The way we talk about physical activity matters in chronic illness
Researchers from the University of Southern Denmark, the University of Copenhagen and Central and West Zealand Hospital are calling for a more supportive and realistic approach when healthcare professionals talk to patients about physical activity.
Many people living with chronic illness say advice about physical activity can feel overwhelming or create feelings of guilt. According to the researchers, the way healthcare professionals communicate about physical activity may influence whether patients feel more confident about being active and experience it as meaningful.
This is the main message from Alessio Bricca and Søren T. Skou from the University of Southern Denmark and Central and West Zealand Hospital, together with Julie Midtgaard from the University of Copenhagen and the Mental Health Centre Glostrup, in a new JAMA Insight published in JAMA.
Physical activity does not necessarily mean intense exercise, they emphasise. A walk, taking the stairs or a short bike ride can also make a difference.
Meet the Researcher
Alessio Bricca is an associate professor at the Department of Sports Science and Clinical Biomechanics and a DIAS Visiting Fellow.
The publication summarises research on physical activity, behaviour change and patient communication in chronic illness.
Three questions for the researchers about the study
What does the publication investigate?
We examine how healthcare professionals can talk about physical activity in ways that support motivation and confidence among people living with chronic illness.
What is the most important message?
That the way we talk about physical activity matters. Supportive and realistic conversations may help patients feel more confident about being active, while guilt- or fear-based messaging may have the opposite effect.
How can the findings be used?
The findings can help healthcare professionals create more supportive conversations about physical activity and help patients find realistic and meaningful ways of being active in everyday life.
Supportive conversations rather than guilt
Many patients feel that conversations about physical activity can unintentionally create pressure or feelings of guilt that may be counterproductive to behaviour change.
- Many people believe that physical activity only counts if it involves intense exercise or structured workouts. But for many people living with chronic illness, it is about finding small everyday activities that feel manageable and meaningful in their lives, says Alessio Bricca, associate professor at the Centre for Muscle and Joint Health at the University of Southern Denmark.
Instead of focusing on unrealistic expectations, healthcare professionals should offer reassurance, practical guidance and help patients approach physical activity with more self-compassion, while helping them find activities that work in everyday life.
- If patients feel they are being met with guilt or expectations that it is simply a matter of willpower, it can make it harder to get started. Living with chronic illness often involves pain, fatigue or other barriers that need to be taken seriously, says Julie Midtgaard, professor at the Mental Health Centre Glostrup and the University of Copenhagen.
Key points / recommendations
- Conversations about physical activity can influence motivation and confidence in people with chronic illness.
- Feelings of guilt or fear may make it harder for patients to become physically active.
- Supportive and realistic guidance may work better than pressure or unrealistic expectations.
- Everyday activities such as brisk walking, taking the stairs or short bike rides can also make a difference.
- Healthcare professionals should acknowledge barriers such as pain, fatigue and lack of energy.
- Language such as “wear and tear”, “degeneration” or suggesting that physical activity is easy may affect how patients think about movement and exercise.
- Conversations should focus on possibilities rather than limitations.
- Physical activity can support not only physical health, but also routines, confidence and a sense of control in everyday life.
Small activities still count
The JAMA Insight highlights that even small changes in physical activity may have benefits for health and quality of life.
One international study found that just five extra minutes of daily activity that gets a person slightly out of breath may make a difference for adults who are otherwise relatively inactive.
Supportive communication and opportunities to be physically active with others may also help patients feel more confident about being physically active despite pain, fatigue or uncertainty.
- Activities such as a brisk walk, taking the stairs or short bike rides are all types of physical activity that may be easier to integrate into everyday life, says Søren T. Skou, professor at the University of Southern Denmark and Central and West Zealand Hospital.
Language can shape how patients view illness
The publication also describes how language can influence patients’ understanding of their illness and how they think about movement and exercise.
Terms such as “wear and tear”, “degeneration” or suggesting that physical activity should be easy may make some patients more hesitant to move, while supportive and reassuring communication may help patients feel more comfortable and confident about being active.
- Physical activity can also help people regain routines and a sense of control in everyday life while living with illness, says Søren T. Skou, professor at the University of Southern Denmark and Central and West Zealand Hospital.
The authors therefore argue that conversations about physical activity should focus more on possibilities than limitations and help patients find ways of being active that feel realistic and meaningful to them.
Practical recommendations for healthcare professionals
The publication highlights several ways healthcare professionals can support patients when talking about physical activity:
- Seek permission before raising the topic of physical activity.
- Focus on small and realistic changes rather than ambitious goals.
- Help patients find activities that fit into everyday life.
- Offer reassurance and practical guidance instead of guilt or pressure.
- Acknowledge that pain, fatigue and uncertainty can be real barriers.
- Encourage activities that feel meaningful and manageable for the individual.
Consider social activities such as walking groups or exercise classes where relevant.
About the study
Method
The article is a professional JAMA Insight piece in which the researchers summarise existing research on physical activity, behaviour change and patient communication in chronic illness.
Funding
Not stated in the article.
Conflicts of interest
Søren T. Skou states that he is co-founder of GLA:D, a non-profit initiative at the University of Southern Denmark that works with the implementation of clinical guidelines for osteoarthritis treatment. No other conflicts of interest were reported.
Read the study
Communicating With Patients About Physical Activity, JAMA
Listen to the podcast
Meet the Researcher
Søren Thorgaard Skou is a professor at the Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics.
Meet the Researcher
Julie Midtgaard is a professor at Psychiatric Centre Glostrup and the University of Copenhagen.