ACTIVATE reaches consensus on physical activity

A recent consensus study conducted by an international team of researchers aims to provide a framework of recommendations for physical activity assessment, prescription and promotion in clinical practice (Bricca et al 2026). 

Led by Danish physiotherapist and researcher Kristian Thorborg along with Alessio Bricca and Mette Aadahl, and with support from the International Federation of Sports Physical Therapy (now known as the International Sports and Exercise Physiotherapy Association), the ACTIVATE study involved 27 clinicians and researchers from 13 different countries, including three Australian physiotherapists and researchers – Professor Maria Constantinou MACP (above left), Associate Professor Joanne Kemp FACP and Professor Anthony Schneiders. 

The ACTIVATE consensus statement is based on the World Health Organization (WHO) 2020 Guidelines on physical activity and sedentary behaviour – a set of evidence-based public health recommendations for children, adolescents, adults and older adults on the amount of physical activity (frequency, intensity and duration) required to offer significant health benefits and mitigate health risks. 

The WHO recommends that all adults undertake 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic physical activity per week or some equivalent combination of the two. 

In addition, the organisation suggests regular muscle-strengthening activities and a reduction in sedentary behaviour for all age groups. 

These recommendations have been widely adopted by countries including Australia, which recently updated its own physical activity recommendations: the 24-hour movement guidelines for all Australians (Australian Government Department of Health, Disability and Ageing 2026). 

Maria says it’s an important topic that aligns with the role of the physiotherapist. 

‘We’re not just physiotherapists who use exercise as one of our main modalities – we also treat people who participate in sports and exercise. 

‘It is important that we assess whether our patients are undertaking enough physical activity. 

‘We also need to work with them to identify their barriers and facilitators and support them to increase their physical activity and reduce sedentary behaviours.’ 

As an educator at Southern Cross University, Maria also strongly believes that this understanding needs to be embedded into physiotherapy training programs right from the beginning as a standard part of practice. 

‘It should be part of the consultation process to ask questions about what physical activity the patients are undertaking, to evaluate and then to prescribe a program within the patient’s lifestyle, abilities and presenting symptoms. 

‘It’s also about promoting physical activity, both to stakeholders and to our patients.’ 

Professor Maria Constantinou was part of the team that developed the ACTIVATE consensus statement.

The ACTIVATE consensus statement followed a rigorous process of development and has resulted in 19 recommendations across three categories: how to assess, prescribe and promote physical activity (see below for a condensed version of the recommendations). 

The researchers also identified some of the barriers and facilitators to integrating physical activity assessments, prescriptions and promotion in clinical practice – from finding time to do an assessment within the constraints of a busy practice to convincing the patient of the importance of physical activity. 

‘Supporting the integration of physical activity into a patient’s daily life is key. 

‘We’ve all heard the term “exercise is medicine” – there are many benefits of exercise, it improves physical and mental health and wellbeing, and it’s effective for many different conditions.’ 

One barrier is the use of the term ‘prescription’, which Maria notes was the subject of much discussion during the consensus process. 

‘We discussed the process of how to convey the information to the patient and how to give them the advice in the form of a prescription. 

‘In the end, the recommendation was to give them a prescription document for physical activity and exercise, much like a doctor prescribes medication.’ 

Technology is seen as both a barrier and a facilitator. 

While the use of wearable technology, such as a Fitbit, Apple Watch or Garmin watch, to track physical activity and other health parameters is becoming widespread, the sharing of that data is potentially a legal and ethical challenge. 

‘It’s something a lot of people use to help motivate them so technology is very useful but we do need to consider what we do with that information from a health professional’s perspective. 

‘If a patient wants to use the technology, then we should work with them to do so.’ 

Further research on the barriers and facilitators as well as on implementation of the recommendations is needed, say the authors of the consensus study paper. 

Maria says assessing physical activity should become part of the consultation process in every setting. 

‘That includes physiotherapists seeing patients not just in private practices or outpatient settings, but also in hospitals, in community settings and in rehabilitation settings. 

‘It’s important that the physical activity conversation with patients is incorporated at every opportunity.’ 

She also says that clinicians should work with other health professionals, eg, with the patient’s GP or other specialists, and especially if the patient’s condition is itself a barrier. 

‘We need to understand the pathology of the condition – for example, diabetes or mental health or osteoporosis – and why it might stop the patient from being able to undertake physical activity. 

‘What limitations does it impose on their ability to meet the guidelines? 

‘If it’s beyond our scope to be able to manage the patient’s condition and incorporate the physical activity, we should refer on to relevant health professionals.’ 

For physiotherapists incorporating physical activity assessment, prescription and promotion into their practice, there are a number of things they should consider. 

Maria says it is important for clinicians to understand the barriers preventing the patient from being more physically active so that they can support behaviour change. 

‘Keep assessments brief, use simple language, avoid technical jargon and focus on small, meaningful increases in activity. 

‘You can start patients off with open goals and then gradually increase the time spent doing physical activity. 

‘In addition to documenting their progress in patient records, physiotherapists can also teach patients to document what they’ve done.’ 

ACTIVATE consensus statement (summary) 

Assessment of physical activity in clinical practice should: 

• be considered in any patient seeking care 
• assess the time spent (minutes) in moderate to vigorous physical activity to identify if patients meet the weekly physical activity guidelines of 150–300 minutes moderate or 75–150 minutes vigorous physical activity, as recommended by the WHO 
• assess whether patients engage in muscle-strengthening activities as recommended by the WHO 
• be quick and easy to administer 
• be documented in their medical records. 

Prescription of physical activity in clinical practice should: 

• be offered to all patients not meeting the weekly physical activity guidelines 
• be provided in a written format (as it would be for medications) 
• outline the frequency (eg, five days per week), intensity (eg, moderate-to-vigorous physical activity), time/duration (eg, 30 min per session) and type (eg, walking) 
• include behaviour change techniques and incorporate patient education handouts and resources 
• consider referring patients not meeting the weekly physical activity guidelines to specific physical activity interventions. 

Promotion of physical activity in clinical practice should: 

• be provided in clinical practice to all patients not meeting the weekly physical activity guidelines for extended periods (eg, six to 12 months) 
• support the integration of physical activity into the patient’s daily life.

Quick links:

• References
• Infographic — coming soon