Understanding healthcare professionals’ physical activity promotion behaviours when treating individuals with depression in primary care: a systematic review

Problem
Depression is a common mental health disorder which is mainly managed in primary care. Physical activity (PA) has been shown to reduce symptoms in people with depression, and is recommended by NICE. However, despite the evidence-based benefits of physical activity, many healthcare professionals (HCPs) do not discuss physical activity with patients during consultations. Given how integral HCPs are in the use of PA for the management of depression, we need to further understand their PA promotion behaviours, and identify the barriers and facilitators they face.
Approach
A systematic literature search of databases was conducted to identify articles that reported qualitative and/or quantitative data on (1) HCPs working with individuals with depression, but not exclusively, and (2) HCPs barriers and/or facilitators to PA promotion/treatment for depression. This included knowledge, perceptions, behaviours and views of HCPs. Data were extracted and thematically analysed using the Theoretical Domains Framework (TDF).
Findings
From 10,004 articles identified, 24 met the inclusion criteria for this review. Barriers and facilitators were identified and mapped to the TDF domains, with more barriers than facilitators found. Common barriers across multiple studies included a lack of education or training, lack of infrastructure and low patient motivation. In contrast, facilitators differed across studies, and included HCPs having knowledge of the biochemical processes of how PA affects mental health, and being able to offer a non-pharmacological treatment preferred by patients. HCPs perceived efficacy of PA in treating depression varied across studies, acting as both a barrier and facilitator, however many HCPs did indicate that they would advise, discuss, or recommend PA to patients with depression.
Consequences
Despite depression being the most common mental disorder, no previous work has systematically reviewed HCPs PA promotion behaviours specifically for people with depression. This review presents a range of barriers and facilitators that could be targeted to increase HCP PA promotion behaviour for people with depression. Increasing our knowledge and understanding of HCPs PA promotion behaviours and the barriers and facilitators they face may also help to inform more targeted interventions for HCPs working with this sub-population of mental illness.