Table 5 Patient-related barriers to GPs giving physical activity advice and patients exercising from most to least cited barrier

COVID-19 pandemic and its consequences including closure of sports facilities, health restrictions and the psychological impact

“Next door we have the swimming pool and gym. (…) plenty of patients have not gone back there because they were afraid of Covid 19” (GP8)

Cost of physical activity, particularly sports club memberships

“I am not sure that everything has to be free. Memberships are not very expensive” (GP13)

Lack of time, which some participating GPs felt was an excuse

“It’s up to them if they want to make the time but there is always half an hour to spare” (GP13)

Patient beliefs with some believing you should rest not exercise when you have low back pain

“Often, they mention cleaning, gardening, DIY, their job. But they don’t make any progress, it’s irregular” (GP14).

Lack of suitable sports facilities, remoteness of some patient’s homes, and lack of infrastructure such as fitness trails or cycle paths, particularly in rural areas

“We don’t have a local gym, so patients have to travel 25 km to go to the gym and that is very difficult” (GP11)

“There are very few bike paths and the roads can be dangerous on a bike. There are people who like cycling but don’t do it because of this” (GP15)

Fatigue, particularly associated with a working day

“They work and are tired and there is nothing we can do about that” (GP11)

Patient expectations

“Sometimes we have the impression that they expect us to deliver them from evil” (GP16)

Patient excuses

“They exercise initially but they won’t walk in winter because there could be ice. They won’t go when it’s too dark, foggy or raining” (GP8)

Sedentary culture, particularly the addiction to screens

“How do we make physical activity more attractive than video games?” (GP15)