Why knowing that exercise is healthy isn't enough—and how effective communication, individualized assessment, realistic goals, and progressive programming can help people become more physically active.
Introduction: The Problem With Telling Patients to Exercise More
Most people already know that physical activity is good for their health.
They have heard that exercise improves cardiovascular fitness, supports metabolic health, builds muscular strength, and may reduce the risk of chronic disease.
They may even receive the same recommendation repeatedly during medical appointments.
Exercise more. Walk regularly. Lose weight. Become more active.
But what happens next?
How should someone begin exercising when they have chronic pain, limited mobility, or little previous training experience?
What type of exercise should they perform?
How intense should it feel?
What should they do when a particular movement causes discomfort?
How can someone distinguish between an appropriate training challenge and a reason to modify activity?
And how should their exercise program change as their physical capacity improves?
These questions reveal an important limitation in conventional health advice.
Knowing that exercise is beneficial is not the same as knowing how to exercise safely, effectively, and consistently.
In August 2026, Julie Midtgaard, Søren Skou, and Alessio Bricca published Communicating With Patients About Physical Activity in JAMA.
Their article examined how clinicians can discuss physical activity with individuals living with chronic health conditions.
Rather than relying on generalized advice or emphasizing weight loss alone, the authors proposed a more supportive communication approach that recognizes patient preferences, practical barriers, and personal circumstances.
Their central recommendation is straightforward: effective conversations about movement should help patients identify realistic opportunities for activity rather than leave them feeling that they have failed to meet an ideal standard.
This perspective aligns with a broader scientific understanding of exercise as an individualized intervention.
Why Exercise Advice Often Fails to Produce Behavior Change
There is a difference between receiving information and translating that information into action.
A patient may understand the importance of cardiovascular exercise but lack confidence in beginning.
Another may enjoy resistance training but experience persistent joint pain.
Someone recovering from an injury may fear that activity will worsen their condition.
Others face time constraints, financial limitations, transportation difficulties, caregiving responsibilities, or inadequate access to exercise facilities.
These barriers are not necessarily evidence of poor motivation.
They may reflect genuine limitations in opportunity, physical capacity, or previous experiences.
Consequently, exercise counseling should not begin by assuming that everyone has the same resources or needs.
The goal is to understand what prevents the individual from participating and identify appropriate ways forward.
The Importance of Asking Permission
One of the central recommendations in the JAMA article involves obtaining permission before discussing physical activity.
This approach recognizes that patients should participate in decisions about their own healthcare.
An exercise conversation can begin by exploring whether the individual wants to discuss their current activity habits.
This creates an opportunity to understand the patient's perspective.
Someone may already be frustrated by repeated recommendations to exercise.
Another may have tried several programs unsuccessfully.
A third may be interested in becoming more active but uncertain where to begin.
Rather than immediately prescribing an exercise target, the clinician can learn what matters to the individual.
This is consistent with patient-centered healthcare and shared decision-making.
Effective counseling should be collaborative rather than purely instructional.
Supportive Communication Without Shame
The JAMA authors emphasize acknowledging that difficulty maintaining physical activity is common.
This matters because exercise is frequently discussed in ways that create guilt or self-criticism.
Patients may interpret inactivity as evidence of laziness or inadequate discipline.
However, health behaviors are influenced by environmental conditions, symptoms, psychological experiences, and competing responsibilities.
A supportive conversation can recognize these realities while still emphasizing the value of movement.
Importantly, empathy should not be confused with avoiding meaningful recommendations.
Patients deserve clear information about the health benefits of exercise.
They also deserve practical guidance that accounts for their circumstances.
The objective is to combine scientific accuracy with realistic expectations.
Exercise as Self-Care Rather Than Punishment or Dietary Counter-Weighting
Physical activity is sometimes presented as compensation for eating, weight gain, or perceived personal failure.
This framing may contribute to negative experiences with exercise.
An alternative is to approach movement as an opportunity to improve function and well-being.
