Exercise Prescription Project

Department of Health

Exercise

• reduces mortality and morbidity

• promotes • physical health

• psychological health

• social health

WHO’s recommendations

• at least 30 minutes

• moderate intensity

• on most days of the week

Local situation

• “Population Health Survey” conducted by the Department of Health

–Physical inactivity is common

Primary healthcare to promote physical activities

• A good opportunity–provides services in the community

–gains high level of trust and credibility from the public

• Overseas experiences

Stages of Change Model

• A social psychology model

• Describes motivational readiness of an individual to change behaviour (5 stages)

Pre-contemplation(No intention)

Action(actively engaged)

Maintenance(keep it up)

Contemplation(have intention)

Preparation(preparing)(Prochaska & DiClemente 1984)

Local experience

A study conducted in 2003 by DH• Aim : assess the efficacy of incorporating

exercise prescription and the provision of stage matched health education materials

• Study type : randomized controlled trial• Setting : general practice• Subjects : clients of the participating GPs with

the following inclusion criteria1. 18-64 years old;2. Can read and understand written Chinese; and3. Belong to pre-contemplation, contemplation orpreparation stages in their motivation to do exercise.

Medical assessment

Fill in thequestionnaire for exercise participation

Target populationUnsuitable population

Control group

Randomization

Medically stable

Intervention group

Usual consultation + intervention Usual consultation

Telephone FU interview for Stage of change & exercise participation assessment

Stage of change assessmentInclusion criteria

Excluded cases

Medically unstable

Study Flow

4 weeks later

Pre

Post

Intervention (1)

• Mode;

• Frequency; and

• Duration

Provision of an exercise prescription sheet

Intervention (2)Provision of relevant health education materials

i) Disease specific pamphlets ii) Stage matched booklets

Results

GPs recruited : 17

Patients recruited at pre :636

Patients recruited at FU : 608 (95.6%)

Control group : 304 Intervention group : 332

Outcome measures : patients’

• Stages of changes; and

• Exercise participation levels

Stages of Change• Forward Shift : Stage progression at FU• Backward/No Shift : Stage reversion/no progression at FU

38.547.9

61.5 52.1

010203040506070

Perc

ent

age

Forward shift Backward/No shift

Stage progression in intervention and control groups

Control Intervention

Adjusted OR : 1.51

(95%CI : 1.10 -2.09, p=0.01)

Summary of local experience

• Effect of the exercise prescription project

Increase motivational readiness to exercise

Exercise Prescription Project

Exercise Prescription ProjectAim :• Promote physical activity among the general

public by a multi-sectoral approach and establishing a conducive environment for exercise

Key elements:• Doctors to provide structured and specific health

advice to promote exercise participation (exercise prescription) in a largely healthy population

• Stage matched health education materials• Community participation

Approach

Healthy population various choices of exercise

Supervised exercise

Patients who can do self-exercise

Semi-supervised exercise

Community participation in the EPP

Specialized health professional

Exercise Prescription Project

Collaborators:

Government DepartmentsGovernment Departments

Community participationCommunity participation

Professional bodiesProfessional bodies

Exercise Prescription Project• A Task Force was set up

Task ForceTask ForceExercise Prescription

Development Committee (EPDC)Exercise Prescription

Development Committee (EPDC)

Practitioners Training Committee (PTC)Practitioners Training Committee (PTC)

Community Engagement Committee (CEC)Community Engagement Committee (CEC)

Education and Publicity Committee (EPC)Education and Publicity Committee (EPC)

Exercise Prescription Project

Task ForceTask Force

EPDCEPDC

PTCPTC

CECCEC

EPCEPC

Development of health education resourcesDevelopment of health education resources

Training of Medical and Other PractitionersTraining of Medical and Other Practitioners

Soliciting community resourcesSoliciting community resources

Arranging publicity actionsArranging publicity actions

Doctors

Public

Community

Doctors

Public

Community

Toolkit forExercise Prescription Project

• Introduction to the Exercise Prescription Project

• Guidelines on writing an exercise prescription

• Health education materials for patients

• Exercise prescription pad

Professional Manual -The Exercise Prescription Project

• Overview of the project

• Components of the intervention

Professional Manual – Guidelines on writing an exercise prescription

• Guidance on exercise prescription

Health education materialsfor clients

• Pamphlets for patients with chronic diseases

• Booklets for patients at different stages of change for exercise

Exercise Prescription Sheet

• Specific health advice on exercise

• Work out by the doctor and the patient

• Ownership of one’s own health

Client’s log book

• General information on exercise

• Weekly progress chart

Thematic Websitehttp://exerciserx.cheu.gov.hk

Conclusion

The project will be good for:• Public• Doctors• Community

Let’s build a healthier Hong Kong

Thank you