Beyond The Prescription: Barriers and Facilitators to Follow-Up and Long-Term Management of Exercise and Physical Activity Prescriptions in Primary Care

Exercise and physical activity prescriptions are increasingly used in primary care, yet their effectiveness depends on more than issuing an initial recommendation. This review aimed to examine barriers and facilitators to post-prescription follow-up and long-term management in primary care, focusing on initiation, adherence, monitoring, reassessment, adaptation, professional responsibility, documentation, referral, and digital support. A structured narrative review was conducted. Evidence was identified through structured searches of PubMed/MEDLINE, Scopus, and Web of Science, supplemented by reference-list screening and targeted searches of key reviews and primary studies, and was synthesized thematically across patient, clinician, team, organizational, and health-system levels. Follow-up is commonly hindered by changing patient circumstances, limited consultation time, uneven exercise-specific competence, unclear professional ownership, inconsistent documentation, weak referral feedback, and limited integration of digital monitoring into clinical decision-making. Sustainable follow-up appears to require planned review, explicit role allocation, shared but accountable care, access to exercise-specific expertise when needed, and closed-loop communication across services. A pragmatic follow-up approach should capture implementation, exercise exposure, barriers, tolerability, goal progress, and the resulting clinical decision, with follow-up intensity adapted to patient and prescription complexity. Exercise prescription should be conceptualized as a longitudinal care process in which the plan remains visible, reviewable, and modifiable over time. Future research should clarify optimal follow-up timing, professional roles, progression strategies, digital decision support, and long-term cost-effectiveness.