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Improving health
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National Physical Activity Pathway

The National Physical Activity Pathway (NPAP) is a set of steps a healthcare professional can take to encourage the people in their care to be more active. It targets adults who are inactive or not active enough to benefit their health and can be used in any face to face conversation between you and the person in your care.

The pathway should be used by health and social care professionals in both primary and secondary care roles. It can easily be integrated into existing clinical pathways and will provide health benefits to every adult that becomes more active.

The health benefits of physical activity and its impact on health inequalities can be found on our physical activity overview page.

These resources support health and social care professionals to understand and implement the National Physical Activity Pathway (NPAP) across all appropriate health and social care settings. They will equip health and social care professionals with the knowledge and skills to

  • raise the issue of physical activity and screen adults in your care for current levels of physical activity
  • gauge a person's readiness to change and provide person-centred advice
  • engage, motivate and support people to introduce physical activity into their daily lives.

It may take raising the issue of physical activity at more than one consultation for some people to change their behaviour, just as with other health behaviours, e.g. smoking cessation.

The pathway includes five steps.

  1. Raising the issue of physical activity with those within your care.
  2. Screening for physical activity levels.
  3. Giving person-centred physical activity advice.
  4. Signpost or refer the individual to support that will help them be more active.
  5. Follow up review (and screen again).

We recommend all health and social care practitioners complete our Health Behaviour Change elearning course. You can follow this with our specific elearning course on using the pathway.

When to raise the issue of physical activity

Raising the issue of physical activity can take as little as 30 seconds. The discussion begins with either the practitioner or client raising the issue of physical activity during consultations (step 1). For practitioners, this could be planned or opportunistic. It is unlikely that a person will bring up physical activity themselves, but practitioners need to be prepared for the possibility and be ready to respond to it.

The Scottish Physical Activity Screening Questionnaire (Scot-PASQ) is a good way to start the conversation (step 2).

If they are not already meeting the recommended guidelines, a person's answers to Scot-PASQ will help show how ready they are to change. If a person is ready to change and interested in becoming more physically active, health and social care professionals can give person-centred physical activity advice (step 3 of the pathway).

Data recording and monitoring

Those delivering the pathway should take a record of any Scot-PASQ answers and advice given as part of their routine data recording. The data is useful for reference in future consultations and for any reporting purposes.

Active participation

Once you signpost or refer a person to ways they can be more physically active (step 4), they have to work towards their physical activity goals themselves.

Physical activity doesn't need to be complicated and can include solo activity, for example

  • walking or cycling to work, the shops, school or just for fun
  • taking the stairs instead of the lift
  • taking the bus into town
  • walking home or gardening.

Physical activity could also be increased with more structured support, such as

  • walking groups
  • exercise classes
  • regular swimming sessions.

All activities should reflect the person's needs and interests and will normally take place in peoples' communities. The people in your care can find advice on being more active on NHS inform's keeping active pages (external site).

It is easier to use the physical activity pathway if healthcare professionals are aware of local physical activity opportunities to which people can be signposted. The ALISS (A Local Information System for Scotland) site can help you find physical activity support by postcode.

Follow-up review

Where possible, follow-up consultations should be integrated into existing practice, via clinical pathways or opportunistically via other routine consultations (step 5). The person should be screened again and may need further encouragement to continue to increase their physical activity.