Enhancing the effectiveness of clearance for physical activity participation: background and overall process1This paper is one of a selection of papers published in the Special Issue entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal's usual peer-review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S3-S13 ◽  
Author(s):  
Veronica K. Jamnik ◽  
Darren E.R. Warburton ◽  
Julie Makarski ◽  
Donald C. McKenzie ◽  
Roy J. Shephard ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Disease ◽  
Peer Review Process ◽  
Evidence Base ◽  
Screening Tools ◽  
Evidence Based ◽  
Highly Qualified ◽  
Direct Role ◽  
Agree Instrument ◽  
Clearance Process

Recent feedback from physical activity (PA) participants, fitness professionals, and physicians has indicated that there are limitations to the utility and effectiveness of the existing PAR-Q and PARmed-X screening tools for PA participation. The aim of this study was to have authorities in exercise and chronic disease management to work with an expert panel to increase the effectiveness of clearance for PA participation using an evidence-based consensus approach and the well-established Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Systematic reviews were conducted to develop a new PA clearance protocol involving risk stratification and a decision-tree process. Evidence-based support was sought for enabling qualified exercise professionals to have a direct role in the PA participation clearance process. The PAR-Q+ was developed to use formalized probes to clarify problematic responses and to explore issues arising from currently diagnosed chronic disease or condition. The original PARmed-X tool is replaced with an interactive computer program (ePARmed-X+) to clear prospective PA participants for either unrestricted or supervised PA or to direct them to obtain medical clearance. Evidence-based validation was also provided for the direct role of highly qualified university-educated exercise professionals in the PA clearance process. The risks associated with exercise during pregnancy were also evaluated. The systematic review and consensus process, conforming to the AGREE Instrument, has provided a sound evidence base for enhanced effectiveness of the clearance process for PA participation of both asymptomatic populations and persons with chronic diseases or conditions.

Evidence-based risk assessment and recommendations for physical activity clearance: an introduction1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S1-S2 ◽  
Author(s):  
Darren E.R. Warburton ◽  
Veronica K. Jamnik ◽  
Shannon S.D. Bredin ◽  
Don C. McKenzie ◽  
James Stone ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Risk Stratification ◽  
Review Process ◽  
Peer Review Process ◽  
Screening Tools ◽  
Health Conditions ◽  
Systematic Evaluation ◽  
Evidence Based ◽  
Clearance Process

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally renowned and extensively used preparticipation screening tools. However, recent feedback from end-users has identified limitations to the existing PAR-Q and PARmed-X screening process. As such, a systematic evaluation of the PAR-Q and PARmed-X forms was conducted, adhering to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Recognized experts in physical activity (PA) and prominent health conditions worked with an expert consensus panel to increase the effectiveness of the PAR-Q and PARmed-X PA participation clearance process. The systematic review process established that the health benefits of PA participation far outweigh the risks in the vast majority of asymptomatic and symptomatic individuals. A new risk continuum and decision tree process was created to allow for the effective risk stratification of prominent health conditions, reducing greatly the barriers to PA participation for the majority of individuals. The new PA participation clearance process is available in new paper and online versions (PAR-Q+) and the PARmed-X was replaced with an online interactive computer programme (ePARmed-X+). It is anticipated that this new risk stratification and PA clearance process will reduce markedly the barriers for PA participation for both asymptomatic and symptomatic individuals.

Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S190-S213 ◽  
Author(s):  
Scott G. Thomas ◽  
Jack M. Goodman ◽  
Jamie F. Burr
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Lower Risk ◽  
Peer Review Process ◽  
Screening Tools ◽  
Systematic Evaluation ◽  
Computer Assisted ◽  
Evidence Based ◽  
Intermediate Risk

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools — the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) — require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs.

Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 20111This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S266-S298 ◽  
Author(s):  
Darren E.R. Warburton ◽  
Norman Gledhill ◽  
Veronica K. Jamnik ◽  
Shannon S.D. Bredin ◽  
Don C. McKenzie ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Risk Stratification ◽  
Chronic Conditions ◽  
Peer Review Process ◽  
Core Competencies ◽  
Screening Tools ◽  
Evidence Based ◽  
Consensus Document ◽  
Human Lifespan

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally known preparticipation screening tools developed on the basis of expert opinion. The primary purposes of this consensus document were to seek evidence-based support for the PAR-Q and PARmed-X forms, to identify whether further revisions of these instruments are warranted, to determine how people responding positively to questions on the PAR-Q can be safely cleared without medical referral, and to develop exercise clearance procedures appropriate for various clinical conditions across the human lifespan. Seven systematic reviews were conducted, examining physical-activity-related risks and effective risk-stratification procedures for various prevalent chronic conditions. An additional systematic review assessed the risks associated with exercise testing and training of the general population. Two gap areas were identified and evaluated systematically: the role of the qualified exercise professional and the requisite core competencies required by those working with various chronic conditions; and the risks associated with physical activity during pregnancy. The risks associated with being physically inactive are markedly higher than transient risks during and following an acute bout of exercise in both asymptomatic and symptomatic populations across the lifespan. Further refinements of the PAR-Q and the PARmed-X (including online versions of the forms) are required to address the unique limitations imposed by various chronic health conditions, and to allow the inclusion of individuals across their entire lifespan. A probing decision-tree process is proposed to assist in risk stratification and to reduce barriers to physical activity. Qualified exercise professionals will play an essential role in this revised physical activity clearance process.

