Blueprint for an Active Australia

Action area 9: Healthcare

Authors: Nicole Freene, Sjaan R Gomersall, Tahlia Alsop, Stephen Barrett, Paddy C Dempsey, Denise M Jones, Helen Macpherson, Carol Maher, Niamh L Mundell, Cathie Sherrington, Megan Teychenne.

Strategic priorities

Key strategic priorities with the greatest potential to drive future impact for physical activity promotion in healthcare:

• Healthcare organisations should develop and implement policies and clinical guidelines that support the integration of physical activity promotion into routine practice for both the prevention and management of health conditions. The effectiveness of policy implementation must be regularly evaluated, using ongoing monitoring systems that collect routine physical activity data, to guide improvements over time.
• All healthcare workers should receive training to ensure that they have the necessary knowledge, skills, confidence and competence to deliver evidence-informed physical activity advice in routine practice. Common foundation competencies should be achieved by all healthcare workers to enable them to work to their full scope of practice, while acknowledging the extended scope of practice that exercise specialists (e.g. exercise physiologists, physiotherapists, sports medicine physicians) are able to provide.

Sustainable Development Goals

The United Nations Sustainable Development Goals¹ that support physical activity promotion in healthcare settings include:

For more information see Appendix 1

Consider the case for physical activity promotion within healthcare:

• Health professionals perceive that physical activity promotion is part of their role.³ All health professionals have the capability to promote physical activity across all healthcare settings (primary, secondary, tertiary) for both the primary and secondary prevention of ill health and disease. However, only 16% of nursing and allied health professionals surveyed in Australia were able to describe the physical activity guidelines accurately, potentially limiting their ability to take advantage of physical activity promotion opportunities.⁴
• Healthcare consumers want physical activity advice from their health professional, but few receive this.^5,6
• In Australia, $2.4 billion was spent on health conditions associated with physical inactivity in 2018–19.⁷ Given the large number of healthcare consumers who access the healthcare sector, promotion of physical activity by healthcare workers across all healthcare settings has the potential to broadly increase population physical activity and consequently reduce healthcare costs.
• Using the full spectrum of healthcare settings to promote physical activity supports the World Health Organization’s (WHO) report on Sustainable Development Goals and equitable access to high value care.^1,8 This is alongside a host of co-benefits, such as decreasing environmental pollution, mitigating climate change, and alleviating the cost of living through more affordable transportation alternatives.
• It is estimated that if physical inactivity levels do not decrease globally by 2030 there will be 500 million new cases of preventable long-term conditions, resulting in more than 520 billion international dollars of direct healthcare costs.⁹

• In recent years, several important shifts have occurred in how physical activity is integrated into Australian healthcare. These reflect national and global strategies, such as Australia’s National Preventive Health Strategy 2021–2030 and the WHO Global action plan for physical activity (GAPPA), which call for a stronger focus on prevention,^8,10 improved monitoring and workforce training.
• The expansion of digital health, including telehealth,¹¹ has supported contemporary care models, where health professionals provide physical activity support through digital platforms like apps and remote monitoring, with demonstrated positive impacts on physical activity and health outcomes.^12-14
• There is also a growing focus on embedding physical activity into routine care. For example, registries such as Australia’s Cystic Fibrosis Data Registry prompt health professionals to assess and record physical activity,¹⁵ supporting clinical decisions and national surveillance and is well-aligned with calls for better monitoring.¹⁰
• Workforce capacity is improving through the inclusion of physical activity in pre-service curricula16 and ongoing upskilling through programs like Exercise is Medicine® Australia.¹⁷
• Finally, improved access to resources and referral pathways has strengthened the link between healthcare and community-based programs, such as the Heart Foundation’s Walking program,¹⁸ supporting long-term engagement in physical activity beyond the healthcare setting.

Policy, practice and leadership

• Governments and professional organisations should develop and implement policies and clinical guidelines. Policies should include guidelines on how to assess physical activity and deliver evidence-informed physical activity advice in routine practice. This aligns with the National Preventive Health Strategy and GAPPA, which both call for improved monitoring and a stronger focus on prevention,^8,10 and with registries that already prompt health professionals to record physical activity.¹⁵
• Health professionals should foster collaboration within and outside the healthcare sector to support people to make behavioural changes to increase physical activity. Connections between the healthcare sector and other community-based physical activity programs should also be strengthened.¹⁹ Referral pathways to programs such as Heart Foundation Walking can support long-term engagement beyond the healthcare setting.¹⁸

Organisation and service delivery

• Health professionals should be supported to provide physical activity advice in primary care settings using federal government funding mechanisms (e.g. the Medicare Benefits Schedule and/or the Practice Incentive Payment program). This could be through increased awareness and use of existing items (e.g. chronic disease care plans) or through establishing dedicated physical activity promotion items that are accessible by all primary care disciplines including general practice, nursing, midwifery and allied health.^5,6,20,21
• Workforce
• All healthcare workers, including the peer support workforce, allied health assistants, Aboriginal and Torres Strait Islander and multicultural health workers, should be trained to support people to be more active.⁴ Only 16% of nursing and allied health professionals surveyed could accurately describe the physical activity guidelines.⁴
• Training organisations (e.g. universities, vocational training providers and peak bodies) should scaffold physical activity promotion across healthcare workers’ careers, from foundational competencies in undergraduate and vocational education through to ongoing professional development.^16,17
• All healthcare workers should receive training in physical activity promotion foundation competencies,² while understanding the importance of appropriate referral to exercise specialists (e.g. physiotherapists, exercise physiologists, sports medicine physicians) when extended support is required.

Community awareness and engagement

• Governments should invest in public health campaigns that raise awareness of the benefits of physical activity for both prevention and management of health conditions, and that empower consumers to seek physical activity advice from their healthcare providers.^5,6 Co-design campaigns and resources with consumers to ensure that materials are inclusive and culturally responsive.^22,23

Research, data and innovation

• A review of the evidence for this action area identified the following priorities for investment in research, data and innovation.
• Leverage digital health infrastructure to support and scale-up physical activity promotion in healthcare settings. This could include expanding the use of decision-support systems, automated prompts, telephone coaching and remote monitoring (wearables) to support healthcare workers to deliver tailored advice and follow-up for physical activity behaviour change. Governments and organisations should invest in innovation and research to evaluate the impact of digital health solutions in diverse healthcare settings.
• Improve understanding of which implementation strategies are most effective in healthcare systems. For example, exploring whether system-level interventions (decision-support prompts, performance incentives, leadership engagement) effectively embed physical activity promotion in routine practice and identifying which contextual factors (organisational culture, resource constraints, team composition) influence fidelity, sustainability and scale-up.
• Improve understanding of the physical activity promotion training landscape for healthcare workers. Research should explore the consistency of training across disciplines, barriers to uptake, reach and the impact of training on knowledge, skills, confidence and practice change. The comparative effectiveness of different workforce training models should be evaluated.
• Rigorously evaluate physical activity promotion initiatives in healthcare settings in terms of changes to healthcare worker practice, changes in consumer physical activity participation and cost efficiency and effectiveness.
• Standardise and integrate physical activity monitoring and surveillance into routine care. Research should explore how innovative technological solutions could enable accurate, accessible and secure data collection, and sharing among healthcare professionals and sectors. Ideally, these physical activity measures would be integrated into electronic records and minimum data sets to support benchmarking, evaluation and reporting, while ensuring privacy and interoperability.

Heart Foundation related information for healthcare