There is strong evidence supporting physical activity (PA) as a tool for managing and preventing non-communicable diseases such as diabetes, hypertension, and depression (1). Despite the known health risks of inactivity, around 37% of adults in England and 25% globally do not meet recommended PA levels (2, 3). On average, adults in the United Kingdom visit their general practitioner (GP) approximately five times a year, with half of these consultations related to managing long-term health conditions (4). Thus, primary care settings offer an opportune platform to engage a large portion of the population in health promotion efforts (5). Moreover, GPs are perceived as trusted sources of health information and lifestyle advice (6) and regularly encounter patients who could benefit from increased PA to prevent or manage long-term health conditions (6).

Evidence suggests that primary care-based PA interventions are promising and recommended to increase PA (7–11). However, implementing these interventions in routine primary care remains a challenge. For instance, in the United Kingdom, only 15% of GPs report providing PA advice, and only 35–53% of patients report receiving such advice or being screened for inactivity (12, 13). Given that time constraints are a major barrier to PA promotion in primary care amongst GPs (14), there has been increasing interest in utilising other primary care-based healthcare professionals (HCPs) in promoting PA (14). Furthermore, collaborative approaches to PA promotion, have been shown to increase PA engagement amongst patients (9). For example, Kettle et al.'s (9) meta-analysis found that interventions involving primary care professionals (e.g., GPs, nurses) alongside additional support from other specialists (e.g., physiotherapists, counsellors) significantly increased self-reported moderate to vigorous physical activity (MVPA) compared to interventions delivered solely by GPs alone. This review further reported that multiple contacts with other PA specialists, including one with a primary care health professional (e.g., GPs, nurses) are needed to increase participation in MVPA. Findings from this review, thus corroborates previous review (15) that suggests that additional intervention supports from healthcare professionals (HCPs) within and or outside the general practice setting will be needed to effectively implement and sustain the delivery of efficacious PA interventions.

In the United Kingdom, the primary care system is reconfiguring into primary care networks (PCNs) and there are new roles such as link workers (LWs) and first contact physiotherapists (FCPs) as front-line primary care workers health professionals (16–18). These new roles offer opportunities to integrate PA into PC through collaboration among diverse healthcare professionals. However, little is known concerning the ways in which these diverse HCPs could work together to promote PA. Emerging evidence(11, 19) suggest that FCPs LWs, and practice nurses (PNs) have the potential to enhance the capacity for promoting PA in busy primary care settings by incorporating routine PA assessments and behaviour change counselling. However, little is known concerning current PA promotion practices in primary care or how HCPs collaborate in PA promotion efforts. Therefore, the aim of the present study is to gain a deeper understanding of current PA promotion practices among diverse primary care HCPs and to explore how these professionals collaborate to promote PA.

Procedure

This study conforms to the Consolidated Criteria for Reporting qualitative Research (COREQ) (20) (see additional file 1).

Participants were recruited from a previous cross-sectional survey of primary care health professionals in England (19) by stating at the end of the survey a willingness to join a follow-up qualitative study. Survey items were developed from previous research and has been published elsewhere (19). As part of the survey items, participants were asked about their PA habits (i.e. in the past two weeks, on how many days per week have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?). Based on their PA habits (30 minutes or more of PA, which was enough to raise breathing rate), participants were categorised as sufficiently/very active (30 + minutes most days), insufficiently/moderately active (30 + minutes about half the days), or inactive/low (30 + minutes rarely or never). Figure 1 illustrates the PA habit groups of survey participants who consented to an interview at the end of the survey. Forty-four participants (24%) agreed to be interviewed. Following recruitment emails and reminders,19 (43%) participants provided consent and were interviewed.

Data collection

Semi-structured interviews were conducted by the first author. The interview guide was developed based on key findings from a previous survey (19) for the interview guide framework (see Table 1). This initial interview guide was peer reviewed from SH, which led to further refinement of the interview questions. The interviews (n = 19) were conducted via Zoom and Microsoft Teams, each averaging 45 minutes. Interviews were securely recorded, transcribed verbatim, and anonymised.

The first author (JO) recruited participants, conducted interviews, and analysed the data. To enhance trustworthiness, a second reviewer (SH), who possesses extensive experience in qualitative data analysis, independently analysed a subset of the interviews. This process helped to enrich the interpretation of the data and ensured the use of multiple participant quotes to substantiate the identified themes.