Healthy Public Policy Options to Promote Physical Activity for Chronic Disease Prevention: Understanding Canadian Policy Influencer and General Public Preferences

2019 ◽  
Vol 16 (7) ◽  
pp. 565-574 ◽  
Author(s):  
Jennifer Ann McGetrick ◽  
Krystyna Kongats ◽  
Kim D. Raine ◽  
Corinne Voyer ◽  
Candace I.J. Nykiforuk
Keyword(s):  
Physical Activity ◽  
Chronic Disease ◽  
Disease Prevention ◽  
General Public ◽  
Public Policies ◽  
Chronic Disease Prevention ◽  
Evidence Based ◽  
Policy Options ◽  
Physical Activity Policy ◽  
Levels Of Support

Background: Attitudes and beliefs of policy influencers and the general public toward physical activity policy may support or impede population-level action, requiring improved understanding of aggregate preferences toward policies that promote physical activity. Methods: In 2016, the Chronic Disease Prevention Survey was administered to a census sample of policy influencers (n = 302) and a stratified random sample of the public (n = 2400) in Alberta and Québec. Using net favorable percentages and the Nuffield Council on Bioethics’ intervention ladder framework to guide analysis, the authors examined support for evidence-based healthy public policies to increase physical activity levels. Results: Less intrusive policy options (ie, policies that are not always the most impactful) tended to have higher levels of support than policies that eliminated choice. However, there was support for certain types of policies affecting influential determinants of physical activity such as the built environment (ie, provided they enabled rather than restricted choice) and school settings (ie, focusing on children and youth). Overall, the general public indicated stronger levels of support for more physical activity policy options than policy influencers. Conclusions: The authors’ findings may be useful for health advocates in identifying support for evidence-based healthy public policies affecting more influential determinants of physical activity.

The Promotion and Implementation of Exercise is Medicine® in Kinesiology

2020 ◽  
Vol 9 (4) ◽  
pp. 319-323 ◽  
Author(s):  
Carena Winters
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Chronic Disease ◽  
Health Care Professionals ◽  
Clinical Care ◽  
Evidence Based ◽  
Physical Activity Assessment ◽  
Activity Assessment ◽  
Exercise Referral

Evidence supporting exercise as a medicine in the prevention and management of chronic disease is indisputable. Created in 2007, Exercise is Medicine® (EIM) aims to make physical activity assessment and promotion a standard in clinical care, connecting health care professionals with qualified exercise professionals to provide evidence-based physical activity resources and programs to everyone of all abilities. Opportunities exist for exercise professionals in several areas within EIM, including exercise referral and prescription, EIM on Campus, and physical activity and EIM education. Connections between EIM and kinesiology and the need for exercise professionals to contribute to the EIM evidence are discussed.

scholarly journals Development of a behaviour change workplace-based intervention to improve nurses’ eating and physical activity

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Brian T. Power ◽  
Kirsty Kiezebrink ◽  
Julia L. Allan ◽  
Marion K. Campbell
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Physical Activity Behaviour ◽  
Evidence Base ◽  
Workplace Intervention ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Activity Behaviour

Abstract Background There is a critical need for an intervention to improve nurses’ eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. Methods The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques. Results Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. Conclusions An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease1This paper is one of a selection of papers published in the Special Issue entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer-review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S80-S100 ◽  
Author(s):  
Neil D. Eves ◽  
Warren J. Davidson
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Exercise Intervention ◽  
Peer Review Process ◽  
Chronic Obstructive ◽  
Evidence Based ◽  
Screening Process ◽  
Obstructive Pulmonary Disease ◽  
Asthma Patients

The 2 most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Growing evidence supports the benefits of exercise for all patients with these diseases. Due to the etiology of COPD and the pathophysiology of asthma, there may be some additional risks of exercise for these patients, and hence accurate risk assessment and clearance is needed before patients start exercising. The purpose of this review was to evaluate the available literature regarding the risks of exercise for patients with respiratory disease and provide evidence-based recommendations to guide the screening process. A systematic review of 4 databases was performed. The literature was searched to identify adverse events specific to exercise. For COPD, 102 randomized controlled trials that involved an exercise intervention were included (n = 6938). No study directly assessed the risk of exercise, and only 15 commented on exercise-related adverse events. For asthma, 30 studies of mixed methodologies were included (n = 1278). One study directly assessed the risk of exercise, and 15 commented on exercise-related adverse events. No exercise-related fatalities were reported. The majority of adverse events in COPD patients were musculoskeletal or cardiovascular in nature. In asthma patients, exercise-induced bronchoconstriction and (or) asthma symptoms were the primary adverse events. There is no direct evidence regarding the risk of exercise for patients with COPD or asthma. However, based on the available literature, it would appear that with adequate screening and optimal medical therapy, the risk of exercise for these respiratory patients is low.

