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Hippocrates said ‘Walking is man’s best medicine’—and this may have some personal challenges for you if you’re very busy with work, or kids, or both, or you may be in pain or have other priorities … but my question for you is: Can you limit your sitting and sleeping to just 23 and 1/2 hours a day?

Dr Mike Evans, physician, Canada

More than 6 million YouTube viewers around the world are aware of this chapter’s opening quote. Canadian physician Dr Mike Evans literally ‘went viral’ with his whiteboard animation of stories that illustrate the enormous potential of regular physical activity and limiting sedentary behaviour in the primary and secondary prevention of many diseases. However, this potential still remains largely untapped and only partially realised in day-to-day clinical practice. Despite the many calls for adoption of physical activity as a vital sign,13 only a third to half of primary care physicians regularly counsel their patients on physical activity.4, 5

Many national action plans on physical activity recommend that clinicians should counsel on physical activity,6 yet progress to meet targets has been slow and inconsistent.7 The lack of physical activity training in medical and allied health school curricula, as well as in continuing professional development, means that clinicians often lack experience, knowledge and confidence to counsel their patients on physical activity.8, 9 Many clinicians meet physical activity counselling outcomes with scepticism and distrust,10 and instead reach for the familiar default—the prescription pad—even when a medication has limited evidence or a large number needed to treat (NNT), as well as the ever-present risk of adverse events. Failing to counsel on physical activity represents a missed opportunity—one that would enable clinicians to improve the health of patients, and with minimal cost.11, 12

Here we summarise the need for regular physical activity counselling in clinical practice. We share a straightforward framework for counselling that can be used easily in a variety of settings. This precedes Chapter 4, where we explore the different principles and elements of exercise prescription.

Establishing the optimum template for physical activity counselling takes time and practice, and can be achieved by considering the following questions in turn:

  • Why perform routine physical activity counselling?

  • Who should be performing the counselling? And who should be receiving it?

  • When and where should counselling be performed?

  • What should be included in the counselling?

  • Where else can the clinician turn to find counselling resources?

  • What should the clinician do if their time with a patient is limited?

  • What else can be done to support routine counselling?


As emphasised in Chapter 1, physical inactivity has reached pandemic proportions. It is a global-scale problem that demands effective, scalable and low-cost solutions. One such solution is physical activity ...

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