As the COVID-19 pandemic has entered a new phase, preconditions change for the better when it comes to the implementation of PAP. This newsletter includes an opening speech of Flemish Minister for Public Health in Brussels, an update from the EUPAP implementation in Malta, as well as you can read more about a pilot project in Italy regarding a collaboration between emergency medicine and sports medicine for patients with cardiovascular disease.

In addition, you can read more about a few research articles on Physical Activity on Prescription in practice.

Flemish Minister's for Public Health opening speech in Brussels

We are excited to announce that during his opening speech Wouter Beke, Flemish Minister for Welfare, Public Health, Family and Poverty Reduction, recognized the value of Physical Activity on Prescription for health workers and citizens. Watch a full opening below.

EUPAP Implementation in Malta

This will be the first time that Physical Activity on Prescription (PAP) will be implemented in Malta. They have chosen to target patients with obesity and diabetes, due to the high prevalence in the Maltese population.

In Malta, approximately 41% of children and 69% of adults have overweight or obesity; and according to the International Diabetes Federation, 10% of all 20-79 years-old in Malta have diabetes. Even though there is overwhelming evidence that regular physical activity has wide-ranging health benefits, the WHO Global Health Observatory (GHO) estimates for Malteses adults (aged 18+ years) show that 59% meet the WHO recommended physical activity levels for health.

General Practitioners and Physiotherapists have received training to become prescribers in the EUPAP project. As part of the pre-implementation process, resources were prepared both for the professionals and for their clients who will receive PAP. The prescription form and the International Physical Activity Questionnaire will facilitate PAP prescription and help the prescriber keep track of the clients’ progress, while the activity diary will allow clients to set their targets and goals and track their progress. Informative leaflets will provide guidance both for professionals and clients about type, amount and intensity of physical activity.

Malta will start implementing PAP in February 2022.

For further information, you can contact Ms Roberta Zarb Adami by email roberta.a.zarb-adami@gov.mt.

The picture collage below shows the resources which were prepared by the EUPAP implementation team in Malta to facilitate Physical Activity Prescription.

Collaboration between emergency medicine and sports medicine – a pilot project in Treviso, Italy

The Italian pilot project includes a collaboration between the emergency medicine department and the sports medicine unit, with the aim of offering physical activity on prescription (PAP) for therapeutic purposes. PAP is directed towards patients with chronic cardiovascular conditions. These patients are referred by their general practitioners or by the hospital.

Patients are evaluated, with a cardiovascular risk stratification, pharmacological therapy is optimized, and a PAP is provided at the end. Patients are then reviewed at follow-up with variable frequency and, where indicated, the prescribed therapy and PAP are adjusted.

"Usually patients are referred to us after revascularization procedures or an acute coronary syndrome but why do we have to wait for an event? Can’t we prevent it instead?" - Says doctor Patrizio Sarto, head of the Exercise and Sports Medicine Unit. Read more.

The Swedish PAP model increases physical activity

PAP in accordance with the Swedish model increases the level of physical activity in adult patients who are insufficiently active. This is shown in a review on the effects of three core elements in the PAP-S model: person-centred dialogue; individually tailored physical activity recommendation with written prescription; and follow-up. Physical activity on prescription in accordance with the Swedish model increases physical activity: a systematic review | British Journal of Sports Medicine (bmj.com)

PAP models can be implemented as part of regular healthcare in the prevention and treatment of diseases. Above and beyond PAP, clinicians may also consider sedentary behaviour counselling. The intention with this approach is to assist with the adoption and maintenance of reductions in sedentary behaviour as an initial step towards increasing physical activity.

Start with reducing sedentary behavior: A stepwise approach to physical activity counseling in clinical practice - ScienceDirect