Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions

Abstract

IntroductionThe benefits of physical activity for people living with long-term conditions (LTCs) are well established. However, the risks of physical activity are less well documented. The fear of exacerbating symptoms and causing adverse events is a persuasive barrier to physical activity in this population.This work aimed to agree clear statements for use by healthcare professionals about medical risks of physical activity for people living with LTCs through expert consensus. These statements addressed the following questions: (1) Is increasing physical activity safe for people living with one or more LTC? (2) Are the symptoms and clinical syndromes associated with common LTCs aggravated in the short or long term by increasing physical activity levels? (3) What specific risks should healthcare professionals consider when advising symptomatic people with one or more LTCs to increase their physical activity levels?MethodsStatements were developed in a multistage process, guided by the Appraisal of Guidelines for Research and Evaluation tool. A patient and clinician involvement process, a rapid literature review and a steering group workshop informed the development of draft symptom and syndrome-based statements. We then tested and refined the draft statements and supporting evidence using a three-stage modified online Delphi study, incorporating a multidisciplinary expert panel with a broad range of clinical specialties.ResultsTwenty-eight experts completed the Delphi process. All statements achieved consensus with a final agreement between 88.5%–96.5%. Five ‘impact statements’ conclude that (1) for people living with LTCs, the benefits of physical activity far outweigh the risks, (2) despite the risks being very low, perceived risk is high, (3) person-centred conversations are essential for addressing perceived risk, (4) everybody has their own starting point and (5) people should stop and seek medical attention if they experience a dramatic increase in symptoms. In addition, eight symptom/syndrome-based statements discuss specific risks for musculoskeletal pain, fatigue, shortness of breath, cardiac chest pain, palpitations, dysglycaemia, cognitive impairment and falls and frailty.ConclusionClear, consistent messaging on risk across healthcare will improve people living with LTCs confidence to be physically active. Addressing the fear of adverse events on an individual level will help healthcare professionals affect meaningful behavioural change in day-to-day practice. Evidence does not support routine preparticipation medical clearance for people with stable LTCs if they build up gradually from their current level. The need for medical guidance, as opposed to clearance, should be determined by individuals with specific concerns about active symptoms. As part of a system-wide approach, consistent messaging from healthcare professionals around risk will also help reduce cross-sector barriers to engagement for this population.

Opportunities to engage health system leaders in whole systems approaches to physical activity in England

“…The Richmond Group of Charities working across health and social care has established a 'Movement for all' programme and the 'We Are Undefeatable' campaign to promote physical activity to people with long term conditions. A recent consensus statement on physical activity risk endorsed by these charities recommended that the benefits outweigh the risks for most people with health conditions to get active [57]. Sport England has also identified people with long-term conditions as a priority group in their latest action plan [58].…”

Behavioural epidemiology of physical activity in people living with chronic conditions

“…Furthermore, many physical activity providers lack knowledge and confidence in providing activities for people with chronic conditions. Reid et al ’s research helps address health professionals’ concerns, which should result in clearer messaging to patients 5. However, this messaging must be accompanied by accessible opportunities that meet the varying abilities and interests of these populations.…”

“…However, the WHO Guideline Development Group identified important gaps in the evidence for this population, which may be attributable, in part, to a lack of research funding in this field 4. In their recent consensus statement, Reid and colleagues provide guidance for practitioners on promoting physical activity in people living with long-term conditions 5. Their paper is a valuable contribution to the field, however, substantially more research and implementation activity is needed to increase activity levels in these populations.…”

Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions: a scoping review protocol

“… 55 While recently published guidance supports healthcare professionals to address concerns relating to the exacerbation of common symptoms at the point of initiating physical activity and exercise, they do not address how such interventions might need to be modified, which appears to be important for sustainability. 54 Even less is known about the role of interventions to address sedentary behaviour in this population. 20 53 58–60 Reducing sedentary behaviour may be a useful adjunct approach for those who lack the capacity or motivation to undertake physical activity and exercise.…”

“…Existing evidence suggests that identifying and targeting non-disease specific issues (eg, symptoms such as pain, fatigue, breathlessness) are important factors associated with increased intervention effectiveness 47 53. This may be important within the context of physical activity and exercise interventions, where uptake is hampered by concerns that symptoms may be aggravated 54. Additionally, adherence in this population is low and the sustained engagement of people with both MLTCs and frailty is disrupted by periods of ill-health, exacerbation of their conditions and increased symptom burden, coupled with lack of guidance and support on safe and effective physical activity in these circumstances 36 55–57…”