Inspiring discussions about the 24-Hour Movement Guidelines in primary care

With the release of Canada's 24-Hour Movement Guidelines for Adults 18-64 and 65+ years, the focus has shifted to promoting a daily healthy balance between three crucial movement behaviours—physical activity, sedentary behaviour, and sleep—among adults living in Canada. Now, primary care providers have the chance to focus their interactions toward how adults can “make their whole day matter” to achieve positive health outcomes. However, just discussing physical activity in a primary care appointment comes with challenges; limited time, few referral options (e.g., community programs), and costs are barriers that both providers and adults accessing care face. So, how are providers expected to discuss three movement behaviours?

Considering this dilemma, we saw the need for a user-friendly tool that would help providers discuss all three movement behaviours with adults in primary care. In May of 2021, we formed a working group of expert researchers and professionals in medicine, kinesiology, health promotion, communications, and knowledge translation. We conducted a scoping review to see if any available tools addressed all three movement behaviours (i.e., integrated tools) and to learn what tool features were most favourable among existing physical activity, sedentary behaviour, and/or sleep tools. No integrated tools existed, so we compiled our scoping review findings into seven recommendations that developers of future movement behaviour tools should consider. We followed these recommendations and created an evidence-based Tool and User Guide that were comprehensive enough to support productive discussions and had easy-to-follow steps to make providers want to pick up and use them, yet were succinct enough to fit into a primary care appointment.

We then conducted two research studies with 46 primary care providers across British Columbia, Alberta, and Ontario, including nine family medicine physicians, 17 family medicine residents, six nurses, two nurse practitioners, four dietitians, two pharmacists, four social workers, one psychologist, and one psychotherapist working in a family health team. These providers expressed a desire for a Preamble and a Handout to accompany the Tool and User Guide, which we collectively called the “Toolkit”, and suggested revisions at multiple steps leading to consensus on a final product: The Whole Day Matters Toolkit for Primary Care.

The Whole Day Matters Toolkit for Primary Care can be used by providers to focus their discussions on optimizing physical activity, sedentary, and sleep behaviours among adults accessing care who are 18+ years. The Toolkit is a fillable PDF that you can insert as a custom form in your electronic medical record, is accessible for use by screen-readers, comes in English and French, and contains four evidence-based resources:

·    A one-page Preamble that explains the Toolkit

·      A one-page Tool that uses a modified 5 A’s Framework and motivational interviewing prompts

·      A one-page User Guide that helps providers learn to use the Tool

·      A two-page Handout for adults accessing care that can be used collaboratively during an appointment or given to adults to fill out at home

The Toolkit incorporates the latest Canadian guidelines on movement behaviours and the most recent evidence on movement behaviour discussion tools for primary care. The Toolkit was funded by the Public Health Agency of Canada and supported by the Canadian Society for Exercise Physiology (CSEP). You can download it on the CSEP website under the “Resources” tab or look for it on the Canadian Medical Association’s Physician Wellness Hub. We hope the Toolkit helps you optimize movement behaviours among adults in your practice.

Tamara L. Morgan is a fourth year PhD Candidate in the School of Kinesiology and Health Studies at Queen’s University and is an avid promoter of healthy movement behaviours.

 

Dr. Michelle Fortier is a Full Professor in the School of Human Kinetics at the University of Ottawa, was the principal investigator on the primary care Physical Activity Counselling Trial, was one of the eight founding members of Exercise is Medicine Canada and is a physical activity behavior change and motivational interviewing expert.

 

Dr. Rahul Jain, is an academic Family Physician at Sunnybrook Health Sciences Centre and an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto. He is passionate about translating evidence into clinical practice to prevent and manage cardiovascular disease.

 

Dr. Kirstin N. Lane, is an Assistant Professor (Teaching Stream) in the School of Exercise Science, Physical and Health Education at the University of Victoria. She is also on the Canadian Society for Exercise Physiology (CSEP) board of directors and Vice-Chair of the CSEP Professional Standards Committee.

 

Kaleigh Maclaren is a communications professional focused on communications strategies that help solve problems and engage audiences. She has brought this expertise to her involvement in the knowledge translation activities of various Canadian guidelines related to movement behaviours. 

 

Dr. Taylor McFadden is a Senior Research Advisor on the Physician Wellness and Medical Culture team at the Canadian Medical Association. Her primary role is to support physicians in Canada across the career lifecycle through the development, implementation and evaluation of wellness-related initiatives, programs, and research. Note: The opinions and conclusions expressed are the writers’ own and are not those of the Canadian Medical Association.

 

Dr. Jeanette Prorok is Manager of Special Projects & Evaluation at the Canadian Frailty Network and Adjunct Professor in the School of Rehabilitation Sciences at Queen’s University. Dr. Prorok is also a health services research and evaluation consultant at JPRO Research & Consulting.

 

Jill Robison worked on the Physical Activity Counselling Practice Support Program for Nova Scotia Health. She is a registered Physiotherapist. 

 

Zach Weston is the CEO of the Canadian Society for Exercise Physiology (CSEP) and has been a Clinical Exercise Physiologist for over 25 years certified by both CSEP and the American College of Sports Medicine.  He is also a part time faculty member at Wilfrid Laurier University.

 

Dr. Jennifer R. Tomasone is an Associate Professor in the School of Kinesiology and Health Studies at Queen’s University. She led the Knowledge Translation efforts for the Canadian 24-Hour Movement Guidelines for Adults.