Although psychological outcomes associated with participation in exercise are important, consideration also needs to be given to patients' wider needs. Exercise therapy is much more than simply a way of providing facilities for patients to take part in exercise; like other therapies, it is an active psychological process. When promoting exercise with patients it is also crucial to consider the long-term consequences of this type of therapy. Many clinical patients will previously have been mostly sedentary or they will not possess the psychological skills or knowledge to adhere to a regular exercise programme and therefore they will need more than exercise alone. Ideally, exercise should be offered in conjunction with exercise counselling that is aimed at equipping individuals with skills, knowledge and confidence so they feel able to participate in physical exercise on a regular basis throughout the rest of their lives. Therefore, it is important that exercise therapy incorporates practical strategies that give patients the physical and psychological tools to sustain their exercise behaviour and experience positive psychological gains from exercise once the therapy comes to an end. In accordance with the principles of the transtheoretical model (Prochaska & DiClemente, 1983) exercise therapy sessions should use a variety of cognitive–behavioural techniques (such as cognitive reappraisal and consciousness raising, goal setting, self-monitoring and finding social support) for promoting positive exercise attitudes, experiences and behaviour. Exercise and lifestyle counselling should be offered within a counselling framework and, ideally, exercise therapists will have some experience of counselling psychology. Perhaps one of the most well-known and used approaches in mainstream counselling psychology is Carl Rogers's theory of person-centred therapy (1957) and it would be important for exercise therapists to demonstrate the core conditions of unconditional positive regard, empathy and congruence in their relationships with patients.
Exercise and lifestyle counselling
