Physical Activity Counseling

Physical Inactivity as a Public Health Concern

Physical inactivity is a public health problem worldwide. Major health improvements could be achieved if the majority of most Western populations achieved the minimum recommendations of 30 minutes of moderate activity, such as walking, on most days of the week. Strategies to promote increases in physical activity at a population level are wide ranging and include government policy, environmental changes such as increasing the number of bike paths, promotional activities led by organizations such as schools and workplaces, activities that focus on groups such as exercise classes, and individual approaches such as mailing people information or meeting with them on an individual basis to counsel about how they might achieve more physical activity in their lives.

Historically, individual approaches to increasing physical activity levels focused on sport and structured exercises that were “prescribed” to clients. Exercise prescriptions were formulated for various groups of the population such as older adults, people with type 2 diabetes, and pregnant women. However, reviews of interventions aimed at promoting physical activity have shown that a person-centered approach is likely to be more effective than a “one size fits all” prescription. In the early days of the use of the person-centered approach, a term such as exercise consultation or exercise counseling may have been used. Exercise was usually defined as a structured activity, such as attending a gym or an exercise class, with an aim of increasing fitness levels. The current preferred term is physical activity counseling/consultation because of the shift toward everyday activities such as walking or gardening, being considered important.

Approaches to Physical Activity Counseling

Most approaches to physical activity counseling assume that individuals move through stages of decision making and behavior change. At one end of the spectrum, there are people who are regularly active and need encouragement to stay active; at the other end of the spectrum, there are people who have not considered being more active and who need information about the benefits an active life might bring to them. In the middle of the spectrum are individuals who are thinking about change or who may have tried to change, but have not succeeded. Sometimes moving through stages happens spontaneously or through self-help procedures. However, health professionals, such as exercise psychologists, can assist people to move through stages.

Specific guidelines about using a person-centered approach to increasing activity levels have been published. These guidelines are based on the available knowledge of what assists people in making exercise behavior change and suggest the following steps:

• Step 1: Determine physical activity history. Discuss the reasons that the client has for wanting to increase activity. Take note of when the client was last active, the kinds of activities he or she might like now, and a measure of recent physical activity (e.g., a 7-day recall of activity).
• Step 2: Discuss decision balance. Ask the client to consider what the pros and cons of increasing activity are for him or her. If there are more cons than pros, ask the client to consider how to minimize some of the cons.
• Step 3: Ensure social support. Determine with the client what kind of support he or she might need and who can provide it.
• Step 4: Negotiate goals. Help the client set realistic and time-phased goals for gradually increasing activity up to a level they have determined (e.g., “In 4 weeks' time I would like to be walking for 30 minutes more on at least 3 days of the week”). Write these goals down.
• Step 5: Discuss relapse prevention. If there is time or if the counseling session is with someone who is already active, then discussion on how to prevent relapse from regular activity should take place. Identifying situations in which relapses back to more sedentary living are seen to be likely, such as holidays, changing jobs, or increased family responsibilities, is a first step in preventing relapse. The client must also consider how to avoid the relapse or minimize the effect of these risky situations.
• Step 6: Provide information on local opportunities. All information on relevant local activities, such as walking paths, swimming pools, and classes, should be on hand to supplement discussion as required.

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