Patient-Clinician Communication About Physical Activity

Summary

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Podcast Summary: JAMA Clinical Reviews

Episode: Patient-Clinician Communication About Physical Activity
Date: August 6, 2026
Host: Dr. Ann Coppola
Guest: Dr. Alessio Brica, Center for Muscle and Joint Health, University of Southern Denmark

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Episode Overview

This episode features a conversation between Dr. Ann Coppola and Dr. Alessio Brica, focusing on effective communication between clinicians and patients regarding physical activity, particularly for individuals with chronic conditions. Drawing from Brica's recent publication in JAMA's Communicating Medicine series, the discussion explores practical strategies, common misconceptions, the importance of empathy, and evidence-based advice for initiating and sustaining physical activity behavior changes among patients.

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Key Discussion Points & Insights

1. Importance of Physical Activity for Chronic Conditions

[01:26 - 02:12]

• Dr. Brica emphasizes the robust evidence supporting health benefits of physical activity for those with chronic conditions, noting that it seldom increases risks for serious adverse events.
• He highlights a crucial yet overlooked issue: low physical activity rates persist, partly due to the challenges in how clinicians approach this topic with their patients.

Notable Quote:
“Physical activity is a very good investment for people with one or more chronic conditions...the vast majority of patients with chronic conditions have very low levels of physical activity...an overlooked aspect...is how clinicians talk and communicate about physical activity with patients.”
— Dr. Alessio Brica [01:33]

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2. Initiating the Conversation: Sensitivity is Key

[02:12 - 02:55]

• Dr. Brica advocates for gentle, permission-asking approaches such as:
  • “Is it okay if we talk about physical activity?”
  • “Has a healthcare professional talked with you about physical activity?”
• Acknowledges this is a “delicate phase” due to possible past frustrations or sensitivities.

Notable Quote:
“These patients have heard many times that they should be more physically active, but still they have not managed to do so. So the entry question is particularly important to set up the scene for a nice conversation.”
— Dr. Brica [02:35]

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3. Addressing Resistance or Negative Reactions

[02:55 - 03:30]

• Accepting not all patients will improve their activity.
• Advises asking follow-up, open-ended questions to explore patient’s reasons:
  • “May you elaborate on why you don't want to talk about physical activity?”

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4. Clarifying “Physical Activity” vs. “Exercise”

[03:30 - 04:58]

• Dr. Brica distinguishes:
  • Physical activity: Any movement throughout the day (e.g., gardening, walking, cycling to work).
  • Exercise: Specific, structured, and planned activities, often for therapeutic goals in chronic conditions (“exercise therapy”).

Notable Quote:
“Physical activity is basically any movement that is done during the day...Exercise is something much more specific...It falls within the umbrella of physical activity, but it's a structured plan.”
— Dr. Brica [03:46]

• Tailor recommendations based on patient preferences (structured programs vs. informal activity increases).

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5. Stigma, Blame, and Emotional Barriers

[05:23 - 06:16]

• Many patients feel judged or stigmatized in these discussions (parallels to weight loss conversations).
• Effective communication reframes physical activity as an “opportunity” and normalizes the struggle.
• Suggests explicit empathy and reassurance to create psychological safety.

Notable Quote:
“It's about shifting the conversation from being judgmental to presenting physical activity as an opportunity...there are many challenges in life that could go in the way...making the patients aware that this is common can reassure them...”
— Dr. Brica [05:39]

• Example phrase for clinicians:

  “I know that physical activity is hard. There are many challenges and barriers...But I’m here to try to find opportunities where you could become more physically active.”
  [06:18]

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6. Integrating Physical Activity with Other Health Behaviors

[06:33 - 07:24]

• Ideally, clinicians should address all key health behaviors (weight loss, smoking cessation, alcohol use, sleep, and physical activity), but always individualize based on the patient's situation and clinician’s comfort.

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7. Practical Advice: Dose and Intensity

[07:24 - 08:28]

• The “optimal dose” is what the patient is able to do and wants to do, in line with “every move counts” philosophy (per latest WHO guidelines).
• While 150 minutes per week of moderate-intensity activity is a general long-term goal, starting with very small, manageable increments is often appropriate.

