Just over a third of men (37%) and a quarter of women (25%) in England take the recommended 30 min of physical activity per day.⁴⁵ Many environmental, cultural and social factors have contributed to the decline in population activity levels.

• We live in the age of convenience when labour and time-saving devices are prized
• Commuting long distances to work is commonplace
• Home entertainment such as television, videos and computers keep people inactive for long periods of time
• There is an increased number of cars, making pedestrian forms of transport such as walking and cycling more hazardous
• Reduction in occupational activity

It has been estimated that the physical activity involved in daily living 50 years ago was the equivalent of running a marathon every week (NAO Report, 2001).⁴⁶

Some of the commonly reported barriers to being more physically active include:

• Lack of time
• Lack of suitable facilities, skill or appropriate equipment
• Lack of enjoyment

It is interesting to reflect on the notion that far from creating more leisure time the inventions of modern technology e.g. computers, and mobile phones have actually resulted in an increased demand on individuals in terms of their availability and therefore their time. It is not surprising that juggling the commitments of work, home and family can create a ‘time burden’ for many. If lack of time is cited as a barrier to being more physically active then it is important to work with the patient in devising strategies to overcome this. For example, instead of having one long burst of activity is it possible to break this into shorter 10-minute pockets of activity throughout the day e.g. having a walk during a lunch break? Ask the patient to track the portion of their day that is dedicated to being active. How does this compare to the time spent on other pursuits? Is there a way of combining activities e.g. spending more time with a friend/partner/family member in the form of a walk, using an exercise bike while watching a favourite TV programme?

Many of those that are overweight or obese feel uncomfortable about where and how they can undertake physical activity. Some individuals are of the opinion that a gym, fitness class or swimming pool is required for physical activity to be valid and cite this as a barrier as to why it is not possible or suitable for them to exercise. However, it has been shown that individuals tend to adhere better to physical activity that is self-directed and convenient to them, compared to physical activity done under supervised conditions at specialised facilities.¹ Patients could be prompted to make use of local facilities such as the park or walkways or cycle paths. There is little need for specialist equipment other than comfortable fitting shoes and loose clothing for walking. If patients are embarrassed about being visibly out of breath or sweating excessively they should be encouraged to work their fitness level up slowly.

It is vitally important that patients choose to take up an activity which they will enjoy doing, otherwise it will feel like a chore. Physical activity can also feel uncomfortable to those who are extremely overweight and it is important that individuals are encouraged to continue with their efforts to become more physically active, no matter how small. Ask individuals to think of a time in their lives when they were more physically active. What did they do then? Would they be able to take this up again, and would they enjoy it? How will they make sure that they can keep this up? Do they need additional help or support?