'Function First' - optimising physical activity prescriptions in primary care

<p dir="ltr"><b>Background</b></p><p dir="ltr">As people age and accumulate long-term conditions, physical activity and physical function often decline. Primary care could contribute to improving this, however the best approach is uncertain.</p><p dir="ltr"><b>Aim</b></p><p dir="ltr">To develop a programme theory explaining how interventions improve physical activity and function, in people with long-term conditions. To co-design a prototype intervention.</p><p dir="ltr"><b>Design and Setting</b></p><p dir="ltr">Realist evidence synthesis and co-design for primary care service innovation.</p><p dir="ltr"><b>Methods</b></p><p dir="ltr">Realist synthesis combined evidence from a wide range of literature with stakeholder views. The resulting context, mechanism and outcome (CMO) statements informed co-design and knowledge</p><p dir="ltr"><b>Results</b></p><p dir="ltr">1) GP consultations tend not to prioritise physical activity and function. If the culture of the practice is supportive of physical activity, then encouraging physical activity will become part of usual routine.</p><p dir="ltr">2) Physical activity promotion is inconsistent and uncoordinated. If physical activity promotion is better resourced, then this will improve opportunities to change behaviour.</p><p dir="ltr">3) People with long-term conditions have varying physical activity levels, attitudes and opportunities. If physical activity promotion is adapted to individual needs and preferences, then people will be more likely to carry on.</p><p dir="ltr">4) Many general practice staff lack knowledge and confidence about promoting physical activity. If training makes staff more capable, then they will be better able to promote physical activity.</p><p dir="ltr">5) If a programme makes sense and is trustworthy, then patients and professionals will engage with it.</p><p dir="ltr">Resources were co-designed for developing: an environment that encourages physical activity, knowledge about physical activity, and a new role for someone who can encourage people to use local opportunities to be more active.</p><p dir="ltr"><b>Conclusions</b></p><p dir="ltr">This product needs further development, consideration alongside current schemes and contexts, including those relevant to the Covid-19 pandemic, and testing in a future study. The integration of realist and co-design methods strengthened this study.</p>