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Information

Editors

MinnaAittasalo

Exercise Counselling

Essentials

  • Exercise counselling is a process where clients are supported in making gradual changes to their exercise habits.
  • Recommendations in this article are mostly based on the Finnish Current Care guideline Physical activity and exercise training for adults in sickness and in health http://www.kaypahoito.fi/en/ccs00049 and on advice provided by the UKK Institute - Centre for Health Promotion Research in Finland http://ukkinstituutti.fi/en/. Consult also locally available recommendations and patient education materials.

Aims and implementation

  • The aims of exercise counselling should be set individually depending on the client's starting point. The counselling may at first only focus on sparking interest or modifying attitudes.
  • For people who are willing to change and have had previous positive experience of physical activity, increasing the amount of activity may be a completely realistic goal.
  • Clients should be helped to find their own way of making a change.
  • Systematic exercise counselling is a targeted process proceeding in an organized manner from session to session. The 5 A's model helps to outline the process (Table T1).

The 5 A's model

Assess
current physical activity, preparedness to change exercise habits, skills, attitude, knowledge.
Advice
the client on the benefits of physical activity as opposed to inactivity, on the amount of activity required, suitable forms of activity, and health risks.
Agree
with the client on a personal target, and make a concrete plan.
Assist
the client with identifying any obstacles to physical activity and means of overcoming such obstacles and in finding suitable sports and fitness facilities.
Arrange
follow-up visits, and plan the follow-up method/s.

How to intensify counselling

Physical exercise brochures

  • Physical exercise brochures provide information about the benefits of exercise and about the recommended amount and quality of exercise.
  • Find out about locally available useful support materials.
  • Brochures or leaflets should always be gone through with the client.

Physical Activity Prescription

  • Material that takes into account the client's individual needs may be more effective than general physical exercise brochures. An example of this is the Physical Activity Prescription (PAP) following the 5A minimum principles http://ukkinstituutti.fi/en/products-services/physical-activity-prescription-pap/. Find out about locally available application of PAP.
  • A Physical Activity Prescription helps to bring up the topic of physical activity, guides the client towards a good exercise counselling practice and facilitates cooperation within health care.
  • Studies have shown the Physical Activity Prescription to increase physical activity in the short term, at least. However, regular follow-up is necessary to maintain the results.
  • The emphasis should be on physical activity as part of everyday life, which may be more permanent than structured physical exercise. Writing a Physical Activity Prescription takes 5-15 minutes depending on whether it is filled in completely by the doctor or used simply as a referral.

Fitness testing

  • Fitness testing with feedback may increase the subjects' interest in physical activity but usually does not accomplish long-term changes in their exercise habits.

Step counter or step counter app

  • Step counters and step counter apps are easy to use and provide immediate feedback on the amount of activity in a form that is easy to interpret. Step counters are most accurate in measuring walking, which is the most common and easiest form of exercise.
  • Targeted, guided use of a step counter with feedback promotes physical activity in the short term.
  • Instead of giving a general target number of steps (such as 10 000 steps a day), the target should be set in relation to the client's current level of activity. The aim may be, for example, to add 4 000 steps to the average daily number of steps, which, depending on the person's stride length, is equivalent to about half an hour's brisk walk. In people with a very low level of activity, adding 2 000 steps may be a good first target.
  • The average daily number of steps should be assessed based on the numbers of steps taken on at least 3 normal days (such as 2 weekdays and 1 holiday).

Follow-up

  • Follow-up will help to achieve more permanent results.
  • Making follow-up appointments shows clients that the health care professional is interested in their physical activity and ready to support them in achieving any goals that have been set.
  • Therefore, follow-up must be more frequent, the more unaccustomed the client is to physical activity.
  • Most clients need support for a minimum of six months.
  • Follow-up will not necessarily require meeting in person but can be done using communications technology (telephone, text messages, e-mail, internet).
  • Follow-up can best be done in cooperation between professionals in health care and physical training (such as municipal departments for sports).

Physical activity recommendations

  • Healthy people aged 18-64 years:
    • At least 2½ h per week of endurance training equivalent to brisk walking, or at least half this amount, i.e. 1 h 15 minutes per week, of exercise equivalent to jogging
      • Sessions as short as a few minutes can be taken into account.
      • The recommendation can also be fulfilled by combining brisk and strenuous exercise.
    • Strength training on no less than two days a week
    • Exercise exceeding the minimum requirement can increase the health benefits.
  • People over 65 years:
    • In addition to endurance training, training maintaining and improving suppleness, balance and muscle strength
    • Pregnant women
      • Endurance training equivalent to brisk walking for a minimum of 2½ h per week
    • Women who have given birth within the last year
      • Quantitatively the same recommendation as for people aged 18-64, but adding special notes on how to start exercising, on breast-feeding and on training pelvic floor muscles. Find out about locally relevant materials for these.
  • Children under 7: a minimum of 3 hours of physical activity every day
  • Children and adolescents aged 7-17 years:
    • A minimum of one hour of brisk and strenuous exercise per day
    • Physical activity should be varied and age-appropriate.
    • Physical hobbies should be supplemented by everyday physical activity.
    • Breaks should be taken to avoid lengthy physical inactivity.
    • Find out about locally available materials for pupils and students.
  • Find out about locally available modified physical activity recommendations for adults
    • with somewhat impaired mobility
    • needing walking aids or
    • using a wheelchair.