A total of 19 HCPs practicing across six primary care regions in England participated in this study. Most participants were male (52.6%) and aged between 26–45 (57.9%). Most were GPs (36.9%) followed by LWs (26%), FCPs (21%) and PNs (15.8%). Majority (47.4%) of participants were sufficiently/very active (30 + minutes most days followed by insufficiently/moderate (36.9%) active (30 + minutes about half the days) and inactive/low (15.8%) (30 + minutes rarely or never). Further participant characteristics are listed in Table 2. Analysis of the data identified four main themes, and five sub-themes: (i) Patient driven PA communication (ii) promoting a culture of PA promotion (subthemes: onsite PA initiatives. and personal experience as a driver for PA promotion) (iii) Team approach to enhance PA promotion in PC (subthemes: someone needs to sit with them, and lack of PA referrals) (iv) Education and training

Participants recognised their unique position to promote PA to those that would most benefit from PA, "We have the right people in front of us; those who are least active and could gain the most from physical activity are the patients visiting us. They represent the ideal target audience, and we see them regularly" (GP 7). However, most GPs and PNs reported that patients often approach them primarily seeking medications, "This tendency arises because we frequently see individuals who are unwell, making them less receptive to information (GP 3). They come to us for medications related to their conditions” (PN 2). As such, participants felt that patients are less receptive to PA promotion. A GP said, “We often see people who are unwell and not always receptive to information. They've come for specific disease treatment, and discussing PA can feel like speaking a different language. The environment in primary care at the moment is very much firefighting and we’re trying to create that prevention narrative. We’re really just firefighting in these situations" (GP 1).

Similarly, FCPs observed that GPs, often prescribe medication rather than promoting PA for managing chronic musculoskeletal conditions. A FCP had this to say on review of patients care plan “GPs often tend to prescribe medications for MSK issues possibly because they do not have time to encourage patients to be active or maybe the patients want pain medications” (FCP 1). Consequently, these perceptions of patient disinterest or expectations influenced the type of PA promoted. Thus, to promote PA amongst patients who are not receptive, participants felt that encouraging any level of movement was worthwhile: "I try to use the word 'movement' because it engages people who might not see themselves as exercisers. It's about encouraging them to do what they can without making them feel guilty" (PN 2) and “I think it’s about finding out what they enjoy, so trying to get any movement is good movement” (FCP 4).

However, one GP, however reported that certain patients irrespective of their presenting complaint are keen to know the specific PA guidelines, A GP shared insights into the types of patients: "I work in an affluent area with well-educated, professional individuals. Often, patients from this background seek facts and figures, having done their own research and come prepared with questions.

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In these cases, they appreciate clear guidelines and concrete information to guide their efforts. There are definitely people who engage well with this method" (GP 2). While many GPs were familiar with objective PA assessment tools like the General Practice Physical Activity Questionnaire (GPPAQ), they raised concerns about these tools being impersonal: "No, I don’t use them. If you introduce a formal scale, it feels forced and can undermine the trust and rapport you’ve already built with the patient throughout the conversation" (GP 4). Similarly, a PN mentioned, "I want my assessment to be really patient led, where I let the patient tell me what they do to stay active or fit, rather than just scoring them or using a rigid tool" (PN 3). As a result of the desire to make PA assessments more personal and tailored to the patient, many HCPs opted for subjective PA assessments based on the National Health Service (NHS) guidelines. One LW shared, "I usually ask if they are meeting the basic recommendation of 30 minutes of moderate physical activity every other day" (LW 2). Another participant added, "For me, simply asking whether they follow the NHS guidelines is enough" (GP 1).

PROMOTING A CULTURE OF PA PROMOTION. This theme concerns how enhancing patient access to PA opportunities, and the personal PA habits of HCPs, have the potential to contribute to fostering a culture of PA promotion. Two key subthemes were generated: on-site PA initiatives, and personal experience as a driver for PA promotion. The subtheme “on-site PA initiatives” highlights the importance of on-site PA sessions and walking groups to remove participation barriers and normalise PA. The subtheme “personal experience as a driver for PA promotion” highlights how personal PA habits deepens enthusiasm for promoting PA to patients.

Onsite PA initiatives.

GPs and PNs acknowledged that the cost of supervised facility-based programs posed a barrier for many patients. A GP noted “The cost of accessing some of these referral programmes is a barrier to our patients and could further act as a barrier to patients who are already not receptive to PA advice” (GP 6). Finding PA opportunities that could be of less burden to patient in terms of accessibility was therefore seen as ideal. As one PN explained, “I try to talk to them about things they can do, like housework, or even walking…...things they might not immediately think of as PA. It helps overcome any mental block they may have against exercise" (PN 3).

