Perform Sufficient Level of Physical Activity

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For Who?		By Whom?^b	How Often?
Empowerment
All	Educate on: Benefits of physical activity and risks associated with sedentary behaviour and inactivity¹ Physical activity recommendation according to age and life stages	Primary Healthcare Providers	Opportunistically
Pregnant women	Educate on the benefits of sufficient level of physical activity on maternal and perinatal health, and safety considerations according to stage of pregnancy (Table 1.)²	Primary Healthcare Providers	Opportunistically
Assessment
All	Assess current physical activity level (i.e. Type, Intensity, Duration, Frequency)*⁴	Primary Healthcare Professionals	Opportunistically
	Screen for symptoms or signs suggesting increased risk for engaging in physical activities (Table 2.)
Management
Women having any symptoms or signs suggesting increased risk for engaging in physical activities	Refer for further medical work up^# OR	^#Trained Healthcare Professionals	As soon as symptoms reported or signs detected
	Provide work up^	^Doctors
Women with insufficient physical activity	Assess readiness to change, and provide brief intervention according to stage of change⁵ (Table 3.)	Trained Healthcare Professionals	Opportunistically
	Advise to perform sufficient level of physical activities according to individual preference and capacity: At least 150 minutes to 300 minutes of moderate-intensity aerobic physical activity per week; OR 75 minutes to 150 minutes of vigorous-intensity aerobic physical activity per week; OR an equivalent combination of moderate- and vigorous-intensity physical activity achieving at least 600 MET-minutes throughout a week (Table 4.) AND Muscle strengthening activities of moderate or greater intensity that involve all major muscle groups on 2 or more days a week for additional health benefits²aerobic exercise and resistance training for bone health⁶
	Follow up to ensure client is participating in physical activities safely and effectively⁷
Post Menopause women	Advise to do weight-bearing aerobic exercise and resistance training for bone health⁶	Trained Healthcare Professionals	Opportunistically

1. Empowerment

a. For Who: All

Recommended Care Components^a:

                                            Educate on:
                                            Benefits of physical activity and risks associated with sedentary behaviour and inactivity1
Physical activity recommendation according to age and life stages

                                        

By Whom^b: Primary Healthcare Providers

How Often: Opportunistically

b. For Who: Pregnant women

Recommended Care Components^a:

Educate on the benefits of sufficient level of physical activity on maternal and perinatal health, and safety considerations according to stage of pregnancy (Table 1.)²

By Whom^b: Primary Healthcare Providers

How Often: Opportunistically

2. Assessment

a. For Who: All

Recommended Care Components^a:

                                            Assess current physical activity level (i.e. Type, Intensity, Duration, Frequency)*4 
                                        

Screen for symptoms or signs suggesting increased risk for engaging in physical activities (Table 2.)

By Whom^b: Primary Healthcare Professionals

How Often: Opportunistically

3. Management

a. For Who: Women having any symptoms or signs suggesting increased risk for engaging in physical activities

Recommended Care Components^a:

                                            Refer for further medical work up#
                                            
                                            OR

                                            Provide work up^

By Whom^b: ^#Trained Healthcare Professionals / ^Doctors

How Often: As soon as symptoms reported or signs detected

b. For Who: Women with insufficient physical activity

Recommended Care Components^a:

Assess readiness to change, and provide brief intervention according to stage of change⁵ (Table 3.)

Advise to perform sufficient level of physical activities according to individual preference and capacity:

At least 150 minutes to 300 minutes of moderate-intensity aerobic physical activity per week;
OR
75 minutes to 150 minutes of vigorous-intensity aerobic physical activity per week;
OR
an equivalent combination of moderate- and vigorous-intensity physical activity achieving at least 600 MET-minutes throughout a week (Table 4.)
AND
Muscle strengthening activities of moderate or greater intensity that involve all major muscle groups on 2 or more days a week for additional health benefits²aerobic exercise and resistance training for bone health⁶

                                            Follow up to ensure client is participating in physical activities safely and effectively7
                                        

By Whom^b: Trained Healthcare Professionals

How Often: Opportunistically

c. For Who: Post Menopause women

Recommended Care Components^a:

                                            Advise to do weight-bearing aerobic exercise and resistance training for bone health6
                                        

By Whom^b: Trained Healthcare Professionals

How Often: Opportunistically

*Consider to use standardised, validated assessment instrument to assess adequacy of physical activity level e.g. Global Physical Activity Questionnaire (GPAQ)
MET = Metabolic Equivalent of Task

^a	Grade of recommendation according to colour code: Recommended (Strong) Conditionally recommended Practice points Generally not recommended Not recommended (Strong)

Primary Healthcare Providers – All providers of health services in primary healthcare settings
Primary Healthcare Professionals – Includes doctors, dentists, chinese medicine practitioners, nurses, pharmacists, physiotherapist, occupational therapist, dietitians
“Trained” Healthcare Professionals – Additional post-qualification training required to deliver the respective care component(s)

Table 1. Safety Considerations of Physical Activity for Pregnant Women²

Additional Safety Considerations

Avoid activities in supine position after the first trimester of pregnancy

Avoid physical activity during

excessive heat
high humidity

Avoid participating in activities which

involve physical contact
pose a high risk of falling
limit oxygenation

Table 2. Symptoms and Signs Suggesting Increased Risk for Physical Activity that Require for Medical Work-up prior to Participation*^

Clinical Features Suggesting High Risk for Physical Activity

Pain, discomfort in the chest, neck, jaw, arms or other areas that may be due to ischaemia
Shortness of breath at rest or with mild exertion
Dizziness or syncope
Orthopnoea or paroxysmal nocturnal dyspnoea
Ankle oedema
Palpitations or tachycardia
Intermittent claudication
Known heart murmur
Unusual fatigue or shortness of breath with usual activities

* Adopted from the Pre-participation Health Screening and Risk Stratification⁸

^ These signs or symptoms must be interpreted within the clinical context in which they appear because they are not all specific for significant cardiovascular, pulmonary, or metabolic disease

Table 3. The Physical Activity Stage of Change and Suggested Next Step⁵

Stages	Description	Next Step
Pre-contemplation	Not physically active now Does not intend to become more physically active in the next 6 months	Ask the patient if you can talk about physical activity in the future
Contemplation	Not physically active now Intends to become more physically active in the next 6 months	Discuss and help the patient make a plan and set a start date
Preparation	Physically active now BUT not to the recommended level	Help the patient make a plan and set a start date
Action	Engaging in sufficient level of physical activity to the recommended level for less than 6 months	Ask if the patient is ready to start another healthy behaviour
Maintenance	Engaging in sufficient level of physical activity to the recommended level for the past 6 months

Stages: Pre-contemplation

Description:

Not physically active now
Does not intend to become more physically active in the next 6 months

Next Step: Ask the patient if you can talk about physical activity in the future

Stages: Contemplation

Description:

Not physically active now
Intends to become more physically active in the next 6 months

Next Step: Discuss and help the patient make a plan and set a start date

Stages: Preparation

Description:

Physically active now
BUT not to the recommended level

Next Step: Help the patient make a plan and set a start date

Stages: Action

Description:

Engaging in sufficient level of physical activity to the recommended level for less than 6 months

Next Step: Ask if the patient is ready to start another healthy behaviour

Stages: Maintenance

Description:

Engaging in sufficient level of physical activity to the recommended level for the past 6 months

Next Step: Ask if the patient is ready to start another healthy behaviour

Table 4. MET Equivalents of Common Aerobic Activities and Energy Expenditures

Further Readings Community Resources Reference Materials for Healthcare Professionals Education and Self-Help Materials for the General Public References