Along with identifying moments of opportunity, and getting physical activity on to the agenda at those moments, staff need to feel confident to make the conversations happen.
There is quite a bit in the literature on low levels of training in relation to physical activity. Undergraduate training programmes in the UK and abroad suffer from a lack of adequate training in physical activity and behavioural change counselling (1,2,3,4,5) although considerable efforts have been made recently to try and address this (4,6,7,8). Consequently, although enthusiasm exists for tackling physical inactivity, the knowledge and confidence levels in physical activity prescription remain low amongst all groups of health care workers (2,4,7,9,10,11,12,13).”Lack of knowledge/training in PA counselling” is the second most cited barrier in the review by Herbert et al. (14), cited by 8 of the 14 studies reviewed 
Our experience suggests a number of interrelated issues which can undermine staff confidence.
- Connaughton, A. V, Weiler, R. M. and Connaughton, D. P. (2001) ‘Graduating medical students’ exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for Healthy People 2010.’, Public health reports (Washington, D.C. : 1974). SAGE Publications, 116(3), pp. 226–34. doi: 10.1093/phr/116.3.226.
2. Cardinal, B. J. et al. (2015) ‘If Exercise Is Medicine, Where Is Exercise in Medicine? Review of U.S. Medical Education Curricula for Physical Activity-Related Content’, Journal of Physical Activity and Health, 12(9), pp. 1336–1343. doi: 10.1123/jpah.2014-0316.
3. Chatterjee, R. et al. (2017) ‘GPs’ knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England’, British Journal of General Practice, 67(663), pp. e668–e675. doi: 10.3399/bjgp17X692513.
4. Dacey, M. L. et al. (2014b) ‘Physical activity counseling in medical school education: a systematic review.’, Medical education online, 19, p. 24325. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4111877&tool=pmcentrez&rendertype=abstract (Accessed: 24 June 2015).
5. Douglas, F., Torrance, N., et al. (2006b) ‘Primary care staff’s views and experiences related to routinely advising patients about physical activity. A questionnaire survey.’, BMC public health, 6(1), p. 138. doi: 10.1186/1471-2458-6-138.
6. Douglas, F., van Teijlingen, E., et al. (2006) ‘Promoting physical activity in primary care settings: health visitors’ and practice nurses’ views and experiences.’, Journal of advanced nursing. Blackwell Publishing Ltd, 55(2), pp. 159–68. doi: 10.1111/j.1365-2648.2006.03903.x.
7. Gates, A. B. (2015) ‘Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients’, British Journal of Sports Medicine, 49(4), pp. 207–208. doi: 10.1136/bjsports-2014-094442.
8. Hebert, E. T., Caughy, M. O. and Shuval, K. (2012) ‘Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review’, British Journal of Sports Medicine, 46, pp. 625–631. doi: 10.1136/bjsports-2011-090734.
9. Joy, E. L. et al. (2013) ‘Physical activity counselling in sports medicine: a call to action.’, British journal of sports medicine, 47(1), pp. 49–53. doi: 10.1136/bjsports-2012-091620.
10. Knox, E. C. L., Musson, H. and Adams, E. J. (2015) ‘Knowledge of physical activity recommendations in adults employed in England: associations with individual and workplace-related predictors.’, The international journal of behavioral nutrition and physical activity. BioMed Central, 12(1), p. 69. doi: 10.1186/s12966-015-0231-3.
11. Kordi, R., Moghadam, N. and Rostami, M. (2011) ‘Sports and exercise medicine in undergraduate medical curricula in developing countries: a long path ahead.’, Medical education online, 16. doi: 10.3402/meo.v16i0.5962.
12. Phillips, E. M. (2012) ‘A call to arms (and legs): Exercise prescription for medical students’, PM and R. Elsevier Inc., 4(11), pp. 914–918. doi: 10.1016/j.pmrj.2012.09.1159.
13.Sallis, R. et al. (2015) ‘Strategies for promoting physical activity in clinical practice.’, Progress in cardiovascular diseases, 57(4), pp. 375–86. doi: 10.1016/j.pcad.2014.10.003.
14.Weiler, R. et al. (2012) ‘Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow’s doctors equipped to follow clinical guidelines?’, British journal of sports medicine, 46(14), pp. 1024–6. doi: 10.1136/bjsports-2012-091380.
15.Reid H (2018) Moving Medicine: the development of a web-based platform to facilitate good quality conversations on physical activity across clinical practice in the NHS Unpublished Master’s thesis, University of Oxford