People have the right to be involved in discussions and make informed decisions about their care, as described in making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

The evidence statements underpinning the recommendations are listed in the evidence section. Full details of the evidence are in the evidence reviews and economic modelling report for this guideline.

See also the recommendations for research and gaps in the evidence.


The recommendations have been made within the context of other national and local strategies and interventions to increase or maintain physical activity levels in the population.

These might include addressing barriers to activity, for example, through changes to the physical environment or other measures to support an active lifestyle. (See NICE's guidelines on physical activity and the environment and walking and cycling).

The availability of local opportunities to be active will influence whether brief advice has an impact on people's physical activity levels.

Brief advice

The term 'brief advice' is used in this guidance to mean verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion.

Box 1 Physical activity: definition and current UK recommendations


Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. It takes many forms, occurs in many settings, and has many purposes (such as daily activity, active recreation, and sport).

Health-enhancing physical activity includes multiple types of activity: cardiovascular; muscle and bone strengthening; and balance training (see the UK Chief Medical Officers' physical activity guidelines for more information).

National recommendations

Follow the UK recommendations on the type, intensity and duration of activity (see the UK Chief Medical Officers' physical activity guidelines).

Box 2 Benefits of physical activity
  • Prevents and helps to manage conditions such as coronary heart disease, type 2 diabetes, stroke, mental health problems, musculoskeletal conditions and some cancers.

  • Has a positive effect on wellbeing, mood, sense of achievement, relaxation and release from daily stress.

Whose health will benefit?

Adults aged 19 and older who are inactive ('inactive' refers to those who are not currently meeting the UK physical activity guidelines).

Recommendations 1 and 2

Who should take action?

Primary care practitioners – that is anyone working in primary care whose remit includes offering lifestyle advice. Examples include: exercise professionals, GPs, health trainers, health visitors, mental health professionals, midwives, pharmacists, physiotherapists and practice nurses.

Recommendation 1 Identifying adults who are inactive

  • Identify adults who are not currently meeting the UK physical activity guidelines (see box 1). This could be done, for example:

    • when the opportunity arises during a consultation with a primary care practitioner or while people are waiting

    • as part of a planned session on management of long-term conditions.

  • Use professional judgement to determine when this assessment would be most appropriate, for example, when someone is presenting with a condition that could be alleviated by physical activity. When assessing activity levels, remain sensitive to people's overall circumstances. If it is not appropriate during the current consultation, carry out an assessment at the next available opportunity.

  • Do not rely on visual cues (for example, body weight). Use validated tools such as the general practice physical activity questionnaire (GPPAQ) to assess physical activity levels. (This is an example of a validated questionnaire for assessing the current level of physical activity of someone aged 16 to 74. The index can be cross-referred to Read Codes and can be used to determine whether brief advice might be appropriate. See government guidance on using the general practice physical activity questionnaire.)

  • For people who are not meeting the UK guidelines, identify the most appropriate time to discuss physical activity with them. This might be during the current consultation or in a later consultation, and might involve referral to another member of the primary care team. If they agree to a future consultation, make sure it occurs at the earliest opportunity. Ensure the person at least leaves the initial consultation aware of the health benefits of physical activity (see box 2).

  • Record the outcomes of the physical activity assessment. Use Read Codes if appropriate. (Read Codes is the standard clinical terminology system used in general practice in the UK.)

  • Encourage people who are assessed as meeting the UK physical activity guidelines (see box 1) to maintain this level of activity.

Recommendation 2 Delivering and following up on brief advice

  • Advise adults who have been assessed as being inactive to do more physical activity, with the aim of achieving the UK physical activity guidelines. Emphasise the benefits of physical activity. (See box 1.)

  • When delivering brief advice, tailor it to the person's:

  • Provide information about local opportunities to be physically active for people with a range of abilities, preferences and needs.

  • Consider giving a written outline of the advice and goals that have been discussed.

  • Record the outcomes of the discussion.

  • Follow up when there is another appointment or opportunity. The follow-up could consist of a conversation about what physical activity someone has been doing, progress towards their goals or towards achieving the UK physical activity guidelines (see box 1).

Recommendations 3 to 5

Who should take action?

Commissioners of health services, including primary care and public health services.

Recommendation 3 Incorporating brief advice in commissioning

  • When commissioning services to prevent or treat conditions such as cardiovascular disease, type 2 diabetes and stroke or to improve mental health, ensure brief advice on physical activity is incorporated into the care pathway.

  • Ensure brief advice on physical activity is incorporated into services for groups that are particularly likely to be inactive. This includes people aged 65 years and over, people with a disability and people from certain minority ethnic groups.

  • Include physical activity assessment and brief advice as part of a strategy for addressing domain 2 of the public health outcomes framework indicator on the proportion of physically active and inactive adults.

  • Ensure assessment of physical activity and the delivery of, and follow up on, brief advice (see recommendations 1 and 2) are built into local long-term disease management strategies. Highlight physical activity as an independent modifiable risk factor for many conditions (see box 1). Strategies should also raise awareness of physical activity assessment as part of relevant quality and outcomes framework (QOF) indicators.

Recommendation 4 Systems to support brief advice

  • Ensure systems such as Read Codes are being used to identify opportunities to assess people's physical activity levels and deliver brief advice.

  • Ensure resources (for example, standard documents and forms) and systems are available to assess, record and follow up on the provision of brief advice.

  • Ensure information about local opportunities to be active (including non-sporting activities) is available and up to date. This could include online maps and route finding for walking or adapted cycling.

Recommendation 5 Providing information and training

Provide information and training for primary care practitioners. This should cover:

  • how physical activity promotion fits within their remit and how it can help prevent and manage a range of health conditions (see box 2)

  • the definition of physical activity: what constitutes moderate and vigorous physical activity, and what intensity, duration and frequency of physical activity is needed to achieve the UK physical activity guidelines (see box 1)

  • groups more likely to be inactive (see recommendation 3)

  • misconceptions about who needs to increase their physical activity (based, for example, on visual cues such as body weight)

  • how to undertake physical activity assessments

  • local opportunities for physical activity

  • the needs of specific groups, such as people with disabilities, including local opportunities for them to be physically active

  • delivery of brief advice including, for example, the skills to motivate people to change (see NICE's guideline on behaviour change: general approaches).