Therefore, GPs emphasised that the structure of general practice can facilitate access to referral options like walking: "Patients often have to travel long distances to reach gyms, which many find daunting. Therefore, having options like walking groups or support for walking, along with safe outdoor spaces, is essential" (GP 3). Walking groups led by LWs were identified as an effective way to encourage PA : "Being able to inform patients about our walking groups really boosts their confidence" (LW 2). Another LW said “aside from the social benefit of the walking groups, they also provide us with the opportunity to support patients through helping them overcome barriers to physical activity? while also working with them to collaboratively set a goal” (LW 2). Additionally, hosting walking groups at the GP surgery was viewed as a way to demonstrate the practice's commitment to promoting PA: "Patient often live close to their GP surgeries are more likely to attend a GP appointment, so instead of just coming for a consultation, they’re visiting the surgery for a walk as well" (LW 1).

It was also suggested that the physical environment of the GP surgery could impact PA promotion: "The physical environment would make a big difference. Having bike parking outside, those kinds of things" (GP 3). Another GP added, "Then there’s the building setup, like encouraging stairs over lifts. You can also support health promotion with leaflets, posters, GPs using standing desks, and educating staff" (GP 5). Furthermore, incorporating PA sessions within the general practice building was suggested as a promising way to engage patients in exercise: “Having gym facilities on-site sets a powerful example; the GP surgery needs to embody good health to effectively advocate for it” (GP 1). Another GP, who has integrated a gym into their practice, added, “Providing this space for patients within a medical setting emphasises that PA is just as essential as the pharmacy downstairs” (GP 3). However, concerns about the practical implementation of this initiative were raised, particularly regarding the primary care funding model, which prioritises the volume of clinical services delivered: “The most effective way to increase profits is to have more patients on your list. Dedicating rooms for a gym reduces GP income; those spaces could be used for essential clinical services to expand our patient population and boost earnings per capita” (GP 7) For this initiative to succeed, a GP suggested “all key stakeholders within the general practice must recognise PA as a priority” (GP 2).

Personal experiences of the benefits of PA were viewed as important to promote PA to patients with conviction and enthusiasm. According to a PN “Without personal experience of its benefits, you might only grasp its importance on a superficial level. While everyone acknowledges its significance, if you’re just reading about it in guidelines, you won’t have the same depth of understanding or passion” (PN 3). Adding to this perspective, a GP emphasised the impact of personal involvement in PA, stating “Being personally physically active serves as a constant reminder of its importance for patients, and I think that’s a key aspect for me” (GP 5). Similarly, participants less active recognised the importance of role modelling for PA promotion: “I am not too active… I feel that becoming more active could help me to tell people more about PA. It’s a case of practising what you preach” (GP 2). While being physically active seems to influence PA promotion practices, most participants identified systemic barriers, particularly time constraints, as a major challenge. One FCP stated, "I am very active and feel encouraged to share the benefits of PA with my patients. However, time remains a significant barrier for me" (FCP 1). Another participant echoed this concern, saying, "At the end of the day, it all comes down to having enough time to promote PA. I am active and always want to share how it has benefited me mentally, but sometimes, I just don't have the time to promote it as effectively as I'd like" (PN 2).

TEAM APPROACH TO ENHANCE PA PROMOTION: This theme concerns the challenges faced by GPs and PNs in promoting PA to patients and how collaboration with other PC HCPs could enhance the capacity of PC to promote PA. Two sub-themes emerge: Someone needs to sit down with them to discuss PA, and Lack of PA referral. The subtheme “Someone needs to sit down with them to discuss PA” highlights the challenges GPs and PNs face in delivering PA behaviour change support. It explores how LWs and FCPs collaborate with other HCPs to provide enhanced PA support through personalised PA advice and the promotion of PA in the management of musculoskeletal (MSK) conditions. The subtheme, ‘Lack of PA referral, highlights the challenges link workers encounter in receiving adequate PA referrals from GPs and PNs. It also emphasises how the overwhelming volume of social-related referrals limits link workers' ability to effectively promote PA. This subtheme further emphasises the need for an increased number of LWs to manage these referrals effectively and ensure timely and adequate PA behavioural change support for patients.

