Discussions about physical activity in general practice: analysis of video-recorded consultations

Background Clinical guidance recommends promoting physical activity during general practice consultations. The frequency and content of physical activity discussions in UK general practice are poorly understood. Aim To explore the content of physical activity discussions during routine consultations between patients and GPs. Design and setting Secondary analysis was undertaken of video-recorded UK general practice consultations from the One in a Million study, which was conducted in the West of England. Method In total, 294 consultation transcripts were available; these were screened to identify consultations that included or omitted physical activity advice when recommended by National Institute for Health and Care Excellence guidance. The content, quality, and depth of advice provided by GPs were scored to ascertain how meaningful the advice was. Results Physical activity was relevant to management according to clinical guidance in 175/294 (59.5%) consultations. In 64 (36.6%) of these consultations, physical activity was discussed as part of clinical management; the depth of discussion was judged as ‘meaningful’ in 22 (12.6%) consultations. Although physical activity advice tended to be given most often for musculoskeletal problems, depth of advice did not appear to be related to the presenting problem. When physical activity advice was relevant and omitted, consultations prioritised another overriding presenting problem, or clinical management focused on another intervention. Conclusion Physical activity advice, following national guidance, was potentially relevant to more than half of GP consultations; GPs delivered advice of varying depth in a third of these consultations. Future work should explore ways of delivering physical activity advice effectively, efficiently, and equitably within the constraints of general practice.