‘Talking the walk’ – how to motivate patients to be physically active

Exercise psychologist Dr Paula Watson provides practical tips for nurses to foster physical activity motivation in their patients

As the 2024 Olympic Games approach their finale, patients may be feeling more inspired to get moving themselves. Yet too often life gets in the way of these plans for more activity and, despite good intentions, the opportunity for a personal Olympic legacy becomes overshadowed by busy lives, school pick-ups, work deadlines and evenings in front of the TV.

For nurses working in the community, physical activity may often come up in conversations related to weight or general health, or when patients bring it up themselves. Given the extensive health benefits of physical activity, it could be worthwhile including the question: ‘Could I ask how much movement you do?’ in all your routine consultations.

How much physical activity should patients aim for?

Five years ago, the chief medical officers from the four home nations published guidelines for engagement in physical activity for health.¹ (Table 1)

It is important to bear in mind that these guidelines are intended for professional use rather than to be shared directly with the public, for whom terms such as ‘sedentary’, ‘intensity’ and ‘aerobic’ may be difficult to understand.²

For many patients, particularly those with chronic health conditions or who have been inactive for some time, 150 minutes a week may feel unobtainable so the idea should be to ‘build up towards the recommendations’ rather than consider them a target for everyone.

In fact, research shows that the greatest health gains are achieved when those who are very inactive start doing just a little physical activity (eg, going from nothing to 30 minutes of physical activity across the whole week).¹

While it is helpful for nurses to be aware of the specific physical activity guidelines, language such as ‘some is good, more is better’ may be more helpful for patients.²

It is also important to talk about movement as a holistic concept, and emphasise that all types of movement including household chores, walking for transport and playing with the children ‘count’. This can be affirming for patients who do not take part in formal exercise or sport but are in fact meeting the recommended guidelines through incidental movement.

If health benefits can be gained from such a small amount of physical activity, why don’t more people do it?

When approaching conversations about physical activity, it is important to be mindful of the many barriers people face to being active. These may be biological (eg, age, gender, disability), socio-cultural (lack of social support, religious or cultural beliefs, socio-economic status) or psychological (lack of confidence, lack of motivation, body consciousness).

Patients, and particularly those living with obesity, may have negative past experiences of physical activity that can lead to anxiety and fear of judgement from others.

If we are not careful in how we have conversations about physical activity, our well-intended ‘gentle encouragement’ can be heard as preaching, judging or blaming (eliciting feelings of ‘I’ve failed again’ or ‘what’s the point’).

Another group who may struggle with physical activity are patients with anxiety, depression or other mental health conditions. We often talk about the positive causal link between being physically active and mental wellbeing, but rarely do we talk about the bi-directional element of this relationship. If your mental wellbeing is good, it’s easier for you to be physically active. Conversely, those with poorer mental health often face additional barriers to physical activity (eg, fatigue, social anxiety, low mood).

Tips for motivating patients to be physically active

Nurses are skilled in offering an empathic and non-judgemental space for patients to talk about their health. To do this in relation to physical activity, it can help to think about the theory behind motivation.

Self-determination theory highlights that it is not how much motivation we have that matters, but the quality of that motivation.³ If our motivation is autonomous (ie, engaging in physical activity through our own choice, for enjoyment or to achieve a personally meaningful goal) we are far more likely to stay active in the long term than if our motivation is controlled (ie, engaging in physical activity because we feel we ‘should’ or for others’ approval). For example, one of our recent studies showed having a ‘meaningful why’ is important for beginner runners.⁴

We can foster autonomous motivation in others by satisfying three psychological needs:

Autonomy – giving the patient ownership, choice, and helping them find personal meaning in being active.
Competence – helping the patient believe they are capable of being active.
Relatedness – ensuring the patient feels cared for and knows we are there to support them in being active.

Below, I share some practical strategies for supporting these needs during consultations, which may in turn enhance patients’ motivation to be active.

Video examples of ‘needs-supportive communication’ are available in the HealthyWEY resource (see communication and behaviour change modules), which is an online e-learning toolkit aimed at equipping frontline practitioners to have conversations with parents and carers about weight, physical activity and diet. The communication strategies are transferable across contexts and are relevant for a range of health behaviours.

For further guidance on providing physical activity advice for patients with specific health conditions, refer to the Moving Medicine resource, which also includes a free online training course for having conversations about physical activity.

Supporting patient autonomy

Listen empathically and come from the patient’s perspective

Every patient is individual and may face a variety of barriers to physical activity.

Ask open questions to understand their current physical activity levels, their feelings about being physically active and anything that might stand in the way. Have the conversation in the context of the patient’s culture, age, gender, health condition and other commitments such as work or caring responsibilities.

Importantly, this does not mean you need to be an expert on specific physical activity needs for different groups. Rather, it is about recognising the patient’s own expertise and asking individuals how you can best support them. For example, asking ‘how do you feel your health condition/culture/disability impacts on your ability to be physically active?’ or ‘what kind of support would be helpful for you to become more physically active?’

