• Discuss the energy balance to help clients understand the role of physical activity in the context of obesity rather than as an isolated behaviour
   
• Help the client assess their readiness to become more active using open questions such as “how ready do you feel to become more active….and why?”
   
• Work through the course of a client’s average day and ask them to identify opportunities where they could be more active
   
• Encourage the client to start gently and build up gradually
   
• Know the national recommendations for physical activity (5 x 30 minutes of moderate intensity physical activity - can be broken into 10 or 15 minute bouts - of moderate intensity physical activity, defined as anything which makes you feel warm and breathe harder than normal for prevention of ill health; 60 minutes for weight loss)
   
• Know the limitations of the national recommendations – obese individuals may have low exercise tolerance and their small first steps are unlikely to produce significant weight loss  
   
• Ensure the client has realistic expectations, and pick up on any other positives which the client associated with physical activity besides weight loss
   
• Anyone can (and should) advocate brisk walking, but formalised exercise programmes, should be left to exercise professionals who have experience and qualifications in working with “special” populations.  Exercise professionals who are members of the Register of Exercise Professionals (REPS) have a means of demonstrating their competency in this area
   
• People who wish to go back to organised or competitive sports, which carry an increased risk of injury associated with obesity, should be advised to start gradually and choose a relatively safe activity (such as walking).  For example, an overweight or obese male who played squash in previous years and wants to return to the game could usefully be advised to lose weight and build cardiovascular fitness.  The adage “get fit to play squash, don’t play squash to get fit” is equally applicable to a number of sporting activities for people carrying excess weight.

Examples of activity and energy expenditure

A simple place to start is to draw-up a directory of local services designed to encourage an increase in physical activity. Some services will already exist that the patient can use, but adherence is more likely to occur if the patient chooses his or her activity, either from a list of known options or from their own experience/knowledge.