All GPs agreed that promoting PA was part of their health promotion role and they are trusted source of information, but they felt constrained by time limitations. One GP stating, "Yes, they'll listen to me and hear what I say, but that doesn’t mean they’ll act on it. Someone needs to sit down with them and create space for reflection, which I can’t do. The key is figuring out how we get the time to facilitate and enable that process" (GP1). As a result, most described their involvement as primarily limited to brief discussions about the benefits of PA. One GP explained, “Our role is more about brief interventions, taking a minute to highlight the benefits for a specific condition and maybe suggesting they see a physio, personal trainer, or join an exercise program” (GP 4). Most GPs acknowledged that merely advocating for the benefits of PA in managing medical conditions is unlikely to result in behavioural change. They believed that patients would require more intensive support to become physically active, which is often impractical within the time constraints of a typical consultation. One GP remarked, "The reality is it's very hard to find the time during a consultation. Selling the benefits of PA and supporting them to make the necessary changes is challenging, and it often takes longer than the 15 minutes we have" (GP 6). The same sentiment was echoed by a PN: “someone needs to sit down with them to provide further physical activity support. I am not sure I have got time to fit that into my consultation” (PN 2).

As a result, GPs and PNs emphasised the importance of involving other PC HCPs such as LWs and health coaches to effectively support patients in becoming more active. They believed that assessing readiness for change and guiding next steps should be managed by other team members. One GP noted, "Patients with low motivation, particularly those facing mental health challenges, need extra support. In these situations, the broader team, including social prescribing, is vital. According to a PN “LWs possess a deeper understanding of local PA options, enabling them to effectively signpost patients to appropriate programs” (PN 3). In addition to directing patients to local activities, GPs and PNs believed that LWs should actively encourage patients to participate in their chosen activities. LWs, as one PN mentioned, can also offer more personalised conversations about physical activity, taking into account barriers and enablers that may affect patients’ engagement. A PN stated “I think they provide tailored discussions that consider a broader perspective on what might motivate or hinder patients” (PN 1). This view was also supported by LWs who opined that making a significant impact on patients’ behaviour requires moving beyond traditional responsibilities, such as addressing social isolation and signposting. They believe that fostering patients' confidence to engage in physical activity is a crucial aspect of their role, which involves having coaching conversations with patients. As one LW explained, “Part of my role is to engage in coaching conversations with individuals to identify their goals and needs. I help connect them to relevant services and collaboratively create a plan. For example, if a patient is motivated by attending a class with a friend, I’ll encourage them to join that class” (LW 1). Another LW, noted “while lifestyle activities are important for both physical and social wellbeing, it is important to tailor these activities patient’s abilities and preferences. For example, I wouldn’t suggest a 92-year-old woman run up and down stairs multiple times a day, especially if she doesn't have handrails. Instead, we will usually explore activities she can safely do around the house, like gardening or using a smart TV or other technology to support home-based exercises" (LW 2).

Furthermore, FCPs described how they provide PA support for their patients. FCPs, felt that their role in PC now enables them to advocate for PA not only as a rehabilitative strategy but also to enhance overall health and well-being. FCPs believed that promoting PA for general health and wellbeing is imperative to prevent and manage chronic diseases such as diabetes which are also risk factor for musculoskeletal injuries. According to one FCP, “Obviously, you look at the file of the patient, they have let’s say chronic disease, either cardiovascular or diabetes, most common one COPD. Then you will discuss how that impacts actually on their injury and why, because sometimes the musculoskeletal injuries can come from those as well. Poor metabolic response can manifest in musculoskeletal injuries like tendinopathies, muscle strains. So you have to discuss those factors, risk factors as part of the management” (FCP 3). Consequently, FCPs felt that GPs could effectively build on discussions about physical activity since they have access to patients’ clinical notes. As one FCP noted, “The physiotherapists kick off the conversation, and then other clinicians can reference those notes. If they see the same patient, they might delve deeper into the topic” (FCP 1).

This study explored how HCPs in primary care currently promote PA and collaborate to promote PA. The study found that PA promotion was infrequent and often limited due to perceptions that patients are disinterested in PA advice and expect prescribed medication. When discussed, PA advice was often limited to simplified messages such as “move more” and brief endorsements of the health benefits of PA. Further, routine assessment of PA was uncommon. The study also found limited collaboration between HCPs concerning PA promotion. For example, referrals to LWs often focused on social issues rather than physical inactivity. There was an apparent mindset amongst HCPs favouring facility-based or supervised PA potentially overlooking more accessible, lifestyle-based PA such as walking.

