Patients with cardiovascular disease benefit from cardiac rehabilitation, which includes structured exercise and physical activity as core components. This position statement provides pragmatic, evidence-based guidance for the assessment and prescription of exercise and physical activity for cardiac rehabilitation clinicians, recognising the latest international guidelines, scientific evidence and the increasing use of technology and virtual delivery methods. The patient-centred assessment and prescription of aerobic exercise, resistance exercise and physical activity have been addressed, including progression and safety considerations.

Objective: Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels. Data sources: Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities. Main Results: From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities. Conclusions: Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.

Physical activity (PA) promotion in healthcare is an important strategy for increasing PA levels. Physiotherapists are well-positioned to promote PA, however no studies have investigated PA promotion by physiotherapists Australia-wide. An online survey of practicing Australian physiotherapists was conducted to investigate knowledge of the Australian Physical Activity and Sedentary Behaviour (PASB) guidelines and factors associated with increased promotion frequency. Participants were asked to state the PASB guidelines and a 4-component scoring system was used to measure knowledge. Multivariate logistic regression analysis was conducted to assess factors associated with frequency of promotion. 257 Australian physiotherapists completed the survey. Only 10% were able to accurately state the PASB guidelines and 54% reported promoting PA to 10 or more patients per month. Males were nearly three times more likely than females to promote PA to 10 or more patients per month (OR 2.68, 95% CI 1.25–5.74). Those who lacked counselling skills and felt PA promotion wouldn’t change their patients’ behaviour were much less likely to promote PA. Australian physiotherapists have poor knowledge of the Australian PASB guidelines and infrequently promote PA. Education and training in PA counselling and behaviour change strategies is indicated to enhance PA promotion by Australian physiotherapists.

Purpose: Physical inactivity and sedentary behavior (SB) are independent risk factors for cardiovascular disease and all-cause mortality. No studies appear to have investigated whether SB in cardiac rehabilitation (CR) participants changes over time. The aim of this study was to objectively assess physical activity (PA) and SB of CR participants over 6 wks. Methods: Using a prospective cohort study design, 72 CR participants, age = 64.2 ± 9.6 y (mean ± standard deviation [SD]) (79% male), wore an ActiGraph ActiSleep accelerometer for 7 consecutive days at the beginning and end of a 6-wk program to assess daily minutes of moderate-to-vigorous PA (MVPA) and SB (<100 counts/min). Other outcomes collected were self-reported MVPA (Active Australia Survey) and SB (Past-Day Adults' Sedentary Time Questionnaire), body mass index, waist-to-hip ratio, lipid profile, blood glucose level, quality of life (MacNew), exercise capacity (6-min walk test), anxiety and depression (Hospital Anxiety and Depression Scale). Results: Time spent in MVPA and SB did not change over 6 wks. However, exercise capacity and light-intensity PA significantly improved (P < .01). On average, participants spent 11.8 ± 1.1 hr daily in SB, with 9.5 ± 14.7 min daily in MVPA at the end of the CR program. There was some evidence that males and females had different movement patterns. Conclusions: Levels of PA are low and SB is high in CR participants despite changes in exercise capacity over 6 wks. Participants in CR did increase their PA but only in the light-intensity range. Alternative approaches in CR should be considered to encourage participants to move more and sit less.