Exercise therapy

Domain IX · Biomedical, neuro & digital

What it is

Exercise therapy here means structured, supervised physical activity used as part of mental health care. It is not a psychotherapy. It is planned, prescribed and supervised by exercise professionals or physiotherapists, sometimes after medical clearance. NICE lists group exercise as one treatment…

Format

• Phase A: Option discussion and screening (within your usual sessions). Goals: decide with the client whether exercise is a fitting option, and screen for cautions. NICE says to offer a choice of treatment that matches needs and preferences, and to consider the least intrusive, least…
• Phase C: Referral and start. The client is referred to a group exercise programme, a physiotherapist, a clinical exercise physiologist, or an exercise referral scheme. A PH54 scheme includes an assessment by a primary care or allied health professional, referral to a physical activity specialist or…

Who practises it, and how they are trained or regulated

• Who delivers: depends on the jurisdiction and the service. Exercise referral schemes use a physical activity specialist or service; PH54 sets no specific staff qualification. Physiotherapists are a registered profession; in the UK the regulator is the Health and Care Professions Council (HCPC), and in the US physical therapists are licensed by state, with APTA as the professional body. In the US, ACSM certifies…
• Version followed: NICE NG222, Depression in adults: treatment and management (2022 recommendations, as published on the NICE website and checked October 2026), NICE PH54 Exercise referral schemes, WHO Guidelines on Physical Activity and Sedentary Behaviour (2020), the ACSM preparticipation screening approach introduced in 2015 (as summarised by the American Council on Exercise), ACSM's Exercise is Medicine…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• all-or-nothing thinking after a lapse.
• referral loss; check whether the first session happened.
• pushing. If the client's own reasons are absent, revisit the choice in B2.
• clients using population figures as rigid targets or as a stick to beat themselves with.
• fitness staff without a clinical credential taking on clients who need clinical monitoring.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.