EXERCISE IS MEDICINE, BUT FOR WHAT? A MAPPING REVIEW OF PHYSICAL ACTIVITY RECOMMENDATIONS IN THE UK NICE CLINICAL GUIDELINES

Abstract

INTRODUCTION & AIMS Clinical guidelines are used to inform best practice care, with research evidence a key aspect informing guideline recommendations. Physical activity is recommended for the management of a large variety of health conditions; however, the conditions that physical activity is recommended for has not been synthesised, nor has the quality of the evidence that informs these guideline recommendations. METHODS To understand the extent and type of evidence for physical activity recommendations across different health conditions in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines. METHODS NICE was searched for clinical guidelines that recommended physical activity in the management/treatment of a health condition. Data relating to the condition, guideline date, physical activity recommendation(s) (general or specific), and evidence underpinning the recommendations was extracted. Where applicable, recommendations for research, priorities for implementation, and impact of the recommendations was also extracted. RESULTS 221 clinical guidelines were reviewed, of which 52 provided one or more physical activity recommendations and were included in the analysis. The guidelines covered a range of conditions including cardiovascular, mental health, metabolic, neurological, musculoskeletal, and others. Most guidelines (n=43) provided general physical activity recommendations (e.g. advice to be active) whereas only 9 provided specific recommendations (e.g. type and dose of physical activity). The evidence underpinning the physical activity recommendations in the guidelines was mixed but was mostly based on very low-moderate quality evidence. Despite this, few guidelines recommended further research around physical activity. CONCLUSION Physical activity is recommended in many clinical guidelines, demonstrating its perceived importance for improving health across a wide range of different conditions. The mostly low-quality evidence on which these recommendations are based questions why more guidelines do not recommend further high-quality research into physical activity. This would improve confidence in the evidence and hence confidence in the recommendations made by the guidelines.