Physical activity promotion in community pharmacies: pharmacists’ attitudes and behaviours

Main Article Content


Exercise, Pharmacies, Pharmacists, Community Pharmacy Services, Health Promotion, Walking, Attitude, Surveys and Questionnaires, Cross-Sectional Studies, Portugal


Background: Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active.

Objective: This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice.

Methods: A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies.

Results: In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3).

Conclusions: Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.


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1. Miles L. Physical activity and health. Nutr Bull. 2007;32(4):314-363.
2. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015 Dec;25(Suppl 3):1-72.
3. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462.
4. European Commission. Special Eurobarometer 472 Report Sport and physical activity. (accessed Apr 24, 2021).
5. World Health Organization. Global action plan on physical activity 2018-2030. Geneva: WHO; 2018.
6. Sallis RE, Matuszak JM, Baggish AL, et al. Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care. Curr Sports Med Rep. 2016;15(3):207-214.
7. Estabrooks PA, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA. 2003;289(22):2913-2916.
8. Vuori IM, Lavie CJ, Blair SN. Physical activity promotion in the health care system. Mayo Clin Proc. 2013;88(12):1446-1461.
9. International Pharmacists Federation (FIP). Global pharmacy workforce and migration report: a call for action. The Hague: FIP; 2006.
10. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46.
11. Hassell K, Rogers A, Noyce P. Community pharmacy as a primary health and self-care resource: a framework for understanding pharmacy utilization. Health Soc Care Community. 2000;8(1):40-49.
12. Public Health England. Pharmacy: a way forward for public health. London: PHE; 2017.
13. Shirdel A, Pourreza A, Daemi A, Ahmadi B. Health-promoting services provided in pharmacies: A systematic review. J Educ Health Promot. 2021;10:234.
14. Lemanska A, Poole K, Griffin BA, et al. Community pharmacy lifestyle intervention to increase physical activity and improve cardiovascular health of men with prostate cancer: a phase II feasibility study. BMJ Open. 2019;9(6):e025114.
15. Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009;43(2):89-92.
16. O'Brien S, Prihodova L, Heffron M, Wright P. Physical activity counselling in Ireland: a survey of doctors' knowledge, attitudes and self-reported practice. BMJ Open Sport Exerc Med. 2019;5(1):e000572.
17. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
18. Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr. 2006;9(6):755-762.
19. Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.
20. World Health Organization. Physical activity. (accessed Nov 26, 2020).
21. Petrella RJ, Lattanzio CN, Overend TJ. Physical activity counseling and prescription among canadian primary care physicians. Arch Intern Med. 2007;167(16):1774-1781.
22. Haseler C, Crooke R, Haseler T. Promoting physical activity to patients. BMJ. 2019;366:l5230.
23. Mendes R, Nunes Silva M, Santos Silva C, et al. Physical Activity Promotion Tools in the Portuguese Primary Health Care: An Implementation Research. Int J Environ Res Public Health. 2020;17(3):815.
24. Tully MA, Cunningham C, Cupples ME, et al. Walk with Me: a protocol for a pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults. Pilot Feasibility Stud. 2018;4:117.
25. Hanson S, Jones A. Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. Br J Sports Med. 2015;49(11):710-715.
26. Marupuru S, Axon DR, Slack MK. How do pharmacists use and recommend vitamins, minerals, herbals and other dietary supplements?. BMC Complement Altern Med. 2019;19(1):229.
27. Ball K, Timperio AF, Crawford DA. Understanding environmental influences on nutrition and physical activity behaviors: where should we look and what should we count?. Int J Behav Nutr Phys Act. 2006;3:33.
28. Eades CE, Ferguson JS, O'Carroll RE. Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC Public Health. 2011;11:582.
29. Agomo CO, Ogunleye J. An investigation of strategies enhancing the public health role of community pharmacists: a review of knowledge and information. J Pharm Health Serv Res. 2014;5(2):135-145.
30. Dirks-Naylor AJ, Griffiths CL, Gibson JL, Luu JA. The prevalence of exercise prescription-related course offerings in United States pharmacy school curricula: Exercise is Medicine. Adv Physiol Educ. 2016;40(3):319-322.
31. Costa S, Santos C, Silveira J. Community pharmacy services in Portugal. Ann Pharmacother. 2006;40(12):2228-2234.
32. Osborne SA, Adams JM, Fawkner S, Kelly P, Murray AD, Oliver CW. Tomorrow's doctors want more teaching and training on physical activity for health. Br J Sports Med. 2017;51(8):624-625.
33. World Health Organization. Transforming and scaling up health professionals’ education and training. Geneva: WHO; 2013.
34. Cunningham C, O'Sullivan R. Healthcare Professionals Promotion of Physical Activity with Older Adults: A Survey of Knowledge and Routine Practice. Int J Environ Res Public Health. 2021;18(11):6064.
35. Hooper AD, Cooper JM, Schneider J, Kairuz T. Current and Potential Roles in Sports Pharmacy: A Systematic Review. Pharmacy (Basel). 2019;7(1):29.
36. Dirks-Naylor AJ, Griffiths CL, Bush MA. Exercise is medicine: student pharmacists' perceptions and knowledge of exercise prescription. Adv Physiol Educ. 2018;42(2):289-294.
37. Lobelo F, de Quevedo IG. The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models. Am J Lifestyle Med. 2016;10(1):36-52.
38. Bakhshi S, Sun F, Murrells T, While A. Nurses' health behaviours and physical activity-related health-promotion practices. Br J Community Nurs. 2015;20(6):289-296.
39. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998-1005.
40. Kaae S, Traulsen JM, Nørgaard LS. Customer interest in and experience with various types of pharmacy counselling - a qualitative study. Health Expect. 2014;17(6):852-862.
41. Björkman I, Viberg N, Rydberg L, Stålsby Lundborg C. Health promotion at Swedish pharmacies - views of the staff. Pharm Pract (Granada). 2008;6(4):211-218.
42. Agomo CO, Ogunleye J, Portlock J. A survey to identify barriers in the public health role of community pharmacists. Journal of Pharmaceutical Health Services Research. 2016;7(4):253-261.
43. Henderson M, Page L. Appraising the evidence: what is selection bias?. Evid Based Ment Health. 2007;10(3):67-68.