Consulting skills: How to advise about exercise

Current guidelines on exercise, how to conduct a brief assessment and tips on giving lifestyle advice.

Regular physical activity offers patients significant health benefits
Regular physical activity offers patients significant health benefits

Since papers were first published 60 years ago on the link between inactivity and CHD,1 the evidence for the benefits of exercise has grown.

The CMO's guidelines on physical activity were developed in 2004 and updated in 2011 (see box). Yet a 2006 study showed that:2

  • 93% of GPs agreed promoting physical activity was important in primary care.
  • Only 13% of GPs correctly stated the current guidelines.
Guidelines (age 19-65)12
  • Aim to be active daily. Activity should exceed 150 minutes a week - at least 30 minutes of moderate activity on five or more days, or bouts of 10 minutes or more.
  • Comparable benefits can be achieved with vigorous activity of 75 minutes a week, or combined moderate and vigorous activity.
  • Undertake activity to improve muscle strength on at least two days a week.
  • Minimise sedentary periods.

A 2012 study involving 67 London practices found not a single GP or nurse knew the current guidelines.3

Lack of time and resources was cited as a barrier to GPs routinely advising about physical activity.2

A more recent review of primary care perceptions of physical activity counselling cited lack of training and knowledge as a primary barrier.4

In the Health Survey for England 2007,5 one in four people said they would be more active if they were advised by a GP or nurse, but 54% of patients said their GP gave no advice on diet or exercise.6 A survey by Macmillan Cancer Support found that 72% of GPs do not speak to patients about the benefits of physical activity.7

Lifestyle advice

The first step is to ask about exercise in every appropriate consultation, alongside recording pulse, BP, temperature and respiration.

The Exercise Vital Sign,8 a validated brief assessment, takes about 30 seconds to perform, by asking:

  • On average, how many days per week do you engage in moderate or greater physical activity (like a brisk walk)?
  • On those days, for how many minutes do you engage in activity at this level?

You then multiply the two measures to arrive at an average minutes per week of exercise, which you can compare with the recommended guidelines on physical activity.

The nature of the consultation and knowledge of the patient's activity status will dictate if it is appropriate to discuss increased exercise as a prevention or treatment.

We cannot expect to change behaviour in every consultation, but we can offer continued guidance in follow-up consultations. NICE guidance on physical activity for adults advocates motivational intervention, hand-outs and follow-up.9

Resources and guidance

Exercise now features in 39 UK guidelines,10 but it can be difficult to find specific points of guidance. In a survey of nearly 3,000 GPs in Wales, many stated that health information should ideally be on one site.11

Endorsed by RCGP Wales, Motivate 2 Move (see Resources) has been created to address this. It is a comprehensive educational package designed to tackle the barriers identified above and to increase the health professional's ability to incorporate exercise advice in consultations.

Designed as brief pieces of information with links to more detailed advice for those who need it, the package comprises five sections:

  • UK physical activity guidelines.
  • Health benefits.
  • Motivation.
  • Starting to exercise.
  • Resources.

This has the potential to lower NHS costs and help address obesity.

  • Dr Johnson is a GP and honorary medical adviser, Public Health Wales

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The benefits of regular physical activity
  • Extends life by 4.2 years (male) and 3.7 years (female).13
  • Reduces the risk of breast cancer by 20-30%.14
  • Reduces the risk of colon cancer by 30-40%.14
  • Reduces the risk of heart disease by 20-35%.14
  • Reduces metabolic syndrome and type 2 diabetes by 30-40%.14
  • Reduces BP by an average 7/5mmHg.15
  • Reduces triglycerides by 5-10%.16
  • Increases level of protective HDL cholesterol.16
  • Reduces the risk of hip fracture by 36-68%.14
  • Helps to prevent the risk of falls and fractures in later life.14



  1. Morris JN, Heady JA, Raffle PA et al. Lancet 1953; 262: 1053-7 and 1111-20. 
  2. Douglas F, Torrance N, van Teijlingen E et al. BMC Public Health 2006; 6138. 
  3. Bird W. 2012 Intelligent Health. 
  4. Hébert ET, Caughy MO, Shuval K. BJSM 2012; 46: 625-31. 
  5. Health Survey for England 2007. 
  6. DH. High Quality Care For All. NHS Next Stage Review Final Report, June 2008.
  7. Macmillan Cancer Support.  Move More. Physical activity, the underrated ‘wonder drug’.
  8. Sallis R. BJSM 2010; 45: 473-4.
  9. NICE. Physical activity: brief advice for adults in primary care. PH44. London, NICE, May 2013.
  10. Weiler R, Feldschreiber P, Sttamatakis E. BJSM 2011; 46: 228-32. 
  11. Personal communication, Welsh Public Health. 
  12. DH. UK Physical Activity Guidelines. 2011.
  13. Wen CP, Wai JPM, Tsai MK et al. Lancet 2011; 378(9798): 1244-53. 
  14. DH. Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. 2011.
  15. Fagard RH, Cornelissen VA. Eur J Cardio Prev Rehab 2007; 14: 12-17. 
  16. Swedish National Institute of Public Health. 2010. Physical activity in the prevention and treatment of disease

This is an updated version of an article that was first published in January 2014.

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