Exercise prescription in the management of chronic disease falling through an evidence-practice gap: Perspectives of doctors and nurses in specialist settings

Abstract

Objectives

Exercise is a frontline therapy for the management of chronic cardiometabolic disease, however traditional tertiary health care service models do not include exercise physiology. We aimed to explore professional roles, practices, and services regarding exercise care in chronic cardiometabolic disease from the perspectives of specialist doctors and nurses.

Methods

Using a qualitative description design, semi-structured individual interviews were conducted with 32 doctors and 26 nurses involved in the care of relevant patients with liver, kidney, or cardiac disease, or diabetes, across hospital and community settings in a Queensland metropolitan health service. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Results

Four overarching themes were identified. Despite universal acceptance of the multifactorial benefits of exercise, there was a lack of confidence in patients’ capabilities to exercise and safety concerns due to complex comorbidities. Interviewees considered themselves ‘promotors not prescribers’ of exercise. There was no structured exercise history taken outside of cardiac rehabilitation units with significant variability in advice provided. Access to exercise specialist services was limited and disease-specific, with inconsistent and fragmented referral pathways. General Practitioners were considered responsible for facilitating exercise specialist involvement in ongoing care, with onus placed on patients to initiate.

Conclusions

There is an evidence-practice gap between the established benefits of exercise for chronic disease management and access to exercise professionals and services, resources, and knowledge. This deprioritises exercise as a frontline therapy with patient care implications. This study identified a need to transform the way that exercise care is accessed and delivered in tertiary settings.