical activity and provide exercise referrals. GPs highlighted that their short appointments with patients leave little time for thorough physical activity education and/or referral. This barrier for GPs was also acknowledged by other health care professionals in this study. One GP stressed that limited consult time challenges doctors to recommend and tailor physical activity advice and referrals:

“As GPs, we get really busy. We don’t always have time to talk about lifestyle as much as we should, and sometimes, we’ll mention exercise and diet as 3 words in the whole consult, and that’s it. Sometimes, we don’t have time to delve into it further” (P8, 38-year-old female, GP).

Physical activity participation was recommended; however, referring to physical activity programs is not always a priority. While the benefits of physical activity are acknowledged for a range of health conditions, some health professionals commented that it is not always a treatment priority. Subsequently, participation is encouraged by these professionals but may not lead to an exercise referral:

“There’s more pressing priorities that we need to deal with, and then it might be a throwaway comment that we’ll mention at the end of the consultation” (P8, 38-year-old female, GP).

“There’s obviously a huge evidence base on physical activity and mental health, but I don’t want to recommend exercise for the sake of it, if it doesn’t fit in the treatment plan” (P3, 26-year-old female, clinical psychologist).

Lack of knowledge about physical activity programs. A lack of knowledge about the available physical activity programs was the most prominent barrier to referral. All participants had knowledge of the benefits of physical activity and exercise but felt underprepared to locate appropriate physical activity services to refer patients to despite expressing willingness to learn more about options:

“A lot of health professionals, whether they’re medical, allied health, don’t have sufficient knowledge of the schemes themselves. We have that clear understanding of why exercise is beneficial, but then how does that manifest in day-to-day life?” (P5, 32-year-old female, clinical psychologist).

It arose that health professionals often are given many pamphlets by EPs on physical activity services, but this does not translate into knowing about the services, and rather, they would prefer to learn about options in an interactive, participatory way.

“We get swarmed with so many brochures, and there are so many programs around, but we forget what’s out there, so having that face-to-face communication does make a difference like improving awareness for sure” (P2, 39-year-old female, GP).

“Is it possible for me to try out one of the classes first to see what it’s like before I refer patients?” (P8, 38-year-old female, GP).

Participants had a multitude of other suggestions to increase health professionals’ knowledge of referral programs:

“I would recommend utilizing social media. It’s one of the most powerful tools that we have at the moment. All ages and abilities have access to social media, also reaching out to the local GP practices, putting as much advertising as possible in their foyer areas” (P4, 23-year-old female, accredited exercise physiologist).

“Professional development (PD) that are relevant to the profession that combine physical activity, so you can reaffirm how big a role it can play in supporting clients” (P5, 32-year-old female, clinical psychologist).

“If you have patient success stories where you could say the patient had diabetes with a HbA1c of this, and with exercise physiology, we were able to achieve this outcome. Show real outcomes in a really defined sense. That might help because doctors do think scientifically. We have to do Webinars for our continued professional development, and those are usually given by specialists, so if you could try and like tack on like with a cardiologist or an endocrinologist at the like beginning or end for 10–15 min, that would be a good way to capture GPs” (P8, 38-year-old female, GP).

“If there’s something that could be added on to our medical director system, and it is just a click of a button” (P6, 57-year-old female, GP).

A physiotherapist also added that a cultural shift would be beneficial, starting from education of health professionals during undergraduate university:

“Any professional in general, I think I’ve seen success when the EPs push it with the clinics and make themselves known. I think they just need to know their referral source. I think it would probably help more at, I guess, grassroots level if EP was a more known during our degree. Often, we have students that were EPs in the past” (P7, 33-year-old male, physiotherapist).

Facilitators to Recommending Physical Activity and ERSs

Personal and patient experience of physical activity benefits and exercise services increased willingness to refer. Participants who were active themselves tended to advocate for exercise referrals:

“I have used them personally, and I’ve had really good feedback from patients who have used them” (P6, 57-year-old female, GP).

“They all report positively. The only thing, we have to maintain it, so they’ve had a positive experience, and now it’s about maintaining that” (P5, 32-year-old female, clinical psychologist).

However, 1 GP shared that sometimes patient feedback can be both positive and negative:

“The feedback is mixed, ‘I didn’t have the time. Life’s too busy, or there’s just too much other stuff going on,’ so they might not have actually gone” (P2, 39-year-old female, GP).

Good physical activity literacy about knowledge of potential benefits for patients. Most (n = 5) health care professionals were able to correctly report the Australian physical activity guidelines, and all had extensive knowledge of the relationship between physical activity, exercise, and mental and physical health:

“The exercise guidelines being active on most days of the week, if not every, up to 30 min of moderate intensity, aerobic training, or vigorous intensity, and then in addition to that, 2 or more resistance, training, or strength sessions on nonconsecutive days per week, depending on the individual as well some potential flexibility, training, mobility training” (P4, 23-year-old female, accredited exercise physiologist).

“I recommend it for all clients regardless because of the improvement for across your whole being—mental, social, emotional. I make bigger emphasis if the client presents with a certain presentation like depression or anxiety. Mostly depression is the biggest one I recommend it for” (P5, 32-year-old female, clinical psychologist).

Simple referral process to free exercise with social group options were preferrable. Health care professionals discussed that they recommended certain ERSs more than others if they were simple to refer to or sign-up to, easy and flexible for patients to attend sessions, affordable, and offered group or social options:

“If it’s appropriate for their lifestyle, financially suitable for them, and if it’s been their reason of referral to me” (P5, 32-year-old female, clinical psychologist).

“I choose [LLGA] because of the social component as well. It’s out in the community. It’s affordable. In our local health district, there’s a lot of low socioeconomic status, and a lot of people that we might see may not be able to afford to go to a gym or a trainer, whereas the fact that the classes are free and it’s community based, they offer the virtual options as well, so there’s the flexibility for people that may not feel comfortable going in person. The benefit is that everyone’s welcome, and people can choose to go when they wish. Also, people said it was fun” (P1, 39-year-old male, clinical psychologist).

“Some patients who might be eligible for a GP care plan, they may be able to then access an [accredited] exercise physiologist with a subsidized cost, so that that would influence my—like I’m more likely to bring it up to a patient if I know they are eligible for a care plan” (P8, 38-year-old female, GP).