By Marianne Lie Becker

Credit: Styves Exantus from Pexels

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 health care 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 an article published in JAMA.

Physical activity does not necessarily mean intense exercise, they emphasize. A walk, taking the stairs or a short bike ride can also make a difference.

The publication summarizes research on physical activity, behavior change and patient communication in chronic illness.

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 behavior 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 Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark.

Instead of focusing on unrealistic expectations, health care 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.

Small activities still count

The article 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 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," Skou says.

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.

More information: Julie Midtgaard et al, Communicating With Patients About Physical Activity, JAMA (2026). DOI: 10.1001/jama.2026.6083