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Open the conversation

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Would you be happy to spend 4-5 minutes talking about something that can make a big difference to your future health and wellbeing?

Insight

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

Did you know?

Every conversation you have with people about physical activity is important in supporting behavioural change over the life course

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

Download this great infographic showing the UK Chief Medical Officers’ recommendations (2019) for physical activity in adults and older adults

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“Exercises shouldn’t be framed as six weeks, but forever. It only reinforces it as a short term thing.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

Assess impact of the condition

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How has your musculoskeletal pain affected your physical activity levels and the things you enjoy?

Insight

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Whilst not yet focusing on becoming more active, this open question can get the person talking about how things may have changed for the worse … and thus may increase their readiness for change and recovery. Most people are ambivalent about, rather than resistant to, increasing their physical activity levels. 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 their perspective, agenda and priorities and do not assume they:

  • ought to change
  • want to change
  • are primarily motivated by their health
  • either ARE or ARE NOT motivated to increase their activity levels
  • will respond well to a tough approach from you
  • must (or will) follow your advice

Learning skills like motivational interviewing can help you avoid common pitfalls that sometimes make conversations about behaviour change unrewarding and ineffective. Visit our education section to learn more.

Did you know?

Every conversation you have with people about physical activity is important in supporting behavioural change over the life course

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

Download this great infographic showing the UK Chief Medical Officers’ recommendations (2019) for physical activity in adults and older adults

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“Exercises shouldn’t be framed as six weeks, but forever. It only reinforces it as a short term thing.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

Find out what they already know

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

Insight

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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

Brisk walking can be easily incorporated into everyday life for many people and is an acceptable form of physical activity.

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

Real impact

Share benefits

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Can I share some other things people find beneficial to see what you make of them.

Insight

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Based on your discussion so far, choose to share the benefits you judge will be most relevant and important to them. Some benefits are quite generic and others will be condition specific.

Remember the conversation won’t work if you take away their control. Ask permission and keep this a conversation not a lecture.

Did you know?

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

Brisk walking can be easily incorporated into everyday life for many people and is an acceptable form of physical activity.

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

Real impact

Encourage reflection

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What do you make of what I have just said?

Insight

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Allow some space for people to talk and explore the information rather than asking ‘do you understand?’ which can shut things down. Ask if they need anything clarifying and what concerns they might have about how the information applies to them.

Listen and reflect their concerns: ‘you’re worried about X’. Help them to address these issues by sharing the experience of other people: ‘other people I’ve worked with have had those concerns, but what typically happens when they get started is…’ or ‘whilst there is a small risk of X when you get started, this is outweighed by the risk reduction you experience once you have started moving more’. Ask what they think about what you have said.

Did you know?

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

Brisk walking can be easily incorporated into everyday life for many people and is an acceptable form of physical activity.

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

Real impact

Make it personal

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What would be the top 2-3 reasons for you personally becoming more active, if you decided to?

In addition to the personal benefits that being active can have, living an active life can reduce the risk of many common medical conditions by up to 50%

Offer to share some of this evidence if you feel they might be interested in finding out more about the impact of physical activity on disease prevention.

Insight

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Help them to generate and articulate their own reasons, which may or may not be health-related and recognise they might not be interested in long term disease prevention.

Saying ‘if you decided to’ reminds them that they are the decision maker, not you. This helps keep the discussion open and active, focusing your role on providing support.

Did you know?

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

Brisk walking can be easily incorporated into everyday life for many people and is an acceptable form of physical activity.

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

Real impact

Summarise without adding anything

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Can I summarise what I think you have said?

Insight

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Don’t be tempted to impose your own plan at this stage – they may agree with you just to end the conversation. Summarise the main points of the conversation and find out what they are thinking

This may sound something like: ‘so some of the benefits of physical activity for someone like you with X include A and B and C. The most important reasons for you personally would be P and W’.

Using a summary can be a good way to demonstrate and express empathy, that you can see the world from their perspective. Empathy contributes to outcomes in a range of settings.

Did you know?

OARSI consider land-based exercise, water-based exercise and strength training as core treatments that are applicable to all with knee osteoarthritis

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

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

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“If I was more active I may have more pain and my knees might go.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

Ask the key question

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So, what do you think you will do?

If they decide that they are NOT ready:

Thank them for taking the time to talk with you about physical activity and offer an opportunity to review the conversation. Reassure them that help is available when they feel ready to change.

