Physicians may help patients with chronic medical conditions engage in physical activity by acknowledging barriers, emphasizing that any movement counts, and encouraging manageable increases in activity.
The clinical guidance article synthesized evidence from randomized trials, prospective cohort studies, systematic reviews, and qualitative research to provide practical approaches for discussing physical activity. The recommendations addressed supportive communication, safe activity dose and intensity, behavior change, long-term maintenance, and the use of physical activity to cope with chronic illness.
The researchers emphasized that patients with chronic medical conditions may find it difficult to meet the World Health Organization target of at least 150 minutes of moderate-intensity activity per week, but smaller increases in activity may still provide benefit. They noted an individual participant data meta-analysis of 40,327 participants across 7 prospective cohort studies estimated that increasing moderate-to-vigorous physical activity by 5 minutes per day among all participants, except the most active 20%, could prevent 10% of all deaths. The researchers recommended helping patients identify an activity level that improves health without worsening symptoms, often by starting low and gradually increasing activity.
Evidence reviewed in the article also supported self-monitoring and behavior-focused goals. A systematic review and meta-analysis of 89 physical activity interventions involving 19,212 participants identified self-monitoring and behavioral goal setting as techniques consistently associated with improved readiness to become more active.
Wearable activity monitors may reinforce these approaches by providing continuous self-monitoring and real-time feedback, the researchers highlighted. They noted that a systematic review of 121 randomized clinical trials involving 16,473 participants found that interventions providing wearable devices and physical activity feedback increased overall activity by 1,235 steps per day and moderate-to-vigorous activity by approximately 49 minutes per week over 12 weeks.
The researchers emphasized that social support may also contribute to maintaining physical activity. In a factorial trial of 309 older adults with activity levels below guideline recommendations, all participants received an exercise program and a wearable activity monitor. At 12 months, those assigned to peer-to-peer sharing and learning plus a wearable recorded 195 minutes of physical activity per day vs 168 minutes among those receiving information about health and aging, an adjusted difference of approximately 28 minutes per day.
The same trial also showed that goal setting plus a wearable activity monitor, without peer discussion, did not increase physical activity at 12 months. Participants in that group recorded 177 minutes per day vs 186 minutes in the attention-control group.
How physicians discuss physical activity may also shape patients’ perceptions, the researchers noted. They recommended asking permission to discuss activity and acknowledging barriers related to opportunity, including time, support, and access, as well as capability, including pain, confidence, and skills. They also distinguished physical activity—including everyday movement such as walking to work or climbing stairs—from structured exercise. Emphasizing light-intensity activity and framing physical activity as avoiding inactivity may make movement feel more achievable.
Conversely, the researchers cautioned against communication that implies physical activity is easy or that failure to be active reflects nonadherence. Such messages may foster self-blame, fear, guilt, or self-criticism that can inhibit motivation. They recommended presenting physical activity as an opportunity rather than emphasizing the negative health consequences of maintaining current behavior.
The evidence underlying the recommendations has important limitations. The JAMA Insights article is a clinical guidance article rather than a new primary investigation or systematic review and therefore does not have a single study population, prespecified primary outcome, or overall effect estimate. Its recommendations draw on studies with different designs, populations, interventions, outcomes, and follow-up periods. Findings from individual studies therefore apply to their respective populations and interventions rather than establishing the effectiveness of the recommendations as a single intervention. The researchers also emphasized that discussions about physical activity should be adapted to each patient’s context, preferences, needs, and values.
The researchers recommended reassuring patients that barriers to physical activity are common, encouraging manageable increases in movement, tracking activity, setting achievable goals, and identifying sources of social support. Physical activity can also be tailored to patients' needs when chronic illness disrupts established routines.
“Emphasizing activities that fit into daily life can restore a sense of control, and each brief interaction offers an opportunity to reinforce physical activity,” stated Julie Midtgaard, PhD, of Copenhagen University Hospital – Amager and Hvidovre and the University of Copenhagen, and colleagues.
Skou reported cofounding GLA:D, a not-for-profit osteoarthritis guideline implementation initiative. No other disclosures were reported.
Source: JAMA Insights