For one person, this may mean walking without becoming excessively fatigued.
For another, it may mean returning to recreational tennis.
An older adult may want greater confidence climbing stairs.
A parent may want enough energy and strength to participate in activities with their children.
An athlete may want to improve performance or recover from injury.
These goals provide personally meaningful reasons to engage in activity.
The value of exercise should not be reduced to body weight or appearance.
Starting at the Appropriate Intensity
One of the most common mistakes in exercise programming is prescribing intensity without considering the individual's current capacity.
A workload that is manageable for a trained person may be overwhelming for someone with significant deconditioning.
Conversely, a very low training stimulus may not adequately challenge a highly trained athlete.
The JAMA article recommends a practical approach to perceived intensity.
For many individuals, moderate activity produces faster breathing while still allowing conversation.
This is commonly called the talk test.
It provides a useful approximation of exercise intensity without requiring advanced testing.
However, perceived exertion and heart-rate responses can vary because of medications, autonomic conditions, cardiovascular disease, and other factors.
For patients with significant medical limitations, exercise intensity may require more individualized evaluation.
The goal is to identify a manageable stimulus rather than prescribe the same intensity to everyone.
Why Some Discomfort Does Not Necessarily Mean Harm
Many people avoid exercise because movement produces discomfort.
However, the relationship between pain and tissue injury is complex.
Muscular fatigue and temporary soreness may occur during appropriate training.
Certain rehabilitation exercises may also produce tolerable discomfort.
However, not every painful response should be ignored.
Symptoms must be interpreted according to the individual's diagnosis, clinical history, and the characteristics of the response.
For example, mild muscular discomfort during a rehabilitation exercise may be acceptable in selected circumstances.
Progressive neurological symptoms, chest pain, syncope, or other concerning symptoms may require prompt medical evaluation.
Similarly, certain musculoskeletal conditions require specific movement modifications.
The objective is not to encourage people to push through every symptom.
It is to distinguish manageable training sensations from signs that activity should be modified or medically assessed.
Why Individualized Exercise Prescription Matters
Exercise can be manipulated through several variables.
These include exercise selection, intensity, duration, frequency, volume, rest intervals, movement complexity, and progression.
Different combinations produce different training stimuli.
A patient with reduced cardiorespiratory fitness may benefit from a gradual walking or cycling program.
Someone with muscular weakness may require progressive resistance training.
An individual recovering from injury may need targeted strengthening and task-specific movement practice.
A person with balance limitations may benefit from appropriate balance and coordination training.
However, prescribing all of these interventions without assessment can create unnecessary complexity.
An individualized program begins by determining which capacities are relevant to the person's goals and limitations.
Assessment Before Prescription
A comprehensive movement assessment can provide useful information about physical capabilities.
Relevant domains may include joint mobility, strength, movement coordination, aerobic fitness, balance, and task performance.
However, no single assessment is appropriate for every person.
A patient recovering from surgery may require a different evaluation from a healthy recreational athlete.
Someone experiencing dizziness may need vestibular or cardiovascular assessment.
An older adult with falls may require evaluation of strength, balance, vision, medications, and other relevant risks.
Functional Movement Systems screening can provide structured information about selected movement tasks.
However, screening results should not be interpreted as comprehensive diagnoses or definitive predictors of injury.
Their usefulness depends on the clinical question and how results inform appropriate exercise decisions.
Assessment should guide programming rather than become an end in itself.
When Exercise Selection Should Change
More exercise is not always better.
Sometimes an individual benefits from temporarily removing a particular exercise from their program.
For example, a movement may exceed current tissue tolerance, provoke excessive symptoms, or require physical capabilities the person has not yet developed.
In these situations, a modification may allow continued training while addressing relevant limitations.
A person struggling with a demanding loaded movement may begin with a variation that permits better control.
Someone recovering from an injury may initially use reduced loads or shorter ranges of motion.
As tolerance and function improve, more demanding exercises can be reintroduced.
