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
Evert Verhagen,
Willem van Mechelen,
Inge van den Akker-Scheek,
Lucas H V van der Woude,
Ron Diercks,
Joske Nauta,
Rienk Dekker,
Hidde P van der Ploeg,
Martin Stevens,
J Zwerver,
Leonie A Krops,
Marike van der Leeden,
G J Navis,
L M Buffart,
S Scholtens,
Vincent de Groot,
Femke van Nassau,
Adrie J Bouma,
Helco G van Keeken,
Johan de Jong,
Caroline Kampshoff,
W J R Bossers,
J Brüggeman,
H Leutscher,
M A Swertz,
S van Twillert,
K J van der Velde
Affiliations
Evert Verhagen
Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
Willem van Mechelen
1 Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
Inge van den Akker-Scheek
Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Lucas H V van der Woude
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Ron Diercks
Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Joske Nauta
Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
Rienk Dekker
Department for Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Hidde P van der Ploeg
Department of Public and Occupational Health, Amsterdam Public Health Institute, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Martin Stevens
Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
J Zwerver
Leonie A Krops
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Marike van der Leeden
Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
G J Navis
L M Buffart
Department of Physiology, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
S Scholtens
Vincent de Groot
Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
Femke van Nassau
Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
Adrie J Bouma
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Helco G van Keeken
Center for Human Movement Sciences, University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
Johan de Jong
School of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
Caroline Kampshoff
Department of Medical Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
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.
