Author: Christine Craig, MS, RDN, CDCES
Founder: Nutrition for Daily Living
Physical activity can support diabetes management and cardiometabolic health, but fewer than one in four American adults achieve physical activity recommendations, and people with diabetes report consistently lower physical activity than people without diabetes.1 Simply educating on recommendations or setting a weekly activity target does not address individual factors that influence implementation.
A recent 2026 scientific statement from the American Heart Association (AHA)2 reintroduced the 5As (Assess, Advise, Agree, Assist, and Arrange) as a structured approach to support behavior change. This framework originated in the 1990s to target tobacco cessation and, over time, was adapted for chronic disease self-management.
It evolved from a more directive approach to emphasize shared decision-making and patient-centered goal setting. Today, this approach is used across lifestyle and chronic disease care, including nutrition, obesity, and physical activity counseling. Its goal is to move beyond education to shared decision-making, individualized goal setting, problem-solving, self-management, and ongoing support.2
Using the 5 As Approach for Activity Interventions
Assess:
Before prescribing more physical activity and exercise, first learn what activity looks like in the individual’s real life. What is the individual’s intention and knowledge about movement? Using open-ended questions, ask about current activity, sedentary time, daily routines, previous experiences with exercise and movement, physical limitations, and access to safe places to move. The goal is to understand both where the person is starting and what may influence their willingness and ability to change.5 Example prompts may include: “It sounds like you are open to being more active. Do you have an idea of how you might incorporate regular activity into your day?” or “Is there something that has worked for you in the past?”2 This approach may help identify readiness, preferences, and potential barriers.2 The ADA also recommends assessing baseline physical activity and sedentary time for people with diabetes and encouraging those who are not meeting activity recommendations to increase movement above their baseline.3
Advise:
As diabetes care providers, we are skilled at understanding evidence-based guidelines while also focusing on the individual’s priorities and abilities. Ask permission to share information and connect information and recommendations to the person’s goals and assessed needs. An example prompt may include: “You want to exercise 3 days a week but feel like you are tight on time. Would you be interested in hearing how others have included some physical activity into their busy schedule?”2. Using this approach, can provide evidence-based guidance while respecting the individual’s priorities, readiness, and preferences.
Agree:
Collaborate with the person to establish a realistic SMART goal (specific, measurable, achievable, relevant, and time-bound). The goal should reflect what the person is willing and able to do, rather than a specific guideline target.5 Collaborate on creating a smart goal and reflect interests: “Joining an exercise group in the community sounds like it interests you, do you know of a specific community group that you will join?” “Do you know how often they meet?”2. Starting below the recommended physical activity guidelines2,3,4 can be a meaningful step, particularly for someone who is currently inactive.4
Assist:
Anticipation of barriers, problem-solving challenges, and identifying resources can make the plan more achievable. The AHA and ADA both recommend considering social context and using supportive, problem-solving approaches.5 For people with diabetes, also consider how physical activity may affect glucose levels, medication needs, and other health concerns.4 When additional barriers are identified, consider referral to an appropriate care provider, exercise professional, physical therapist, or community-based program.
Arrange:
Finally, establish a follow-up plan and continued support. Physical activity changes with health status, work, family responsibilities, access, and other life circumstances, so view the initial plan as a starting point. At follow-up, ask what worked, what was difficult, and what the person wants to change.5 Reinforce all progress and confidence in the plan, which includes the health behavior change and not just clinical outcomes. The AHA recommends incorporating follow-up visits, technology, team-based care models, and community resources, if appropriate, to promote sustained behavior change.5
Give the 5 A's Approach Try
Although the 5 A’s approach is not yet integrated into diabetes management standards of care, it reflects many of the same principles as current guidelines: assessing activity, setting individualized goals, addressing barriers, and providing follow-up.1,2,4,5
While the ADA provides guidelines for physical activity in individuals with diabetes, the 5As offers a framework for translating those recommendations into individualized action. By prioritizing shared decision-making, realistic goals, problem-solving, and ongoing support, the 5As can help diabetes care and education specialists support individuals in incorporating more movement into their daily lives.
Christine Craig, MS, RDN, CDCES
Founder: Nutrition for Daily Living and a member of our Expert Presentation team at the DiabetesEd Training in San Diego.
References:
- Jerome GJ, Boyer WR, Bustamante EE, et al. Increasing equity of physical activity promotion for optimal cardiovascular health in adults: a scientific statement from the American Heart Association. Circulation. 2023;147(25):1951-1962. doi:10.1161/CIR.0000000000001148
- Swift DL, Ross LM, Laddu DR, et al. Role of physical activity in obesity treatment and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2026;154(1):e1-e16. doi:10.1161/CIR.0000000000001441.
- American Diabetes Association Professional Practice Committee for Diabetes*; 8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes–2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S166–S182. https://doi.org/10.2337/dc26-S008
- American Diabetes Association Professional Practice Committee for Diabetes*; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S89–S131. https://doi.org/10.2337/dc26-S005
- Kris-Etherton PM, Petersen KS, Després JP, et al. Strategies for promotion of a healthy lifestyle in clinical settings: pillars of ideal cardiovascular health: a science advisory from the American Heart Association. Circulation. 2021;144(24):e495-e514. doi:10.1161/CIR.0000000000001018
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