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Physical Activity Prescription in Primary Health Care: An Ethical Analysis
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DOI：10.3390/healthcare14070934.png)
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Abstract
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Highlights What are the main findings? Primary health care professionals perceive physical activity prescription as ethically demanding, involving ongoing negotiation between patient autonomy, professional responsibility, safety, and equity. Ethical tensions related to autonomy, beneficence, non-maleficence, and justice are addressed through context-sensitive strategies embedded in everyday clinical practice. What are the implications of the main findings? Ethical physical activity prescription requires more than clinical knowledge; it depends on relational competence, ethical judgment, and supportive health system structures. Integrating ethical frameworks and organizational support mechanisms may strengthen the legitimacy, safety, and sustainability of physical activity promotion in primary health care.Highlights What are the main findings? Primary health care professionals perceive physical activity prescription as ethically demanding, involving ongoing negotiation between patient autonomy, professional responsibility, safety, and equity. Ethical tensions related to autonomy, beneficence, non-maleficence, and justice are addressed through context-sensitive strategies embedded in everyday clinical practice. What are the implications of the main findings? Ethical physical activity prescription requires more than clinical knowledge; it depends on relational competence, ethical judgment, and supportive health system structures. Integrating ethical frameworks and organizational support mechanisms may strengthen the legitimacy, safety, and sustainability of physical activity promotion in primary health care.Abstract Background/Objectives: Although prescribing physical activity (PA) is a well-established preventive strategy in primary health care (PHC), its ethical implications remain under-researched. This study examines how general practitioners (GPs) and nurses experience, interpret, and manage ethical tensions in PAP. Methods: A qualitative study was conducted with 28 PHC professionals (13 GPs, 15 nurses) from rural and urban centers in Toledo, Spain (M = 18.4 years of experience). Data were collected through semi-structured interviews and analyzed using reflexive thematic analysis. Beauchamp and Childress' four-principles framework was applied abductively to synthesize ethical conflicts and coping strategies. Results: Two main themes emerged: (1) Ethical conflicts in PAP, characterized by tensions between autonomy and paternalism, and the challenge of balancing beneficence with non-maleficence under institutional pressures; and (2) Professional coping strategies, where clinicians used relational care, individualized tailoring, and interprofessional collaboration to mitigate moral distress. Results indicated that clinical codes, such as unrealistic goals or institutional pressure, often overlapped across multiple ethical principles, necessitating a nuanced, multi-dimensional approach to counseling. Conclusions: PAP is not a neutral clinical task but an ethically grounded practice constrained by structural and organizational factors. To move toward safe and equitable health promotion, PAP must be conceptualized as a relational intervention. We propose an Ethical Reflective Tool and a conceptual framework to support clinical reflection, enhance professional accountability, and guide policy-level support for preventive care in PHC.
Keywords:
primary health care
exercise therapy
ethics
clinical
health promotion
patient-centered care
patient autonomy
qualitative research
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