Use open questions where appropriate, positively reflecting back to the person. The key to empathic listening can be summarised by remembering the OARS acronym

• open questions
• affirmations
• reflections

It is everyone's own personal responsibility to decide whether they want to make a change. This should be discussed positively without judgement or blame.

Honouring their autonomy can be encouraging. The practitioner might say

• You have the power to be more active if you want to.

Interest in discussing physical activity shows the person in your care is open to change, but it may not mean they are ready. In order to respond appropriately it is important to assess a person's readiness to change their behaviour. Some may be more ready than others.

The practitioner might say

• What do you think generally about physical activity?
• Some people with similar symptoms or problems have found that physical activity such as walking has helped. What exercise or walking do you take part in?
• It’s surprising how even small amounts of walking or other exercise can help with your condition. How do you feel about your current level of physical activity?

The person's response to these questions will give you an idea of how ready they are to change and what barriers they think they will have to making those changes.

Their response will help you decide what other aspects of physical activity they need to discuss further.

If you would like more examples on what to listen out for and how to respond, download Readiness to change from our Physical activity advice resources.

Build the person's understanding of the effects of inactivity, using the Physical Activity Guidelines (external site) and detail the benefits of being more active. This can be a good time to explore what type of activity the person thinks they would enjoy, or have enjoyed in the past when they have been more active. If you can get the person to remember how they benefitted from physical activity in the past, it is easier to encourage them to be more active again.

You can raise any of the recognised general benefits of physical activity. We know that being more active can help with

• sleeping better
• feeling more energised
• helping you socialise
• improved general health and wellbeing
• maintaining a healthy weight and much more.

You may want to use the following prompts.

• Increasing your activity levels is one of the best things you can do for your health.
• It will help improve your [mood/sleep/weight/energy levels/back pain, etc.].
• It can reduce the risk of [cardiovascular disease/dementia/diabetes/depression, etc.].

As this is a two way conversation, take time to understand the person in your care’s needs and tailor the advice on the benefits of physical activity specific to them. For example, for those with a long term condition or co-morbidity, you can discuss in greater depth how physical activity can improve these.

For many long term conditions, physical activity can slow its progression or reduce its severity and medication may be reduced or even discontinued. For people without a chronic condition, the emphasis might be on the health risks of physical inactivity and the prevention of disease. Time can be spent building this understanding of the effects of sedentary behaviour.

Those not yet ready to change will likely give reasons why they can’t be more physically active and even those ready to change may have concerns.

Advice may not be taken on board if barriers are not addressed and explored. If someone cites their diagnosis as a perceived barrier, it should be explained that the vast majority of conditions will improve with appropriate activity. A practitioner might say

• Your [hypertension/depression/diabetes] can actually be improved by being more active.

Barriers may also include previous bad experiences, time-constraints, duties as a carer, etc. It is important to acknowledge these barriers and support the person to build motivation or identify solutions to these.

Identified barriers can be explored more thoroughly by discussing how to overcome these, as well as activity options or intensity. Goal setting and confidence building may also be useful depending on the person's support needs.

If you would like more examples on what to listen out for and how to respond, download Common barriers and coping strategies from our Physical activity advice resources.

The practitioner can enhance a person's motivation to change by exploring and acknowledging their reasons for not being more active and helping them to weigh this up against the possible benefits of being more active (pros and cons). Discuss what type of activity they have enjoyed in the past and the reasons that they have said that they want to be more active.

As well as discussing why physical activity is important, it is also important to identify with the person how they can become more active. A practitioner should provide information and signposting appropriate to the individual. This could be to national portals, community-based programmes, or on-site facilities if these have been established.

Remember to advise the person they can find further information for them on the NHS inform keeping active pages.

It may help to write these down for the person and you should always give them a copy of the physical activity advice leaflet.

This is typically where the conversation would finish.

If the person or practitioner thinks that further input would be useful, time to do so should be offered. This can be carried out during the same consultation, or at a more suitable time and setting in the near future.

Ask the person about how important increasing physical activity is to them and how confident they feel about doing it. Using a visual scale of 0 to 10 like a readiness ruler (download Readiness to change from our Physical activity advice resources) may help.

Discuss the scores they give for both readiness and confidence.

• Why not lower?
• Why not higher?
• Where would you like to be?
• What would need to happen for you to get to a higher point?

Ask the person to think about what makes them feel confident and build their belief in their ability to change (e.g. by encouraging them to remember previous successful changes and efforts, thinking of role models and sources of support).

This can also include helping them to identify times when they might find it more difficult to stick to their plans (relapse prevention), and coming up with strategies for coping with these situations. For more detail on types of strategies, download Common barriers and coping strategies from our Physical activity advice resources.

Discuss ideas on how to increase physical activity. A practitioner might say:

• What types of activity do you enjoy or used to enjoy?
• Do you think you could do more of it?
• Can you suggest ways to change your activity pattern (e.g. ways to increase everyday levels of physical activity, through activities such as walking and reducing the amount of time they spend sitting)?

Physical activity isn't just about vigorous activities like cycling or jogging and even moderate activity will help. Emphasise small changes people can make to their daily routine to increase their activity will help. The key is to move more and sit less by

• walking more
• taking the stairs instead of the lift
• taking up other activities with a friend
• taking the car some of the way and walking the rest.

This can be another opportunity to explore what type of activity the person thinks they would enjoy or have enjoyed in the past when they have been more active.

Encouraging the individual to identify small changes to their daily routine, such as walking to work or taking the stairs more often and ask them to try it at least 1 or 2 times a week at first. Emphasise that something is better than nothing, particularly for those some way off meeting the Physical Activity Guidelines (external site).

Encourage the individual to set achievable goals, gradually increasing their level of physical activity over time. For further information on goal setting, download Physical activity goal setting from our Physical activity advice resources.

It helps if those delivering the physical activity pathway are aware of local physical activity opportunities to which people can be signposted. The ALISS (A Local Information System for Scotland, external) site can help you find physical activity support by postcode.

Information for the public is available on the NHS inform keeping active pages (external site).

Discussing barriers up front can help people in your care to identify times specifically when they might find it more difficult to stick to their plans. It gives you an opportunity to help them to come up with strategies for coping with these situations. For more detail on types of strategies, download Common barriers and coping strategies from our Physical activity advice resources.

You may find that in follow up meetings, they started off well after the last discussion, but have slowly lapsed back into physical inactivity. Reiterate the benefits of physical activity and discuss their motivations for change again. Discuss the coping strategies in response to barriers that prompted them to lapse or even discuss goal setting.

At any stage throughout the discussion, the individual may decide not to continue. If so, the practitioner should find a suitable exit strategy, ensuring that the person knows when and where they can discuss this issues again or take further action. To conclude the consultation, where possible, provide the person with the physical activity advice leaflet. Ideally, advice should end with the person knowing

• how physical activity will benefit them
• where to get more information on ways to be more active
• about local physical activity opportunities that may interest them
• that you may have a follow-up review with them to see how they get on with being more active.