Article Text

Original research
Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres: a mixed methodology study on clinicians’ perceptions
  1. Joske Nauta1,2,
  2. Femke van Nassau1,
  3. Adrie J Bouma3,4,
  4. Leonie A Krops3,
  5. Hidde P van der Ploeg1,
  6. Evert Verhagen1,
  7. Lucas H V van der Woude3,5,
  8. Helco G van Keeken5,
  9. L M Buffart6,
  10. Ron Diercks7,
  11. Vincent de Groot8,
  12. Johan de Jong4,
  13. Caroline Kampshoff9,
  14. Martin Stevens7,
  15. Inge van den Akker-Scheek7,
  16. Marike van der Leeden8,
  17. Willem van Mechelen1,5,
  18. Rienk Dekker3
  19. on behalf of the PIE=M consortium
    1. 1Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
    2. 2Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
    3. 3Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    4. 4School of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
    5. 5Center for Human Movement Sciences, University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
    6. 6Department of Physiology, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
    7. 7Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    8. 8Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
    9. 9Department of Medical Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
    1. Correspondence to Dr Joske Nauta; j.nauta{at}amsterdamumc.nl

    Abstract

    Objectives Despite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres.

    Design A mixed methodologies study, using both online questionnaires and semi-structured interviews.

    Setting Dutch university medical centres.

    Participants Clinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres.

    Results Forty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints).

    Conclusions Our study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.

    • PREVENTIVE MEDICINE
    • QUALITATIVE RESEARCH
    • SPORTS MEDICINE
    • ORTHOPAEDIC & TRAUMA SURGERY
    • REHABILITATION MEDICINE
    • ONCOLOGY

    Data availability statement

    Data are available upon reasonable request. The data are available on request. Because of the nature of the data, quantitative data can be shared on a meta level. For the qualitative data, the codebook is available. Please contact the corresponding author for more information (j.nauta@amsterdamumc.nl).

    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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    Data availability statement

    Data are available upon reasonable request. The data are available on request. Because of the nature of the data, quantitative data can be shared on a meta level. For the qualitative data, the codebook is available. Please contact the corresponding author for more information (j.nauta@amsterdamumc.nl).

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    Footnotes

    • Twitter @leoniekrops

    • Collaborators The above authors submitted this paper on behalf of the PIE=M consortium. The members of the PIE=M that were not included in the author list are listed below. All PIE=M consortium members did contribute to the conception and design of the work, the acquisition, analysis and interpretation of the data. WJR Bossers: The Lifelines Cohort Study, the Netherlands. J Brüggeman: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. H Leutscher: Knowledge Centre for Sport and Physical Activity, Ede, the Netherlands. GJ Navis: Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. S Scholtens and MA Swertze: Genomics Coordination Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. S van Twillert: Center of Expertise on Quality and Safety, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. KJ van der Velde: Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. J Zwerver: Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, and Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, the Netherlands.

    • Contributors JN: the overall guarantor for the finished work, the conducted study, access to the data and controlled the decision to publish. FvN, AJB, LAK, HPvdP, HGvK and RDekker: substantial contributions to the conception or design of the work; analysis and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EV, LHVvdW, LMB, RDiercks, VdG, JdJ, CK, MS, IvdA-S, MvdL and WvM: substantial contributions to the conception or design of the work; or the acquisition, analysis and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This work was supported by ZonMw (grant number: 546001002).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.