Physical activity is an important lifestyle behaviour for the prevention of ill-health. There is no doubt that living a physically active lifestyle has positive impacts on physical, mental, and social aspects of health, as well as playing a crucial role in the management of long-term health conditions, like diabetes and heart disease. Economic benefits for society can also be derived from people being active, including reduced costs to the NHS and fewer people on sick leave. Despite this, in England, around 33% of adults report that they fail to meet the government guidelines for aerobic physical activity, and over 74% fail to meet guidelines for strength-based activity.
The UK Government published its 10-year plan for the NHS in England (PDF) in July 2025, highlighting three shifts: from sickness to prevention, hospital to community, and analogue to digital. Physical activity has already been embedded successfully within the NHS to support the management of long-term conditions including cardiac and pulmonary rehabilitation programmes, musculoskeletal (MSK) hubs, cancer management, exercise referral schemes, and through social prescribing. The new 10-year plan emphasises intensive rehabilitation delivered over shorter periods, aiming to provide timely relief from illness and disease. While this approach has potential, effective implementation by healthcare professionals is key. Delivery must account for both clinical priorities and the individual needs of patients, alongside what studies and guidelines tell us about frequency, intensity, duration, and mode of physical activity for optimal health.
The new intensive rehabilitation approach potentially conflicts with established evidence, particularly in pathways where services are already falling short of the amount of rehabilitation time recommended in the 2023 National Clinical Guidelines for Stroke and updated NICE NG236 Guidance for stroke rehabilitation. Clinical care guidelines also recommend that rehabilitation programmes are delivered for as long as the patient continues to benefit. Intensive rehabilitation plans could risk undermining these principles.
Equitable access to rehabilitation is another factor which policymakers should consider during the implementation of the 10-year plan. Evidence suggests that in England, only half of patients eligible for cardiac rehabilitation actually attend, potentially indicating many people face barriers that prevent their attendance. These barriers commonly relate to issues with travel, scheduling and having lower income, so having an intensified rehabilitation programme potentially risks exacerbating these barriers. It is important to increase access for people who need it, and there is encouraging evidence that some remote programmes can improve engagement compared with traditional, face-to-face services. Implementing remote services will help the shift from analogue to digital, but we need to consider if they are effective across different health conditions and for people who potentially face digital exclusion. An alternative approach could be to deliver physical activity programmes with community leisure providers, helping to bridge gaps in long-term access to exercise and rehabilitation. This would also support the 10-year plan priority to move care from “hospital to community”.
Partnership working between the NHS, sport and leisure sector, and local authorities will be vital in the neighbourhood approach to health and care set out in the NHS 10-year plan. These stakeholders will need to come together to develop ways to make best use of their existing facilities, skills and knowledge to give the public access and support to become physically active. Incorporating qualified exercise professionals within the health and care system could provide the person-centred care around physical activity that is needed for the prevention and management of ill-health. For instance, perhaps registered Clinical Exercise Physiologists, who specialise in prescribing and delivering evidence-based exercise interventions for people with a wide range of health conditions, could be integrated into GP practices using the NHS additional roles reimbursement scheme.
The physical activity sector is already largely based in communities. Sport England and ukactive have highlighted the need to utilise the existing network of facilities in communities (for instance in leisure centres, gyms, swimming pools), as well as co-locating leisure alongside health services. There are pockets of good partnership working across sectors that can be used as case studies to develop and scale efficient and effective services for the public, but these need to be unified through a national strategy that can be adapted to local contexts. Perhaps this is an area where neighbourhood health hubs will come into their own, with GPs, nurses and pharmacists working together with exercise professionals and dieticians at local leisure centres.
People are likely to do more physical activity if this is delivered or suggested by a healthcare professional. To achieve a more physically active population, investment will be needed to upskill staff and embed physical activity into mainstream health and social care education. This would give health and social care staff the tools to support people in being more active. Whilst there are educational packages already available to these staff (for example Sport England's Moving Healthcare Professionals Programme; Moving Medicine; RCGP Physical Activity Hub), the reality is that clinicians have limited time in appointments and lack knowledge and confidence to promote physical activity. Increasing knowledge around physical activity in the health and care workforce and supporting them to work closely with exercise professionals will be important for bringing physical activity to the forefront of prevention and treatment in healthcare.
To achieve a more physically active population, investment will be needed to upskill staff and embed physical activity into mainstream health and social care education.
Commentary on physical activity and the NHS 10-year plan has so far focused mostly on the shifts to prevention and community care, but the physical activity sector has much to offer in the shift from analogue to digital. For instance, the plan aims to “make wearables standard in preventative, chronic and post-acute NHS treatment by 2035”. For decades, digital technologies have been used in physical activity research and practice. From elite sport sensors (for example for hydration, heart rate, pressure or force of movements) to everyday fitness wearables and apps, there are many lessons to be learned from that can be applied to NHS healthcare. The 10-year plan aims to improve the NHS app to make it a “digital front door” to the NHS and to build a new HealthStore of apps. Physical activity could be built into the NHS app, while the HealthStore could include physical activity apps that we know work to get people more active. There is a wide range of research showing us what works to get different populations more active using digital approaches. This evidence should be used to make decisions around embedding physical activity within the NHS move to digital.
In the 10-year plan, the government proposes national campaigns and promoting physical activity through individual incentives and awards. Whilst incentives work for different people, there is good evidence to suggest that loss-framed incentives (e.g. losing a reward or having a cost for not being physically active) may be more effective than gain-framed incentives (a reward for being more physically active) to increase physical activity, particularly among those who are inactive or living with obesity. More research is needed to investigate which incentives for physical activity work for whom, in which contexts, for how long, and whether this would be value for money for improving public health.
The physical activity sector—practitioners, researchers, and educators—has a key role to play in delivering the NHS 10-year plan to create a society that is truly “fit for the future”. Physical activity can drive prevention and innovation, but success means careful consideration of the desire for intensive approaches with evidence-based practice, utilisation and expansion of existing community-based programmes, and harnessing digital technologies and programmes to widen access and engagement. Policymakers, the NHS and community organisations need to come together to capitalise on shared knowledge and experience to deliver the plan and, ultimately, improve the health of our society.