However, movement quality should not be used to impose one supposedly perfect technique on every person.
Human movement is naturally variable.
The important considerations are task requirements, individual anatomy, capacity, symptoms, and appropriate load progression.
The Role of Progressive Overload
Progressive overload refers to gradually adjusting training demands to promote continued adaptation.
This may involve increasing resistance, repetitions, duration, intensity, or task complexity.
However, progression should not occur automatically.
The appropriate rate depends on response.
If an individual is improving and tolerating training well, progression may be appropriate.
If symptoms worsen or recovery becomes inadequate, the program may require modification.
Some patients benefit from relatively rapid progression.
Others require smaller adjustments.
The objective is a sustainable relationship between training stimulus, recovery, and adaptation.
Why Self-Monitoring Can Help
The JAMA article recommends self-monitoring as one strategy for supporting physical activity.
Tracking activity may help individuals recognize patterns, monitor progress, and maintain routines.
Wearables, exercise logs, calendars, and simple written records can all serve this purpose.
However, monitoring should be useful rather than burdensome.
A person may benefit from tracking weekly walking time.
An athlete may require more detailed information about training volume and intensity.
A patient with chronic fatigue or variable symptoms may benefit from recording activity tolerance and recovery.
The appropriate level of tracking depends on what information is needed to guide decisions.
Collecting large amounts of wearable data is not inherently beneficial unless the information leads to meaningful action.
Why Behavior-Based Goals Matter
The JAMA authors recommend setting realistic goals focused on activity rather than outcomes alone.
This distinction is important.
Body weight, blood pressure, and physical fitness may change over time, but these outcomes are not completely under conscious control.
A behavioral goal identifies something the individual can directly attempt.
For example, a patient might choose to walk for a manageable period on several days each week.
Another may schedule resistance training twice weekly.
A person recovering from injury may focus on completing a prescribed rehabilitation routine.
These actions can be monitored and adjusted.
However, goals should remain flexible.
Illness, travel, work demands, and other circumstances may require adaptation.
The objective is continued engagement rather than rigid adherence to an unrealistic schedule.
Developing Habits That Fit Real Life
Behavior change becomes more practical when exercise fits existing routines.
A person may be more consistent with walking after lunch than attending an early-morning gym class.
Another may prefer home-based strength training because of transportation or scheduling constraints.
Some individuals benefit from group exercise and social accountability.
Others prefer independent activity.
There is no universal motivational strategy.
Effective programming should account for preferences, availability, perceived barriers, and previous experiences.
A technically sophisticated exercise plan that cannot be maintained may be less useful than a simpler program performed consistently.
Motivational Interviewing and Physical Activity
Motivational interviewing is a collaborative communication approach used to explore personal motivations and ambivalence about behavior change.
Rather than relying primarily on confrontation or persuasion, it emphasizes autonomy, reflective listening, and personally meaningful reasons for change.
A 2024 systematic review and meta-analysis published in The BMJ examined behavioral interventions incorporating motivational interviewing for physical activity among adults.
The review found evidence of beneficial effects, although results varied according to study characteristics and outcomes.
Motivational interviewing should not be viewed as a guaranteed method of producing exercise adherence.
However, it provides an evidence-informed framework for conversations that respect patient autonomy.
For clinicians, the central lesson is that effective guidance requires understanding what patients value—not merely explaining what they should do.
Why Chronic Medical Conditions Require More Than General Advice
Exercise is beneficial for many individuals with chronic medical conditions.
However, these patients may require additional considerations.
Someone with type 2 diabetes may need to account for medication-related hypoglycemia.
A person with cardiovascular disease may require specific intensity guidance.
An individual with osteoarthritis may benefit from progressive strengthening adapted to pain and function.
Someone with a neurological disorder may require movement modifications or specialist rehabilitation.
These considerations should not automatically exclude people from exercise.
Instead, they support appropriate assessment and individualized planning.
The goal is to make physical activity accessible while addressing relevant safety concerns.