Consistent with previous research (24, 25), PA was not routinely assessed, in part due to reluctance to use tools like the General Practice Physical Activity Questionnaire (GPPAQ). Participants viewed the GPPAQ as rigid and impersonal, with the potential to disrupt consultation flow and undermine rapport. This perception may reflect broader challenges in prioritising PA within general practice and a lack of clinician confidence in initiating PA conversations. While the GPPAQ has been shown to be easy to administer (26), its integration may be dependent on broader organisational commitment to PA assessment and appropriate training for HCPs to engage in PA conversations. In addition, perceived patient disinterest in PA advice contributed to clinician reticence in raising the topic of PA. This perception has been echoed in earlier studies (27, 28) but may not align with patient attitudes. Evidence suggests (29) that patients are more receptive to PA advice when it is personalised and directly related to their presenting condition. If HCPs lack the confidence, knowledge, or time to deliver tailored advice, this may reinforce the belief that patients are not interested. Together these finding expands existing literature (27, 28), suggesting that clinician assumptions about patient disinterest in PA may be rooted in a lack of confidence, insufficient training, differing priorities or limited time to deliver tailored guidance. The specific origins of this reticence remain unclear and warrant further investigation. Qualitative studies are particularly needed to explore how clinicians judge patient receptivity and how these perceptions shape PA communication in practice.

Although PA promotion was not consistently prioritised in routine consultations, when it did occur, HCPs typically offered simplified advice such as “move more”. The “move more” message was viewed by some HCPs as a practical and palatable entry point. However, while this simple messaging may reflect a pragmatic approach, it may also indicate gaps in knowledge and importance (i.e., of the PA guidelines or the importance of PA for health), uncertainty around their application, or a lack of confidence in discussing them. Although previous studies (14, 30) highlight limited awareness of PA guidelines among HCPs, this study extends the evidence by showing that implementation barriers may also stem from complexity and perceived irrelevance of threshold-based messages. For instance, a recent review (31) found that both HCPs and patients preferred messages encouraging increase in activity towards guideline targets, and supported the use of simpler, more accessible language to convey concepts such as intensity. These findings suggests that while simplified move more messages may support initial PA engagement, it should be part of a broader strategy to help patients reach recommended PA levels. Beyond the need for knowledge of (and acceptance of) the PA guidelines, HCPs are likely to require practical skills to apply them within brief consultations.

In this study, time pressures limited the scope of brief PA advice to statements about benefits linked to the patient’s condition. GPs acknowledged that advice without behavioural support rarely leads to sustained change. Notably, our findings echo previous research (32, 33) showing that while general health benefits are frequently delivered, key collaborative components essential to PA behaviour change (11, 34) (including identifying patient-specific barriers, co-developing PA goals, and arranging follow-up support) are seldom employed. Consequently, GPs and nurses suggested that other health professionals such as health coaches and link workers may be better suited to deliver comprehensive support. This reinforces concerns (11, 34, 35) about the feasibility of delivering comprehensive PA interventions in time-pressured settings and supports the case for a team-based approach (36). In the context of GP shortages and growing demand (37) multidisciplinary collaboration with other HCP in primary care is increasingly necessary to support effective PA promotion.

Despite recognition of the value of collaborative approaches (36), our findings extend this evidence by highlighting that the barriers that limit the effective implementation of team-based strategies in promoting PA within primary care. Consistent with previous research (36), GPs and nurses acknowledged the potential role of LWs in supporting PA promotion. However, referrals to LWs typically focused on social issues rather than physical inactivity. FCPs made PA referrals more frequently, reflecting their movement centred remit. Notably, a previous survey (19) found that LWs reported greater involvement in PA behaviour change support. However, concerns from LWs, GPs, and nurses about LW’s ability to support PA promotion raises questions about the quality and consistency of PA advice provided through social prescribing pathways. LWs report being overwhelmed by social referrals, limiting their capacity to focus on PA. These findings suggest that the potential of a collaborative, team-based approach to PA promotion in primary care is not being fully realised.

General practice was often described as reactive and focused on managing long-term conditions, with limited time or capacity for preventive discussions such as PA. Some GPs questioned the feasibility of integrating onsite gyms due to spatial and financial constraints, reflecting a broader tendency to undervalue lifestyle-based interventions. In contrast, FCPs reported greater engagement with PA promotion, not only in rehabilitation but also for general health likely due to their focused clinical roles and professional alignment with PA. Prior research shows physiotherapists are more confident than physicians in recommending PA and view it as within their remit (38). While their involvement could expand PA promotion capacity, limited patient access compared to GPs raises concerns about reach and equity. GPs remain trusted advisors and are uniquely positioned to reach diverse populations (6).

