Evaluating how active a person is, as part of a conversation to help them move more in the future, is recognised as being an important aspect of assessment. The way in which this is done, however, remains a cause for debate.

Gathering data about physical activity levels on a system wide basis can be a powerful way of integrating physical activity contacts into patient pathways, for instance through electronic medical records systems. They can also provide important data for demonstrating change and therefore the impact of an intervention, which can in turn drive changes in patient care and support commissioning of physical activity services.

However, recent evidence shows that any activity is better than none, and that there is no simple cut off or ‘threshold’ for health which applies to everyone. Identifying a cut off point introduces a concept of success or failure and can be detrimental to having a person-centred conversation based on individual values. In practice this can be the difference between a judgemental / diagnostic approach such as ‘you’re not doing enough and need to do more’ to a values based one such as ‘why might you want to become more active, personally?’ which can make them more likely to change their own behaviour.

Assessment tools can be used for screening and are particularly useful in systems. Whilst this can support systems delivery, it’s important to recognise that whilst those who say they are inactive generally are, many people who report being sufficiently active are not when compared with objective measures. This leads to many people who would benefit from a physical activity intervention being excluded on the false assumption they are sufficiently active.

Therefore we recommend that if you are going to assess physical activity levels, it can be helpful to approach it in one of two ways:

1. Include the physical activity vital sign in the assessment phase of a healthcare contact, for instance alongside height, weight and blood pressure measurements.
2. As part of a more focussed physical activity conversation, it might be preferable to explore current levels of activity as part of their daily/ weekly routine as a more informal way of ‘assessing’ physical activity behaviours, and resist the temptation to get too hung up on the numbers. This will facilitate a more patient -centred conversation which can then be developed to explore how they feel about becoming more active in the future and how they might go about it. It then provides an opportunity to share information about physical activity guidelines if appropriate, but try to avoid any statements such as ‘you are/ are not doing enough’.