Exercise Counseling With Confidence

In most cases, RDs are qualified to do exercise counseling. Granted, there can be exceptions like providing instruction related to cardiac rehabilitation, physical therapy, or heptathlon training at high altitudes. But most adults do very little structured exercise. For those individuals, dietitians can be great motivators and provide useful advice. Some basic counseling strategies and an understanding of activity-promoting resources can enhance your nutrition therapy sessions and promote meaningful discussions about exercise. When it comes to exercise counseling, it’s important to understand the patients’ perspectives, the primary obstacles they encounter, and be able to problem solve together. Good exercise counselors individualize their interactions with clients, but the following approaches tend to work well when encountering common obstacles to exercise.

1. The “I don’t like exercise” client
A lady once told me that exercise was “torture.” When I explored more, she was talking about going to the gym for intense workouts. She liked to walk and enjoyed the challenge of step goals. So we focused on exactly that.

Reasonable Response: I get it. For some people exercise isn’t something they perceive as enjoyable. Just so I’m sure we’re talking about the same thing, what do you mean when you refer to exercise?

2. The “Exercise is only an antidote to overeating” client
Unfortunately, many people don’t know or think much about the benefits of physical activity beyond weight management (eg, cardiovascular health, diabetes prevention/treatment, brain health and cognitive functioning, bone health, cancer prevention, decreased anxiety and depression, improved sleep). In fact, many of my clients have said things like, “My husband doesn’t need to exercise—he’s thin as a rail.”

Reasonable Response: Although we know exercise can help with weight management, I was wondering if we could talk about some of the other ways exercise may benefit you?

3. The overzealous exerciser
The FITT principle (frequency, intensity, time, and type) can guide our goal setting related to physical activity. The overzealous exerciser sometimes emphasizes intensity over the other three components. RDs can brainstorm ways to help these individuals get into a nearly daily routine of practical activities, including an enjoyable mode of exercise, a convenient location, and moderate intensity. For information on prescribing exercise, check out the American College of Sports Medicine’s position paper on the topic.

Reasonable Response: It sounds like your tendency is to work extremely hard when you start an exercise routine. But when you get crunched for time, burned out, or injured, you stop altogether—a pattern you want to break. Do you have ideas that might help you stay more consistent with exercise?

Many clients respond positively to the approaches above, but they also can benefit from additional resources. Just as dietitians recommend nutrition-related apps, websites, and services, there are a few things we can recommend regarding exercise.

  • Try wearables. Wearable technology is one of the hottest trends in physical activity. Whether it’s a Fitbit, Jawbone, Garmin, Misfit, or Withings product, these devices can increase awareness and assist in goal setting and achievement. If you want to make your discussions easier and more relevant, purchase one and wear it to work so you can “show and tell.”
  • Surf the net. Online resources can be a free way to mix up an exercise routine or encourage exercise when the weather is less than desirable. Websites like, and of course YouTube are sites that your clients may find helpful.
  • Check out apps. Apps like Fitstar and Sworkit let users customize workouts according to their ability, and networking apps like Strava (running and cycling) and mapmyride/walk/run allow individuals to compete against themselves or others.
  • Network. Get to know fitness professionals that work with the same clientele as you. Networking leads to colleagues that you can learn from and refer to when your knowledge base doesn’t meet the needs of your clients. Having personal goals related to fitness also will increase your ability to help others.

— David B. Creel, PhD, RD, HSPP, is a psychologist and an ACSM-certified clinical exercise physiologist. He works as a clinician and researcher at St. Vincent Bariatrics in Carmel, Indiana. Visit his blog at

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