Referral pathways
In Primary Care across the UK, there are almost 900,000 GP consultations daily.14 The average patient visits their GP about 4 times per year.15 During these visits there is ample opportunity for the GP, practice nurse and health care assistant to promote exercise as part of a beneficial lifestyle and as a form of treatment in many diseases. In Secondary Care, there are many thousands of outpatients and inpatient consultations where exercise advice should be incorporated into the treatment plan.
The majority of patients need encouragement towards being more active through simple guiding techniques of Motivational Interviewing and straight forward advice on promoting activity or taking up exercise. Many patients do not want to go to a gym, but prefer to participate in walking, cycling, swimming and dancing, the advice for which falls comfortably within the role of any health professional.
As patients present with more complex problems, with one or more co-morbidities, doctors or nurses may prefer to refer to Local Exercise Schemes or physiotherapists depending on the conditions and level of risk for more detailed advice. However, there is still plenty of simple encouragement regarding walking, gardening and housework, which can be done in parallel, from which most patients will benefit.
For a smaller number of patients their activity needs require rehabilitation through specialised physiotherapists or high level 4 gym instructors, or through pulmonary or cardiac rehabilitation units. Assessments of some of these patients may need to be made by Cardiac, Respiratory or, if available, Sport and Exercise Medicine (SEM) consultants.