Finally, this study identified a prevailing mindset among HCPs towards supervised or facility-based PA, as illustrated by suggestions for onsite gyms and referrals to co-located walking groups and leisure centres. However, participation is often limited by personal, social, and organisational barriers (39), with referrals and uptake declining over time (40). Therefore, PA training should also focus on promoting lifestyle-based physical activities such as walking and cycling that are acceptable, free and sustainable(41)

This study reveals a persistent gap between the UK’s ambition for preventative, person-centred care (42) and the reality of PA promotion in primary care. Routine PA assessment as a ‘vital sign’ (43) could identify inactive patients and trigger follow-up advice or referrals, but success depends on organisational commitment and training for healthcare professionals (HCPs). Integrating PA promotion into the Quality and Outcomes Framework (44) and offering financial incentives, as in smoking cessation (45), may drive uptake.

Simple prompts (for example, “move more”) should be paired with training that builds communication skills for tailored, context specific advice. While Current PA training improves knowledge it often falls short in preparing HCPs to initiate PA conversations (46, 47), reflecting a mismatch between policy expectations and clinical readiness. Research should assess training quality and explore ways to strengthen communication skills for routine, tailored promotion.

To strengthen the role of LWs in PA promotion and realise the United Kingdom Government’s neighbourhood health service focused on prevention (42) better integration of LWs into primary care is essential. While the government plans to expand the LW workforce (48), effective PA promotion amongst LW will require investment in training and clearer role definitions. While existing programmes like Moving Medicine and the Physical Activity Clinical Champions, have improved PA promotion among allied health professionals (46, 49), their availability to LWs is uncertain.

Service level innovations such as the Scottish Government’s recommendation to embed PA-focused social prescribers in GP practices merit consideration (50) .Given limited evidence on social prescribing (51), further research is needed to evaluate effectiveness of LWs in delivering PA interventions and to understand why GPs prioritise social over inactivity referrals, with a view to optimising referral pathways for PA promotion. Future research should investigate how clinical culture, funding structures, and team models influence PA promotion, and explore how FCPs can be effectively supported to deliver PA advice at scale.

The prevailing emphasis on supervised or facility-based activity may inadvertently be a barrier to PA particularly amongst patient that may not be able to attend facility-based activities. Supporting these activities requires a multi-level approach. HCPs should offer personalised advice and goal setting tailored to patients’ daily lives, encouraging simple actions like walking or stair use. Behavioural tools like PA tracking technology (52), can also support ongoing engagement in lifestyle-based PA. For those needing more support, referrals to link workers who connect patients to local resources are valuable. Reimagining general practice as an ‘active environment’ requires a cultural and systemic shift that values everyday movement.

This study is the first, to our knowledge, to qualitatively explore perspectives of FCPs and LWs who are recent additions to the primary care workforce, identifying key gaps and opportunities for enhancing PA promotion in England. Including insights from GPs, PNs, LWs, and FCPs provides a comprehensive view of current practices to inform interventions and policy. Participants were selected for varied PA behaviour from a prior survey, ensuring diverse perspectives. However, social desirability bias (53) may have led to overestimations of PA promotion, and participants may have been more interested in PA, introducing selection bias.

PA promotion in primary care remains limited and is often hindered by the belief that patients are not interested, time constraints, and prioritisation of pharmaceutical interventions over lifestyle changes. When PA advice is delivered, simplified messages like “move more” and endorsing PA for health are commonly used but lacks personalisation and behavioural change support. While collaboration across roles particularly with LWs has potential to provide PA behavioural change support for patients, they remain underused. The emphasis on supervised activities overlooks accessible, lifestyle options that could easily be promoted by HCPs. Addressing these challenges requires systemic change to integrate PA assessment and promotion into routine care pathways. This includes addressing training gaps, improving communication skills among HCPs, and aligning structural incentives to value the role of PA in preventive care. Future research should address these complexities by evaluating current training models, explore how clinicians assess patient readiness for PA, fostering effective interprofessional collaboration, and identifying scalable, equitable, and person-centred strategies to embed PA promotion sustainably within everyday clinical practice.