As pain affects an individual’s physical activity beliefs and behaviours, focusing on this can be a useful way to introduce the topic


Ask Permission

Ask permission to talk about either ‘physical activity’ or ‘something that can make a big difference to your future health and wellbeing’

Spending a moment to set the scene and asking permission can open a constructive person-centred conversation around behaviour change. This keeps the individual actively engaged in the conversation and decision making.


Assess impact

How has their disease affected their physical activity levels and the things they enjoy?

Supporting behaviour change is hard work! This resource is designed to help you navigate this challenging task.

Most people are ambivalent about, rather than resistant to, increasing their physical activity levels. There are pros and cons to both maintaining the same physical activity levels as well as increasing them. Your challenge is to help an individual to consider and share their own ‘pros’ for increasing their physical activity levels and help them to develop these ideas into a workable plan that fits into their life.

Try to understand the individuals own perspective, agenda and priorities and do not assume they:[1]

  1. ought to change
  2. want to change
  3. are primarily motivated by their health
  4. either ARE or ARE NOT motivated to increase their activity levels
  5. will respond well to a tough approach from you
  6. must (or will) follow your advice

Learning skills such as motivational interviewing can help you avoid common pitfalls that sometimes make conversations about behaviour change unrewarding and ineffective.


  1. Mason P, Rollnick S. Health behaviour change : a guide for practitioners. 2nd ed. /. London: : Churchill Livingstone 2010.

Explore benefits

What do they know about the benefits of physical activity in people with musculoskeletal pain?

As an individual is more likely to change if they can personally identify with the ‘pros’ for change, help them to identify how they might benefit from being more active. Find out what they know first so that you can add to their existing understanding by sharing some of the wide-ranging benefits of being more active.



Did you know?

The least active individuals stand to gain the most from a small increase in physical activity.

Large health gains are observed in individuals increasing their activity levels from very low amounts. For instance increasing from 10 to 20 minutes of moderate intensity activity per week has a significant effect on life expectancy despite the fact that they are still far below the recommended 150 minutes of moderate intensity.

Particular efforts should therefore be made to help very inactive individuals change their behaviour. Healthcare provides unique access to many of the least active members of the population so it is vital that each opportunity to positively influence behaviour is capitalised upon.


Department of Health. Start Active , Stay Active: a report on physical activity from the four home countries’ Chief Medical Officers. London: 2011.

NICE. Physical activity: brief advice for adults in primary care primary care. Natl Inst Heal care Excell Public Heal Guidel 44 2013;

Muscle strengthening and balance activities should be done on at least two days per week

A recent rapid review by Public Health England for UK CMOs review of physical activity guidelines emphasises the importance of regular strength and balance activities throughout the life course.

This document highlights the three key transition points of benefit from regular strength and balance activities. At age 18-24 bone and muscle gains are maximised; from 40-50 years strength and balance activities slow the natural decline; finally from 65 years onward activity helps maintain independence and operate above key functional thresholds.


Department of Health. Start Active , Stay Active: a report on physical activity from the four home countries’ Chief Medical Officers. London: 2011.

Public Health England. Muscle and bone strengthening and balance activities for general health benefits: in adults and older adults. PHE publication gateway reference: 2018207. July 2018

Skelton DA, Mavroeidi A (2018) How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course and are there particular ages where MBSBA are important. Journal of Frailty, Sarcopenia and Falls 3(2): 74-84

Start small and build up gradually for a safe approach to starting activity

Habitually sedentary individuals may have unknown cardiovascular disease so should increase physical activity very gradually – suddenly doing vigorous intensity activity may increase risk of myocardial infarction in this inactive group by 100-fold

Those with active symptoms such as chest pain, acute breathlessness, palpitations signs of heart failure may have serious underlying pathology and should be referred for specialist investigation

Thompson PD, Arena R, Riebe D, Pescatello LS, Medicine ACoS. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013;12(4):215-217.