Last week I wrote a blog post "Exercise 1: checking it's safe to start".  In today's post I talk about resources provided by the Department of Health (for England & Wales).  They have an excellent webpage on Physical Activity with links to a series of important initiatives including its publication "At least five times a week" which reviews research on exercise & health.  However what I'd like to concentrate on in this post is the recent and helpful General Practice Physical Activity Screening Questionnaire (GPPAQ).  There is a 22 page "GPPAQ booklet" available (updated in May 2009) which contains background advice about using the GPPAQ.  I've also produced a one-page, motivational handout "Health benefits of physical exercise" from information in the booklet.  

The GPPAQ takes less than a minute to complete, is well researched, and has clear recommendations on its use.  You can download copies of this questionnaire by clicking on "GPPAQ NHS PDF version" or "GPPAQ Word version" .  The availability of a quick, simple, exercise screening tool is a real step forward.  As health professionals we have faffed around for too long asking dubiously vague questions like "Do you exercise pretty regularly?"  The GPPAQ assesses both the physical activity involved during one's working day and also during one's leisure time.  The latter is classified into five categories - physical exercise like jogging, swimming, football, etc; cycling; walking; housework/childcare; and gardening/DIY.  From scores on work and leisure time activity, one is assessed as Inactive, Moderately Inactive, Moderately Active, or Active.  This Physical Activity Index (PAI) then forms the basis for subsequent exercise advice.  

Answers to the latter three categories of leisure time activity (walking, housework/childcare, & gardening/DIY) are not initially included in people's final score for the PAI.  This is because, during validation of the questionnaire, it became clear that people found it hard to estimate accurately the quantity and intensity of exercise in these categories.  When someone reports that they walk regularly, but their Physical Activity Index (PAI) is less than Active, it's usually helpful to explore a bit more thoroughly the quantity and intensity of their walking.  See the download "Assessing health benefits from walking" for a straightforward way of doing this.  I've also included a download "GPPAQ physical activity index (PAI)" which provides a grid for quick assessment of someone's PAI. 

The GPPAQ background booklet goes on to state "Patients who receive a score of less than active should be offered a Brief Intervention in Physical Activity in line with the NICE Guidance (2006)"  It points out:

• When providing physical activity advice, primary care practitioners should take into account the individual's needs, preferences and circumstances.
• They should agree goals with them. They should also provide written information about the benefits of activity and the local opportunities to be active.
• Where appropriate offer a referral into a condition specific or exercise on referral programme, if they are available locally.
• They should follow them up at appropriate intervals over a 3 to 6 month period.
• For those with CHD risk of greater than 30% over ten years, the GPPAQ should be completed annually

... useful stuff ... not only for British General Practitioners, but for health professionals generally and for all of us who are interested in better physical and psychological health.  Next week I write on the broader information available from the US in "Exercise 3: US Department of Health & Human Services, resources for assessment & advice".