If they decide to become more active:

THEN move on to planning. Continue to keep the focus on them generating their own ideas for change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Insight

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The individual has heard about the benefits of physical activity for someone like them and has had the chance to consider the benefits they would most like to experience. They have heard their ideas spoken back to them, which can help to reinforce them. Now it’s decision time. Asking an open question ‘what do you think you will do?’ rather than a closed question ‘so, are you going to do physical activity?’ helps remind them that they – not you – are the decision maker. If they are not ready to change now this can be challenging for you, but they might have good reasons to keep things the same for now. Encouraging further reflection can be an important part of the process of helping people to make successful changes over time. Offer an opportunity to follow up on this conversation to review their thoughts about making changes.

Did you know?

OARSI consider land-based exercise, water-based exercise and strength training as core treatments that are applicable to all with knee osteoarthritis

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

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

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“If I was more active I may have more pain and my knees might go.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

Agree a plan

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Can I share with you some things people find helpful when making a plan?

If they agree, ask them which of these might suit them

Share the relevant resource from the list below with your patient

Increase walking

This simple and progressive 12 week walking programme, developed by the ‘PACE-UP’ trial team is proven to help increase walking and health in the long term

Set some goals

Use our active lifestyles workbook to help those who are interested in building resilience and setting structured goals to create a roadmap for behaviour change

Use a diary

Creating a personalised monthly schedule helps work out where, when and how someone can start to fit opportunities to become more active into their own life

Use an app

EXi iPrescribe Exercise is a NHS approved app, which provides a personalised 12 week physical activity plan with tailored support for people with long term health conditions. It is free to use, just add the code ‘moving’ when logging on

Insight

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Aim to keep the focus on the individual generating their own ideas about change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Did you know?

OARSI consider land-based exercise, water-based exercise and strength training as core treatments that are applicable to all with knee osteoarthritis

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

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

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“If I was more active I may have more pain and my knees might go.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

Arrange follow up

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How would you feel about coming back another time to build on the thoughts and ideas you’ve shared with me today?

Offer a follow up opportunity with you or a colleague appropriate to the environment you work in and resources available.

Insight

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A follow up appointment can be important after a five minute conversation. Spending more time enables you or a colleague to help the individual build on their own reasons for becoming more active and make them more likely to sustain successful behaviour change in the long term.

The arrangement of a follow up appointment would also be appropriate for those people deciding not to become more active yet, but who want to ‘think about it some more’.  The follow up appointment could be face to face but could also be via telephone or text.

Did you know?

OARSI consider land-based exercise, water-based exercise and strength training as core treatments that are applicable to all with knee osteoarthritis

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

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

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“If I was more active I may have more pain and my knees might go.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

Signpost support organisations

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There are some great, free resources available here and on other websites by people who understand what it’s like living with your condition if you’d be interested to have a look

Support organisations

It can be helpful to share the patient information and other leaflets and links to the following organisations:

Royal Osteoporosis Society

The Royal Osteoporosis Society are a charity that provide help and support for people with osteoporosis. Their website contains numerous educational resources for patients and healthcare professionals.

NASS

The National Ankylosing Spondylitis Society provide support, advice and information to people with Ankylosing Spondylosis. Remaining active is vital for people with this condition and NASS have a comprehensive resource to support people being active with Ankylosing Spondylosis including a series of excellent exercise videos.

NRAS

The National Rheumatoid Arthritis Society is ‘the voice’ of people affected by Rheumatoid Arthritis across the whole of the UK. They have some great resources on physical activity.

Versus Arthritis

Versus Arthritis are a charity who work with all forms of arthritis. Their website has excellent educational resources on a broad range of inflammatory rheumatic diseases and a range of physical activity resources including exercises to help manage pain.

We Are Undefeatable

“We Are Undefeatable” is a national campaign by 15 leading health and social care charities to inspire and support people with long-term health conditions to build physical activity into their lives, in a way that suits them.

Insight

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People may or may not be interested in accessing information and support groups, but they can offer unique support for people contemplating physical activity behavioural change with their condition. Particularly given the range and reliability of information on the internet, trusted resources are important to highlight.

Did you know?

OARSI consider land-based exercise, water-based exercise and strength training as core treatments that are applicable to all with knee osteoarthritis

NICE recommend that exercise should be a core treatment in those with osteoarthritis, irrespective of age, co-morbidities, disability and pain.

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

Real impact

“Exercise can prevent flare ups if I keep it up as a routine.”

“If I was more active I may have more pain and my knees might go.”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”