Footstep 5

Getting active

Regular activity builds confidence, reduces fears about doing activities and improves patients’ abilities to manage their pain. It can be reassuring for those with pain to know that regular activity will be beneficial for them, even if it was not a regular part of their lives before the pain arrived.

Feeling physically stronger with more vitality helps the patient and their brain recognise they are not stuck in the revolving cycle of pain, disability and dependence.

Your role is explore options for regular activity with the patient.

You can do this by:

  • Talking about what getting more active and fitter means – it doesn't have to mean running 10km in lycra! Small regular bouts of activity gradually increasing are just as effective – and the patient is more likely to stick at it.
  • Ensuring that you have introduced and discussed the concepts of pacing and goal setting.
  • Talking about different types of fitness and the kinds of activities that can help.

Action to take

Talk about different types of fitness

For example, an action plan to get fitter could include ideas like these:




To loosen muscles and ligaments that have tightened due to inactivity

Helps improve posture

Ideas and resources

Gentle stretches e.g. ARUK keep moving booklet

NHS Live Well exercises for flexibility

NHS fitness studio videos

Gentle Yoga or Pilates




To build stronger muscles and joints

Makes climbing stairs and getting out of chairs easier

Improves balance

Ideas and resources



NHS Live Well exercises for balance, strength and chair-based options

NHS fitness studio wake-up workout

Tai Chi programmes (evidence finds reduced falls and improved balance)




Building up to being able to do more without feeling pain or tiredness

Ideas and resources

Walking – local groups, easy park run

Swimming – aquafit activities

Static/ road cycling

Dancing to fun music

Talk to your patient about how to stay motivated

Here are some tips you could share:

  • Pace and get the challenge level right at the beginning – don’t start with something too difficult
  • Be ready and organised e.g. get trainers out the night before
  • Identify people to work with who can offer encouragement when it is a more difficult day

A note about pain and exercise – grading

Patients may have been told or give the impression that they should let their pain guide how much they should exercise. Whilst this might be helpful in acute pain it is definitely not the case in chronic pain and often means that patients to little or no activity. It is important to explicitly discuss that your patient is safe to move and emphasise the importance of a steady graded increase in activity. Any activity that can be done easily and regularly is beneficial.

What grading exercise really involves:

  • Identify the baseline distance/length of stretch that starts to increase pain levels
  • Halve this and have a rest at the midpoint of the activity
  • Gradually build up distances or time
  • Ensure activity is enjoyable (and therefore likely to be done regularly)

For example, if pain starts to increase after walking the distance between four lamp posts, on day one walk to two lamp posts, have a rest and then complete the walk by walking back. Each week, use pacing skills to increase the distance.

Identify your local resources for increasing exercise and building activity levels

  • Do you have a display in the surgery or on your website?
  • Could you train your reception team in signposting these resources?

Resources for your patient

Extra resources for you

Useful motivational interviewing approaches to use:

Getting active

Summary of key points

  • Regular activity builds confidence, reduces fears about doing activities and improves patients’ abilities to manage their pain
  • The concept of grading exercise can help to build your patient’s confidence and ensure that they enjoy being regularly active
  • Goal setting (SMART) and pacing ensure any efforts to increase activity levels and fitness are as successful as possible
  • It is important to explain that pain does not mean damage or harm. It is over reactive movement, stretch and touch sensors conveying unhelpful messages of danger to the brain when none exists

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