Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres: a mixed methodology study on clinicians’ perceptions

Abstract

ObjectivesDespite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres.DesignA mixed methodologies study, using both online questionnaires and semi-structured interviews.SettingDutch university medical centres.ParticipantsClinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres.ResultsForty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints).ConclusionsOur study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.

Knowledge and practice of the physical activity prescription by generalists and specialist physicians of the City of Kinshasa: A cross-sectional study

“…The most common reason for not prescribing PA was forgetting, followed by a lack of knowledge about current PA prescribing recommendations and lack of time. Our ndings on barriers to PA prescribing are consistent with those of other authors (41)(42)(43)(44)(45)(46)(47). Nauta et al (47) identi ed forgetting as a major reason for not prescribing PA. Persson et al (49) highlighted the current recommendations' ignorance.…”

“…Our ndings on barriers to PA prescribing are consistent with those of other authors (41)(42)(43)(44)(45)(46)(47). Nauta et al (47) identi ed forgetting as a major reason for not prescribing PA. Persson et al (49) highlighted the current recommendations' ignorance. Similarly, other previous studies have been identi ed a lack of time as a barrier to prescribing daily PA (41,44,45).…”

Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals

“…The E = M tool may also be used for ongoing monitoring during treatment. In our interrelated study it was already indicated by clinicians that continuous monitoring of PA behavior is recommended [ 28 ]; If the PA behavior decreases considerably, this may be a sign that the patient is not doing well. When such a tool is used to set up a tailored training program or to measure effects of a medical treatment, PA measurement should include intensity.…”

“…Barriers to the implementation and uptake of exercise prescription include; lack of time, insufficient skills to address patients’ PA behavior, insufficient knowledge of PA guidelines and referral options and subjective influences as immediate and significant barrier to this referral process [ 26 – 31 ]. Strategies to overcome these barriers should focus on increasing clinicians EIM referral skills, improving clinicians knowledge of EIM referral options and develop a support system to ensure that EIM is high on the priority list of clinicians [ 28 ].…”

“…PIE = M consists of three interrelated work packages. Firstly, the current implementation status, facilitators and barriers of E = M were investigated among clinicians from academic hospitals [ 28 ]. One of the recommended strategies to overcome barriers was to develop an E = M-tool.…”