Rehabilitation, Wellness, and Performance Are Different Starting Points
Exercise prescription can serve several distinct purposes.
Rehabilitation emphasizes restoring function, managing clinically relevant limitations, and supporting recovery.
Wellness programming focuses on maintaining or improving physical health and everyday capacity.
Performance training emphasizes adaptations relevant to specific athletic or recreational goals.
However, these categories overlap.
An individual completing rehabilitation may transition toward general fitness.
Someone pursuing wellness may develop performance goals.
An athlete may require rehabilitation following injury.
A comprehensive program should recognize these transitions and adapt training accordingly.
The objective is continuity rather than treating each stage as an unrelated service.
What Personalized Movement Care Looks Like
A patient-centered movement program begins with understanding the individual.
What activities do they want to perform?
What currently limits participation?
Which health conditions influence exercise?
What training experience do they have?
How much time can they realistically dedicate?
What resources are available?
And how will progress be evaluated?
The resulting plan may include multiple components, but each should serve a clear purpose.
For example, a person with poor lower-body strength may benefit from progressive strengthening.
Someone with limited aerobic endurance may need cardiovascular conditioning.
A patient with movement-related fear may benefit from education and graded exposure.
Another may require treatment of a specific medical condition before pursuing more demanding activity.
The program should evolve as the individual responds.
How This Research Informs Move Well
We recognize that exercise advice should translate into meaningful action.
Our Move Well philosophy integrates movement assessment, rehabilitation principles, fitness evaluation, individualized exercise programming, and health coaching.
We emphasize understanding the patient's goals, current capabilities, and relevant limitations before recommending a training strategy.
For individuals recovering from injury, this may involve identifying appropriate exercise modifications and gradually rebuilding physical capacity.
For patients pursuing general wellness, the focus may be on sustainable strength and aerobic conditioning.
For athletes, programming may require more detailed monitoring and progression.
We also recognize that movement screening and fitness assessments are tools rather than guarantees of injury prevention or performance enhancement.
The value of these assessments lies in whether they support better clinical decisions.
Our objective is to help patients understand their physical capabilities, participate in appropriate movement, and build the confidence and skills needed for long-term independence.
Conclusion: The Best Exercise Recommendation Is One a Patient Can Understand and Implement
The benefits of physical activity are supported by a substantial body of research.
However, knowing that exercise is beneficial does not automatically make it accessible.
Patients may face physical limitations, uncertainty, fear, competing responsibilities, or previous negative experiences.
Effective clinical communication must account for these circumstances.
The 2026 JAMA article emphasizes that movement counseling should be respectful, collaborative, and practical.
Its recommendations align with the principles of individualized exercise prescription.
Appropriate assessment identifies a starting point.
Meaningful goals create direction.
Realistic programming supports participation.
Monitoring provides feedback.
And progressive adaptation allows the plan to evolve.
The goal of Move Well is not simply to tell people to exercise. It is to help them understand how to move, why their program matters, and how to develop the physical capacity necessary to live life on their terms.
Research References
Midtgaard J, Skou ST, Bricca A. Communicating with patients about physical activity. JAMA. 2026;336:1272–1273. https://doi.org/10.1001/jama.2026.6083
Walzik D, Wences Chirino TY, Zimmer P, Joisten N. Molecular insights of exercise therapy in disease prevention and treatment. Signal Transduction and Targeted Therapy. 2024;9:138. https://doi.org/10.1038/s41392-024-01841-0
McGee SL, Hargreaves M. Exercise adaptations: molecular mechanisms and potential targets for therapeutic benefit. Nature Reviews Endocrinology. 2020;16:495–505. https://doi.org/10.1038/s41574-020-0377-1
Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ. 2024;386. https://doi.org/10.1136/bmj-2023-078713
Courneya KS, Vardy JL, O'Callaghan CJ, et al. Structured exercise after adjuvant chemotherapy for colon cancer. New England Journal of Medicine. 2025;393:13–25. https://doi.org/10.1056/NEJMoa2502760