Prescribing protocols highlight lifestyle management of obesity as a first line intervention, and behavioural interventions should be given a fair chance before decisions to prescribe are made. Practitioners should ask themselves: are patients being given a quality assured physical activity intervention? 

What is a quality assured lifestyle intervention?

This can usefully be defined as one which:

• Clarifies the expectations of each professional in the care pathway, relative to other professionals.  For example, is a formalised assessment of readiness to change behaviour expected within a short opportunistic GP consultation, or is dedicated practice nurse or exercise professional time to be made available?
   
• Is sufficient patient contact time given for the outcome you want to achieve?  For example, negotiating a physical activity programme with the client, and discussing likely outcomes and expectations is likely to need dedicated time which may not be available during an opportunistic client visit
   
• Is based on evidence of characteristics of effective interventions. For example, how does an exercise referral scheme need to change to incorporate what we know about achieving client adherence over the longer term? See below
   
• Has a clearly defined outcome measure and evaluation method which shows you whether or not you have achieved your aim. For example pre programme and post programme fitness assessments may show changes in waist circumference but will not measure adherence over the longer term, which is an important goal. This could be recorded via a self reported or prompted physical activity diary or questionnaire
   
• Influences the overall care pathway. For example, if the patient loses inches it should inform a clinical decision about whether to defer or avoid prescribing medication. Operating a physical activity intervention in isolation from the rest of the care pathway should be avoided
   
• Has a meaningfully recordable outcome which can be added to patient notes, either electronically or on paper.  For example, being able to record, in real time, key elements of a physical activity action plan negotiated with a client during the consultation
   
• Can have its outcomes conveniently fed back to primary care staff to ensure systemic use and continuous review and refinement.  For example, sharing data on client’s adherence and any physiological changes associated with increased physical activity during practice meetings to maintain the project;s profile within a broader care pathway