Exercise Prescription and Guidelines

The UK guidelines, first issued by the four Chief Medical Officers and refreshed in July 2026 with the headline adult targets unchanged, set recommendations for each stage of life. For adults aged 19 to 64, the aim is at least 150 minutes of moderate intensity activity a week, such as brisk walking or cycling, or 75 minutes of vigorous activity such as running, or even shorter durations of very vigorous activity such as sprinting or stair climbing, or a combination of these intensities, together with muscle-strengthening activities that work the major muscle groups on at least two days. Adults should also minimise time spent sedentary and break up long periods of sitting. A simple way to judge intensity is the talk test: during moderate activity a person can talk but not sing, while during vigorous activity they have difficulty talking without pausing for breath. The 150 minutes can be accumulated in bouts of any length across the week.

The guidelines also cover other groups. Children and young people aged 5 to 18 should average at least 60 minutes of moderate-to-vigorous activity a day across the week, and should take part in a variety of types and intensities of activity across the week to develop movement skills, muscular fitness and bone strength. Under-fives should be active throughout the day: infants through floor-based play including tummy time, and toddlers and pre-schoolers for at least 180 minutes across a range of activities, with pre-schoolers including 60 minutes of moderate-to-vigorous activity. Older adults should aim for the same 150 minutes as younger adults where they can, with added emphasis on activities to improve or maintain muscle strength, balance and flexibility on at least two days a week, which help maintain function and reduce falls. Disabled adults are encouraged to aim for 150 minutes a week, building up gradually, with strength and balance work twice weekly. Pregnant women can continue or start moderate activity, aiming for 150 minutes a week and including pelvic floor exercise. The unifying principles are that some activity is better than none, that any movement counts, and that benefits keep accruing with more.

Prescribing exercise means turning the guidelines into a plan the person can actually follow, individualised to their goals, fitness, preferences and any medical conditions. A useful framework is the FITT principle: Frequency (how often), Intensity (how hard, judged by the talk test, a rating of perceived exertion or heart rate), Time (how long each session) and Type (aerobic, resistance, balance or flexibility work). A prescription starts from the person's current level and is progressed gradually. Changing one FITT variable at a time is a useful, conservative strategy that reduces the risk of injury or discouragement, though progression may adjust more than one component depending on the person's goals, response and clinical context. For someone who is inactive, the first target is rarely the full 150 minutes; it is simply to move more than they do now, since the largest health gains come when the least active become a little more active.

Exercise is genuinely dose-related: the risk of illness and death falls as activity rises, with the steepest benefit at the lower end of the curve, and there is no need to reach a gym to benefit. Walking, active travel, gardening and household tasks all count. Where a more structured route is needed, exercise referral schemes and community programmes can support people with long-term conditions, and specific evidence-based programmes exist for many diagnoses. Safety is individualised rather than a barrier: for the large majority the risks of activity are small and far outweighed by the benefits, and formal pre-exercise assessment is reserved for those with symptoms, unstable or uncontrolled disease, or another specific clinical concern, rather than applied to everyone.

Knowing the guidelines is not enough; the challenge is weaving activity into routine care. Moving Medicine, an initiative led by the Faculty of Sport and Exercise Medicine (FSEM) with Sport England and the Office for Health Improvement and Disparities (OHID), gives clinicians practical, evidence-based tools to do this. Its Active Conversations resources are an evidence-based course built around the time a clinician actually has, offering one-minute, five-minute and longer consultation frameworks that use collaborative, non-judgemental behaviour-change conversations, informed by motivational interviewing, so that even a brief exchange can prompt change. This fits the wider Making Every Contact Count (MECC) approach, in which routine appointments across the National Health Service (NHS) are used as opportunities to raise healthy behaviours.

The Active Hospitals toolkit extends the same thinking to secondary care, helping teams reduce the harm of bed rest and keep inpatients moving, which connects directly to the prevention of hospital deconditioning. Beyond the consultation, clinicians can signpost accessible resources such as the free Active 10 and Couch to 5K apps, local exercise referral schemes, and activities run by councils and the voluntary sector. The SEM clinician's role is to give clear, personalised advice, to prescribe activity as deliberately as any other treatment, and to connect people to the support that helps them sustain it.

• •UK adults are advised to do at least 150 minutes of moderate or 75 minutes of vigorous activity weekly, or shorter durations of very vigorous activity, plus muscle-strengthening on two or more days.
• •Children and young people (5 to 18) should average 60 minutes of moderate-to-vigorous activity a day across the week; older adults add muscle strength, balance and flexibility work on two days to reduce falls.
• •The talk test judges intensity: moderate means able to talk but not sing, vigorous means difficulty talking without pausing.
• •The FITT principle (Frequency, Intensity, Time, Type) structures an individualised prescription, often progressed one variable at a time as a conservative strategy.
• •Some activity is better than none, and the greatest gains come when the least active become a little more active.
• •Moving Medicine and its Active Conversations frameworks help clinicians prescribe activity briefly, using collaborative behaviour-change conversations, as part of Making Every Contact Count.