scholarly journals Development of a behaviour change workplace-based intervention to improve nurses’ eating and physical activity

2020 ◽  
Author(s):  
BRIAN POWER ◽  
Kirsty Kiezebrink ◽  
Julia L Allan ◽  
Marion K Campbell
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Qualitative Interviews ◽  
Healthcare Delivery ◽  
Physical Activity Behaviour ◽  
Evidence Base ◽  
Workplace Intervention ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Activity Behaviour

Abstract Background There is a critical need for an intervention to improve nurse’s eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. Methods The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities; (1) identifying the evidence base; (2) understanding the determinants of nurses’ eating and physical activity behaviour change through theory-based qualitative interviews and survey; (3) identifying intervention options using the Behaviour Change Wheel; and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques. Results Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses’ beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses and key determinants included: environmental context and resources; behavioural regulation; emotion; beliefs about consequences; knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. Conclusions An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses’ eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

Evidence-based risk assessment and recommendations for physical activity clearance: cancer1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S101-S112 ◽  
Author(s):  
Lee W. Jones
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Exercise Training ◽  
Cancer Patients ◽  
Exercise Testing ◽  
Peer Review Process ◽  
Evaluation Criteria ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
Data Reporting

Physical activity is becoming increasingly acknowledged as an integral component of in the multidisciplinary management of cancer patients. Intensive inquiry in this area is likely to increase further over the next decade; however, cancer-specific, evidence-based risk assessment and recommendations for physical activity are not available. A systematic literature review was performed of all studies conducting an exercise training intervention and (or) any form of objective exercise test among adults diagnosed with cancer. Studies were assessed according to evaluation criteria developed by a panel of experts. A total of 118 studies involving 5529 patients were deemed eligible. Overall, the results suggest that exercise training and maximal and submaximal exercise testing are relatively safe procedures with a total nonlife-threatening adverse event rate of <2%. There was only 1 exercise training-related death. However, the quality of exercise testing methodology and data reporting is less than optimal. Thus, whether the low incidence of events reflects the true safety of exercise training and exercise testing in cancer patients or less than optimal methodology and (or) data reporting remains to be determined. Evidence-based absolute and relative contraindications to physical activity and exercise training and testing are provided as well as probing decision-trees to optimize the adoption and safety of physical activity in persons diagnosed with cancer.

Training Practitioners in Evidence-Based Chronic Disease Prevention for Global Health

2007 ◽  
Vol 14 (3) ◽  
pp. 159-163 ◽  
Author(s):  
Ross C. Brownson ◽  
Gunter Diem ◽  
Vilius Grabauskas ◽  
Branka Legetic ◽  
Rimma Potemkina ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Disease ◽  
Action Plan ◽  
Critical Mass ◽  
Training Programme ◽  
Evidence Base ◽  
Lessons Learned ◽  
Evidence Based ◽  
Health Practitioners ◽  
Public Health Practitioners

Too often, public health decisions are based on short-term demands rather than long-term research and objectives. Policies and programmes are sometimes developed around anecdotal evidence. The Evidence-Based Public Health (EBPH) programme trains public health practitioners to use a comprehensive, scientific approach when developing and evaluating chronic disease programmes. Begun in 2002, the EBPH programme is an international collaboration. The course is organized in seven parts to teach skills in: 1) assessing a community's needs; 2) quantifying the issue; 3) developing a concise statement of the issue; 4) determining what is known about the issue by reviewing the scientific literature; 5) developing and prioritizing programme and policy options; 6) developing an action plan and implementing interventions; and 7) evaluating the programme or policy. The course takes an applied approach and emphasizes information that is readily available to busy practitioners, relying on experiential learning and includes lectures, practice exercises, and case studies. It focuses n using evidence-based tools and encourages participants to add to the evidence base in areas where intervention knowledge is sparse. Through this training programme, we educated practitioners from 38 countries in 4 continents. This article describes the evolution of the parent course and describes experiences implementing the course in the Russian Federation, Lithuania, and Chile. Lessons learned from replication of the course include the need to build a “critical mass” of public health officials trained in EBPH within each country and the importance of international, collaborative networks. Scientific and technologic advances provide unprecedented opportunities for public health professionals to enhance the practice of EBPH. To take full advantage of new technology and tools and to combat new health challenges, public health practitioners must continually improve their skills.

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