A physician’s approach to discussing physical activity can strongly influence whether a patient with a chronic condition actually makes exercise part of their routine. While citing the strong scientific evidence behind the benefits of physical activity — now firmly established — is important, data alone often aren’t enough to motivate behavior change. For many patients, particularly those managing chronic illness, the conversation needs to go beyond statistics to truly inspire them to carve out time for exercise.

This is discussed in an article published in JAMA, in which Julie Midtgaard, PhD, Copenhagen University Hospital, Copenhagen, Denmark, and colleagues also provided guidance on how to communicate on these topics. “This article offers physicians some suggestions on how to promote physical activity among patients with chronic conditions, to be adapted to the context, preferences, needs, and values of each individual patient,” the authors wrote.

“Talking about physical activity and its importance — even during and after treatment — is not easy, but it is important that this aspect of care not be overlooked,” Alice Avancini, PhD, a research fellow in exercise and oncology at the Department of Neurosciences, Biomedicine and Movement Sciences at the University of Verona in Verona, Italy, explained to Univadis Italy, part of the Medscape Professional Network. “Especially at the time of diagnosis, it is very common for patients to focus on certain aspects of the disease and treatment, while putting others, such as physical activity and nutrition, on the back burner,” added Avancini, who works daily with patients with cancer at various stages of the disease.

Tailored Communication and Movement

“To think that a brief conversation could change the behavior of a sedentary patient seems optimistic, but in clinical practice, it happens much more often than we imagine. Not because the doctor convinces the patient but because that conversation may be the first time the patient perceives physical activity as a real part of their treatment, not as a moral obligation or a rebuke,” Maria Grazia Romano, a general practitioner at ASL Roma 3 in Rome, Italy; a specialist in nutritional science; and a member of the Italian Federation of General Practitioners and the Italian Society of Preventive Medicine and Lifestyle, told Univadis Italy. “The point isn’t the length of the conversation but the quality of the message,” she said.

The first message that emerges from the article by Midtgaard and colleagues is that any recommendation must be tailored to the patient’s context, preferences, and capabilities. The authors suggest starting by asking permission to discuss the topic and acknowledging barriers to physical activity, ranging from pain to a lack of time, support, or confidence in one’s abilities.

It’s also worth remembering that physical activity encompasses any movement that expends energy, not just structured workouts at the gym. That includes everyday activities such as walking or climbing stairs. How the message is framed matters too: Positioning physical activity as a way to break up inactivity and highlighting the benefits of even low-intensity movement can make the recommendation feel more approachable. Framed positively, the advice may be easier for patients to accept and act on.

“Apart from extremely rare cases, all patients can engage in some form of physical activity,” Avancini explained, noting that what matters is tailoring the exercise program, which can even be followed by patients with metastatic cancer, as suggested by Avancini and colleagues in a recent study. “In my experience, the messages that work best are those that normalize physical activity and bring it back into daily life,” added Romano, who spoke about the importance of setting concrete goals. According to Romano, it’s not enough to say “this is good for you”; it’s better to use understandable, explanatory phrases such as “stabilizes blood sugar” or “lowers blood pressure.”

The frequency and duration of physical activity must also be personalized. As noted in the JAMA article, the World Health Organization recommends that adults engage in at least 150 min/wk of moderate-intensity physical activity or at least 75 minutes of vigorous-intensity physical activity, but this cannot be the initial goal for everyone.

Romano explained that telling a patient “you have to do 150 minutes a week” often overwhelms them. Saying “let’s start with 5 minutes a day, even at home, and then see how it goes” reassures them. The intensity of physical activity should also not be overlooked. “Doing fewer minutes but at the correct intensity can be much safer and more effective than prolonged sessions at light intensity,” commented Avancini, who noted that specific recommendations tailored to various symptomatic contexts are now available.

A Relationship of Trust and Ongoing Dialogue

The strategy implemented in Verona by Avancini and colleagues when prescribing physical activity programs for patients with cancer consists of a very thorough initial consultation, lasting about 90 minutes, followed by continuous and frequent feedback. “The journey is never linear but is built together with the patient: There may be periods when the volume or intensity of physical activity is increased, while in others we must take a step back because the patient may be experiencing specific toxicities or adverse events from their treatments,” he said, emphasizing the importance of discussing with patients their personal goals for their treatment journey — goals around which physical activity must be tailored.

“The strength of community-based medicine lies in its physical and temporal proximity to the patient; we can afford to see them even just a few days apart and for just a few minutes. That’s when the actual prescription is formulated; we explain why it’s necessary, how it should be done, how long it should last, and what warning signs to monitor,” said Romano, who noted some of the obstacles that primary care physicians may encounter: limited time, other clinical priorities, difficulty translating advice into concrete recommendations, and a lack of rapid assessment tools.

“But there is a solution: We need to treat physical activity as a prescribable therapy, with a dedicated time slot, clear goals, and a scheduled follow-up. This is what distinguishes a medical prescription from the advice anyone could give,” he stated, explaining that the approach works especially well when the patient perceives that the doctor isn’t imposing an obligation but is working with them to develop a strategy.

The Importance of Specific Training

One of the issues that still make prescribing physical activity to patients with chronic diseases rare is the lack of specific training for physicians. “Physical activity is an intervention that must be prescribed with the same caution as a medication,” Romano said, noting that there are situations requiring particular caution: patients with cardiovascular instability, uncontrolled respiratory symptoms, severe pain, significant functional limitations, or conditions in which exercise can trigger an acute exacerbation.

“In these cases, the risk may be that doctors play it safe to avoid ‘causing harm,’ but this means depriving the patient of a fundamental therapy. The key is to distinguish between what is risky and what is simply new to the patient,” he said. In this context, physician training and dialogue among specialists are two areas that undoubtedly have room for improvement. “From the perspective of physician training, more time should be devoted to physical activity as medicine as early as medical school,” said Romano. “Referring a patient to a movement specialist can relieve general practitioners and even specialists of doubts and responsibility, and in many cases reassures the patient,” added Avancini, while emphasizing, however, the structural and organizational shortcomings and the lack of dedicated staff. Although the most recent studies show enormous benefits of physical activity — comparable to those of medication — it is difficult to translate these findings into clinical practice, partly due to the lack of established protocols.

From a regulatory standpoint, there has long been discussion (Senate Acts No. 287 and No. 1231) of including physical exercise in the Essential Levels of Care, and the passage of Law No. 149 in October 2025, which recognizes obesity as a medical condition, has opened up interesting possibilities and is beginning to send important cultural signals. Currently, however, the fact that physical activity and exercise sessions are not covered by insurance risks creating enormous inequalities in access to these practices.

“There is still a long way to go, but over the years, we have been witnessing a positive cultural shift, as evidenced by the fact that physical activity and movement are discussed more and more at conferences than in the past,” concluded Avancini.

Avancini and Romano had no conflicts of interest to declare.

This story was translated from Univadis Italy, part of the Medscape Professional Network.