Physical Activity Counselling and Exercise Prescription Practices of Physiotherapists in Nova Scotia

Abstract

PURPOSE: Physiotherapists (PTs) have education and scope of practice to promote the benefits of physical activity (PA) and prescribe exercise in their clinical interactions with patients. As such, they provide an avenue to increase the reach of Exercise is Medicine, to improve the PA levels of the Canadian population. However, no study has assessed Canadian physiotherapists’ perceptions and practices surrounding physical activity counselling and exercise prescription (PAE). METHODS: PTs working in Nova Scotia (n=146) completed an online self-reflection survey regarding their current practices, confidence, barriers, and facilitators in providing PAE to their patients. RESULTS: Overall confidence for PAE was high (most scores >80%) except for in helping patients maintain PA (72.8±25%) and in patients following through on PAE recommendations (66.3±22.5%). PTs include PAE in 85±23% of appointments and prescribe written exercise in 80±20% of appointments, but only refer to other exercise professionals or facilities in 27±27% of appointments. The most salient barriers to providing PAE were patient’s interest in PA, and patients’ preference for medication management over lifeestyle intervention (2.36±0.68 and 2.11±0.66 respectively, out of 4), exceeding the typically cited barrier of lack of provider time. The most helpful facilitator was PTs’ perceived patients’ readiness to do PAE (3.5±0.7, out of 4). PTs are most comfortable providing PAE advice to those with arthritis and musculoskeletal issues (81%) and least comfortable to those with cancer (49%), insulin requiring diabetes (33%), respiratory disease (32%) and mental health concerns (28%). CONCLUSION: The primary barriers for PTs in providing PAE are patient-focused and PTs may benefit from avenues that allow greater referral access to other exercise professionals and a collaborative treatment approach to help patients maintain a physically active lifestyle, especially in those with other chronic disease beyond musculo-skeletal disorders. Exercise is Medicine networks should consider greater collaborations between allied health and exercise professionals to support multi-disciplinary approaches to patient exercise management across the continuum of health care. Support provided by: Lawson Foundation, Nova Scotia Health Authority