Physical Activity Counselling and Exercise Prescription for Adults

What if there was one prescription that could prevent and treat dozens of diseases?

Increasing physical activity and fitness has proven effective in the treatment, management and prevention of chronic diseases.1 However, an estimated 82.4% of Canadian adults are not meeting the Canadian Physical Activity Guidelines2 of at least 150 minutes of moderate to vigorous physical activity per week.

Physical inactivity remains a public health concern and when combined with sedentary behaviours, poses an even greater risk to the health of individuals.3 Clinicians can play a pivotal role in supporting and motivating their patients toward positive health behaviour change. Clinicians can assess physical activity levels, counsel patients, prescribe exercise and, when needed, refer to appropriate health or exercise professionals.

Assessing physical activity levels

Physical activity is a vital sign that can be monitored with the majority of patients seen in primary care today. The Physical Activity Vital Sign (PAVS) or Exercise Vital Sign (EVS) assesses a patient’s physical activity level against the minimum activity requirement set out by the Canadian Physical Activity Guidelines.4 The vital sign is simple to measure and record in every adult patient chart.

Ask patients:

Multiply these two measures to arrive at the average minutes/week of moderate or greater physical activity reported by each patient = (PAVS) or (EVS).

Remember that a PAVS or EVS of more than (or) at least 150 minutes is recommended for adults.

The three M’s of exercise counselling

Engage patients in interactive, rather than didactic, conversations about physical activity. Clinicians can help motivate patients to improve their health using the “Three M’s” of effective exercise counselling: Modelling, Mentioning, and Motivating.5


Model the behaviour by living actively. This will provide practical experience and firsthand knowledge for counselling patients to overcome barriers to being active. Refer to the Canadian Physical Activity Guidelines (Canadian Society for Exercise Physiology) for further information.


Mention the advisability of physical activity and ask them if they would like to learn more about how you might be able to help them become more active. As there are currently no sedentary behaviour guidelines for Canadian adults, ask how they might be able to move more and sit less in their activities of daily living.


Motivate patients by eliciting their own motivations for exercise. Ask open-ended questions to try to identify their values for regular physical activity and their level of readiness for change. Emphasize the personal benefits of regular exercise such as feeling better about oneself.

Prescribing exercise

Clients who demonstrate motivation and readiness for physical activity may be interested in establishing an action plan. For patients aged 18 years and up, the Exercise Prescription and Referral Tool includes a prescription pad format on its front and, on the back, key messages and definitions to discuss with patients. This is available for free download or you can order, for a fee, through Exercise is Medicine® Canada (EIMC).

Referring to other health or exercise professionals

Depending on a patient’s needs, clinicians may choose to refer them to community resources or other recognized health or fitness professionals who have advanced knowledge and expertise in using physical activity as a chronic disease prevention and management strategy. Exercise is Medicine® Canada’s Guide for Prescribing Exercise can assist primary health care professionals to assess, prescribe and make referrals for physical activity.

EIMC invites regulated health care professionals to join the new Exercise is Medicine® Professional Network. The EIMC Professional Network brings together health and exercise professionals promoting physical activity as a chronic disease prevention and management strategy to improve the health of Canadians.

For further information about EIMC or to join the EIMC Professional Network, visit

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This item was last modified on April 24, 2018