How We Discuss Physical Activity Could Shape Chronic Illness Care

For many people living with chronic illness, being told to “exercise more” can sound less like helpful medical advice and more like another demand they are expected to meet. A new JAMA Insight argues that the language used by healthcare professionals may significantly influence whether patients feel capable of becoming physically active, or instead experience guilt, fear and discouragement. The authors say that effective conversations should move away from pressure and perfectionism and toward realistic, compassionate support.

The article was written by Alessio Bricca and Søren T. Skou of the University of Southern Denmark and Central and West Zealand Hospital, together with Julie Midtgaard of the University of Copenhagen and the Mental Health Centre Glostrup. Rather than presenting a new clinical trial, the publication synthesises existing research on physical activity, behaviour change and communication with patients who have chronic conditions. Its central argument is that communication is not a minor detail in healthcare: it can shape motivation, confidence and the meaning patients attach to movement.

Physical activity, the researchers emphasise, should not be treated as synonymous with intense workouts, gym sessions or formal sports. For someone managing pain, fatigue, breathlessness or reduced mobility, a short walk, climbing a few stairs or riding a bicycle for a limited distance may be a more realistic starting point. These activities can still contribute to daily energy expenditure and cardiorespiratory health, while also helping people rebuild routines that illness may have disrupted.

The distinction matters because many patients believe that activity only “counts” when it is strenuous. That belief can create an all-or-nothing pattern: if a person cannot complete a demanding workout, they may conclude that doing anything less is pointless. Behaviour-change research suggests that such thinking can weaken self-efficacy, the person’s belief that they can successfully perform a behaviour. By contrast, achievable actions can generate small experiences of success, making it easier to repeat the activity and gradually increase it when appropriate.

The authors also warn that guilt-based conversations may be counterproductive. Chronic illness can involve fluctuating symptoms, pain, exhaustion, sleep problems, anxiety and uncertainty, all of which may affect a person’s ability to move on a given day. When professionals imply that inactivity is simply a matter of willpower, patients may feel blamed for circumstances they cannot fully control. That emotional response can lead to avoidance rather than engagement, particularly when previous attempts at exercise have intensified symptoms or ended in disappointment.

A more supportive approach begins by acknowledging these barriers and asking permission before discussing physical activity. Clinicians can then help patients identify movements that fit their symptoms, preferences, environment and daily responsibilities. The goal is not to impose a universal target, but to develop an individually meaningful plan. For one patient, that might involve brief walks separated by rest periods; for another, it could mean standing more often, taking the stairs when feasible or joining a supervised activity group.

The JAMA Insight also highlights evidence that even modest increases in movement may be relevant for people who are otherwise largely inactive. One international study cited by the authors found that five additional minutes of daily activity that raises breathing slightly may be associated with health benefits. Such findings do not mean that five minutes is a complete prescription for everyone, nor do they replace personalised medical advice. They do, however, challenge the idea that only long or vigorous exercise sessions have value.

Social and psychological factors may further influence whether patients remain active. Opportunities to move with other people can reduce uncertainty and provide encouragement, especially for those who are worried about pain or physical limitations. Physical activity may also restore a sense of structure and control. In chronic illness, where symptoms can make everyday life feel unpredictable, a manageable routine can have benefits that extend beyond muscles, joints or cardiovascular fitness.

The language used to describe illness can itself affect behaviour. Expressions such as “wear and tear” or “degeneration” may lead some patients to believe that movement is damaging or that their bodies are progressively failing. Similarly, suggesting that physical activity should be easy may make people feel abnormal when symptoms make it difficult. The authors argue for language that is accurate but reassuring, explaining that movement can often be adapted and that discomfort, fatigue or uncertainty should be discussed rather than dismissed.

The researchers ultimately call for conversations that focus on possibilities instead of limitations. Healthcare professionals can offer practical guidance, encourage self-compassion and help patients choose activities that feel manageable and worthwhile. Physical activity is not presented as a cure for chronic illness, and the article does not suggest that every patient should follow the same programme. Its message is more precise: when advice recognises the realities of illness and supports small, meaningful steps, patients may be more likely to feel confident enough to move.

News Publication Date: 6 August 2026

Web References: https://jamanetwork.com/journals/jama/article-abstract/2852552; https://open.spotify.com/episode/7INpkeDTu4AEidcFHe4dUE

References: Bricca A, Skou ST, Midtgaard J. “Communicating With Patients About Physical Activity.” JAMA. DOI: 10.1001/jama.2026.6083