It may help to be aware of common barriers faced by certain groups, and practical considerations when promoting physical activity.

For example:

Women, especially mothers, may face additional barriers to physical activity, such as childcare responsibilities, cultural stereotypes, and lack of opportunity. It is important to work with women to identify ways of fitting physical activity into their day, which might for example include short bursts (eg, 10-15 minutes) of ‘me time’ to do an online yoga session, walk with the pram, or helping women identify female-only physical activity opportunities in the local community. As a psychologist, one of the most common areas I work with is helping mothers recognise that their needs matter – it is ok, and important, to take care of themselves. It is not selfish nor should they feel guilty for looking after their own health and wellbeing (the ‘put your own oxygen mask on first’ analogy can be helpful here).
- Further ideas for supporting accessible physical activity for women are provided by This Girl Can.
- Physical activity is also important for women who are pregnant. Guidance is provided in the UK Chief Medical Officers’ (2019) infographic, and expanded in the HealthyWEY module.
Muslim women’s participation in physical activity may be influenced by cultural factors, such as the need for modesty, particularly after puberty. Practical support may include helping women source ‘sport hijabs’, identifying local activities with female-only sessions, changing spaces and female coaches, and that allow flexible dress. Further information about facilitating physical activity for Muslim women can be found here.
Individuals with disabilities may face additional barriers such as cost, transport, difficulties in planning or finding sports clubs that provide inclusive support. Mencap provide some useful guidance for promoting physical activity for those with learning disabilities, including downloadable physical activity cards to practice at home, here. Further information about making physical activity accessible for those with disabilities can be found here.

Focus on today, not the distant future

Research suggests it is more meaningful for patients to think about the immediate benefits of physical activity (eg, social, mental health, enjoyment), rather than threats of what might happen in the future (eg, reducing risk for cardiovascular disease).⁵

Ask the patient to imagine what benefits they might personally gain from doing more physical activity, and what impact this would have on their day-to-day life? For patients who are ambivalent, motivational interviewing skills can be helpful.

Encourage choice and enjoyment

Help patients appreciate the variety of ways it is possible to be active, and to try different things to identify what works for them.

Something I like to use when working with clients is an ‘Ideal physical activity task’ (free to download here). This task encourages clients to imagine a world in which they have no physical, financial or psychological barriers to physical activity – what types of physical activity would they really like to try and why?

This can provide a window into the patients’ values and help generate physical activity ideas that align with what is important to them. For example, if:

they enjoy helping others they might like to check out the Good Gym;
they enjoy team sports but have physical limitations, they might like to check out walking football or wheelchair rugby;
family time is the most important factor, they might consider ways to be active with their children.

Supporting patient competence

Remind patients that every movement counts, however small

Encourage patients first to reflect on what they’re already doing – a physical activity diary can be helpful in this. Then start with a small change and build up. For example, if a patient is doing nothing now, explore with them ways they might be able to introduce a 5-minute walk into their day.

If goals are achievable, patients can experience early success – which will in turn enhance their sense of competence and motivation to do more.

Involve the patient in setting their own goals

It is important patients feel ownership of their goals, rather than feeling like they’re being told what to do. Yet at the same time, people often struggle to set their own goals and may look to you for guidance.

A useful tool is ‘guided goal setting’, where you provide a few options, then ask the patient to choose between these, and together you can work the goal into something more personal to them.

This video from the HealthyWEY toolkit shows me demonstrating this kind of collaborative goal setting with a parent (actor) of a young child (focused on changing eating behaviour).

Ensure goals are specific

Setting specific action plans can be a way to help turn good intentions into behaviour.

Once you’ve identified a suitable goal (eg, to do a 20-minute walk three times this week), work with the patient to establish specifically when they will do this (eg, days, time), where they will walk (eg, park, local streets), and anything they need to prepare to ensure it happens (eg, arrange their day, suitable clothing).

You might also consider what barriers might get in the way and help patients come up with a plan to overcome these if they occur.

Take a long-term perspective

Encourage patients to be realistic about how to fit physical activity into their lives, and how they can keep this up in the long run.

Too often people think in ‘all or nothing’ terms, eg, either go to the gym every day or do nothing at all. Remember it’s better to do a little and sustain it, than do a lot for two weeks then quit.

Supporting patient relatedness

Plan for social support

Encourage patients to identify a friend or family member who can support them, either in being active together or through emotional (eg, check-ins or helping with goalsetting) or practical (eg, offering childcare or transport) support.

Signpost to physical activity initiatives

Liaise with link workers or health and wellbeing coaches to find out about the local physical activity initiatives in your area, eg, exercise referral schemes or parkrun, or NHS initiatives such as Couch to 5K.

Empathy and care

The empathy and care that is embedded in nursing practice goes a long way in helping patients feel a sense of relatedness. Never underestimate the impact of remembering a patient’s name, asking about their interests, and showing understanding of the barriers they face.

Dr Paula Watson is an HCPC-registered exercise psychologist working in private practice (Made Up To Move)

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