Lifestyle – 2008 PA guideline

1 In the ongoing care of patients, ask about behaviours that, if changed, can improve health (e.g., diet, exercise, alcohol use, substance use, safer sex, injury prevention (e.g., seatbelts and helmets).


2 Before making recommendations about lifestyle modification, explore a patient’s readiness to change, as it may alter advice.

Physical Activity Vital Sign (PAVS) – 2 questions
  1. “On average, how many days per week do you engage in moderate to strenuous exercise like a brisk walk?”
  2. “On average, how many minutes do you engage in exercise at this level?”

By repeating the assessment of PAVS at every clinic visit, you will be able to track changes in their physical activity levels over time.

The 2008 Physical Activity Guidelines recommends 150 minutes per week of moderate intensity physical activity or 75 minutes of vigorous intensity physical activity or some combination of the two


3 Explore a person’s context (e.g., poverty) before making recommendations about lifestyle modification (e.g., healthy eating choices, exercise suggestions) so as to avoid making recommendations incompatible with the patient’s context.

Rx exercise:

Safety Screening
  • Heart condition that limit physical activity or s/sx of stable / unstable angina
  • Hx of LOC or lose balance due to dizziness
  • Bone or joint problem (back, knee, hip) that could be made worse with physical activity
  • or use ACSM Risk stratification screening questionnaire
Determining Your Patient’s Readiness to Change  – 5 Stages of change & action step
Use Exercise Stages of Change Questionnaire
  1. Precontemplation (no intention)
    • Discuss health benefits of being more physically active & emphasize the pros of changing their behavior & help pt work through the cons of being more physically active
    • Pt is likely not ready to receive a physical activity Rx
  2. Contemplation (thinking about becoming physically active)
    • Continue to emphasize the pros & reducing the cons of being more physically active
    • The individual may be becoming receptive to receiving basic guidance on becoming more physically active
    • Writes Rx – refer to exercise professional
  3. Preparation (pt is active & making small changes, but not meeting PA guidelines)
    • Write Rx: refer to nonclinical exercise professionals
  4. Action (pt is meeting the PA guidelines for <6mo)
    • Encourage continued exercise
    • Strengthen their commitment to change and ability to fight urges to slip back into unhealthy behaviours
  5. Maintenance (meeting the PA guidelines >6mo)
    • Encourage continued exercise
    • Encourage pt to spend time with people with similar healthy behaviours; continue to engage in healthy activities to cope with stress instead of relying on unhealthy behaviour

4 In the ongoing care of patients, periodically review their behaviours, recognizing that these may change.

5 In the ongoing care of a patient, regularly reinforce advice about lifestyle modification, whether or not the patient has instituted a change in behaviour.

By repeating the assessment of PAVS at every clinic visit, you will be able to track changes in their physical activity levels over time. The PAVS is highly associated with decreased levels of BMI and odds of obesity and has been tested for face and discriminant validity.


Moderate intensity Activity
  • Brisk walking, ballroom dancing
  • Biking <10mph (16kph)
  • General Gardening, such as weeding
  • Golfing (no cart), etc
Vigorous-intensity Activity
  • Jogging, running
  • Tennis
  • Biking >10mph
  • Aerobic dancing
  • heaving gardening, eg digging, etc

Reference: http://exerciseismedicine.org/assets/page_documents/Complete%20HCP%20Action%20Guide.pdf

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Posted in 58 Lifestyle, 99 Priority Topics, FM 99 priority topics, Others

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