7.3.5. Prescribing physical activity

This intervention involves brief advice given by a primary care specialist to an individual at high risk for chronic diseases linked to sedentary behaviour and lack of physical activity, followed by additional formal steps, such as a prescription for a minimum weekly amount of physical activity, a referral to an exercise referral scheme, or follow-up personalised counselling.

The intervention is modelled based on findings from a recent systematic review and meta-analysis [Goryakin, Suhlrie and Cecchini, 2018 [21]]. Specifically, prescribing physical activity increases leisure (sports) physical activity by 168.6 extra metabolic equivalent of task (MET) minutes per week, which is approximately equivalent to 56 extra minutes of moderate exercise a week. However, total physical activity is likely to increase by a smaller amount, as people may adjust their behaviour by spending less time doing other types of exercise [Graf and Cecchini, 2019 [23]]. Specifically, it was estimated that total physical activity will increase by about 96 MET-minutes per week when this adjustment is taken into account.

The eligible population is restricted to persons aged 50-75 years of age with at least one of the following risk factors: overweight; physical inactivity; diabetes; hypertension; smoking. In line with the reviewed evidence, it is expected that 26.4% of the eligible population will be exposed to the intervention, based on the data that: about up to 80% of people visit their general practitioner at least once a year in developed countries [Sanchez et al., 2015 [51]]; 55% of patients are likely to participate [Goryakin, Suhlrie and Cecchini, 2018 [21]]; and about 60% of doctors/practices agree to participate [Goryakin, Suhlrie and Cecchini, 2018 [21]]. In line with the reviewed evidence, maximum effectiveness is achieved after six months and gradually wears off to zero by the end of the first year. Eligible persons can participate again in the future.

The cost consists of two components: programme and individual-level expenses. The programme cost comes from expenses on programme administration and on recruitment and training of doctors; while the individual costs consists of doctor-provided consultations and of maintaining contacts with the participating patients. As giving a prescription for physical activity can be done in the context of a routine primary care visit, it is assumed that only about 10% of the visit time is needed for such a prescription. Total intervention costs vary between USD PPP 1.61 and USD PPP 1.66 annually per capita.