[Individually adapted counseling about physical activity in medical practice]

The risk to health posed by a sedentary lifestyle is a problem of our times. In contrast to the previous assumption that only fairly high-intensity sporting exercise undertaken over a minimum period of 20 min produces health-related benefits, recent studies have shown that even everyday activities (climbing stairs, brisk walking and cycling) can have a benedicial effects on health, particularly in those who take little exercise. So now the recommendation is: exercise of moderate intensity lasting 30 min at least 5 times a week, corresponding to an energy consumption of about 150 kacl/day or 1000 kcal/week. The results of experimental studies on sport and arthritis and sport and osteoporosis point to the advisability of taking up or maintaining an active sporting lifestyle. For one thing, it can be assumed that a moderate amount of movement does not increase the risk of developing arthritis: for another, sporting activity during early and late childhood produces a high maximum bone mass, therby delaying the development of osteoporosis in later life. The new guidelines on the extent and intensity of health-giving exercise make it easier to advocate exercise and sport for disease prevention and health promotion because they appear to implement. More difficult, however, is deciding on a suitable method for motivating inactive individuals to increase their level of physical activity. A model that has proved effective in smoking cessation programmes, and one that can also be applied to exercise counselling (transtheoretical model), can help in the selection of an appropriate counselling strategy. Depending on whether an individual is inactive, or sporadically or regularly active, each one employs his or her own strategies primarily to maintain this lifestyle. Assuming that the counselling is adapted to the level of activity, the patient's attitude and behaviour can be influenced both more effectively and more economically.