Publication Review: Consensus statement on risks of physical activity

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

Authors: Hamish Reid, Ashley J Ridout, Simone A Tomaz, Paul Kelly, Natasha Jones (on behalf of the Physical Activity Risk Consensus group)

Reference: Published online – https://bjsm.bmj.com/content/early/2021/11/03/bjsports-2021-104281

Background: Physical activity has a key role in the prevention & management of long-term medical conditions (LTCs), but despite this people with LTCs are much more likely to be inactive than those without. The benefits of increasing activity levels in people with LTCs far outweigh the risks. Healthcare professionals report barriers to discussing activity with their patients, and patients themselves express concerns such as high perceived risk and fear of symptom exacerbation. This collaboration between the FSEM, Sport England, OHIP and the RCGP aimed to produce clear statements for healthcare professionals about the medical risks of increasing physical activity for adults living with LTCs, through expert consensus.

Methodology: The multistage process included background patient & clinician involvement, a rapid literature review and a steering group workshop to inform development of symptom-based statements. A 3-stage modified Delphi process (of 28 experts from a broad range of clinical specialties) was used to create and refine the statements.

Conclusion: Five ‘impact statements’ and eight symptom/syndrome-based statements were created (see infographic below), with high levels of final agreement (88.5-96.5%). These statements support healthcare professionals to effect positive behavioural change through person-centred, symptom-based conversations. As part of a broader initiative between SE, OHIC, the RCGP and the Richmond Group of Charities this statement forms the basis for wider discussion around risk in physical activity, and how to empower people with LTCs to be more active. In agreement with the WHO, the authors suggest review of pre-participation medical clearance for people with LTCs. Collaboration between healthcare and the sport & physical activity sectors is needed to remove the systemic barriers to activity faced by those with LTCs.

Summarised by: Ashley Ridout

Specialty Registrar (Oxford Deanery) & member of authorship team