Notable Quote:
“The optimal dose and intensity is the one that the patient wants to do and can do now and over time...the WHO guidelines...recommend that every move counts.”
— Dr. Brica [07:35]

• Practical starting advice: Small bouts (e.g., up to 10 minutes), aiming for “breathing faster while still being able to talk.”

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8. Sustaining Increased Physical Activity

[08:53 - 10:05]

• Celebrating progress is important; maintenance is the “second biggest challenge.”
• Recommends evidence-based strategies:
  • Social support (exercise with a friend/buddy)
  • Self-monitoring (wearables, digital tools, activity logs)
  • Setting “activity” goals (e.g., walking 10 minutes M/W/F before dinner), rather than “outcome” goals like weight loss or fitness.

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9. Final Thoughts & Key Takeaways

[10:05 - 10:31]

• Dr. Brica closes with a message for clinicians:
  • “Every word counts” in these conversations—choose language carefully.
  • Acknowledges the collaborative nature of his research team.

Memorable Moment:
“We tell patients that every move counts; I would tell clinicians that every word counts when communicating about physical activity.”
— Dr. Brica [10:10]

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Summary Table of Notable Quotes and Timestamps

| Timestamp | Speaker | Quote | |-----------|---------------|-------------------------------------------------------------------------------------------------------------------------------| | 01:33 | Brica | “Physical activity is a very good investment for people with one or more chronic conditions...vast majority have very low levels...” | | 02:35 | Brica | “These patients have heard many times that they should be more physically active...So the entry question is particularly important...”| | 03:46 | Brica | “Physical activity is basically any movement that is done during the day...Exercise is much more specific...” | | 05:39 | Brica | “It's about shifting the conversation from being judgmental to presenting physical activity as an opportunity...” | | 06:18 | Brica | “I know that physical activity is hard...But I'm here to try to find opportunities where you could become more physically active.” | | 07:35 | Brica | “The optimal dose and intensity is the one that the patient wants to do and can do now and over time...every move counts.” | | 10:10 | Brica | “We tell patients that every move counts; I would tell clinicians that every word counts when communicating about physical activity.”|

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Useful Takeaways for Clinicians

• Ask permission: Start with gentle, open questions to set a collaborative tone.
• Normalize barriers: Acknowledge difficulties and struggles as common, reducing stigma.
• Distinguish activity vs. exercise: Clarify these concepts to avoid overwhelming patients.
• Personalize approaches: Respect patient preferences, abilities, and contexts.
• Promote small steps: Encourage incremental, accessible changes rather than an “all at once” approach.
• Support maintenance: Recommend social and self-monitoring strategies, and celebrate progress.
• Integrate with whole health: Be mindful of how physical activity fits with broader health behavior discussions.

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Listen & Learn More

For more, find the full article linked in the episode description and explore additional resources at jamanetworkaudio.com.

Transcript

[A]

Hi, I'm Derek Angus, a senior editor at JAMA and host of Healthy Dialogue, a new podcast from the JAMA Network. Join me as we go beyond the latest discoveries with nuanced, in depth conversations with the world's leading experts to explore the most pressing issues in health and healthcare, from trends in autism diagnosis to private Equity acquisition to AI and much, much more. Visit JamaneTWORKaudio.com or search Healthy Dialogue wherever you get your podcast to subscribe.

[B]

Hello and welcome to our listeners around the world. You're listening to JAMA Clinical Reviews. Thanks for joining us. I'm Ann Coppola, Senior Editor at Jamaica, professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and Director of the Penn Medical Communication Research Institute. Joining me today is Dr. Alessio Brica, who is at the center for Muscle and Joint Health in the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark. We will be discussing his piece from JAMA's Communicating Medicine series titled Communicating with Patients about Physical Activity. Welcome Alessio.

[C]

Very happy to be here. Thanks for having me.

[B]

Let's start with the underlying premise of the article. Why did you choose to focus on physical activity for individuals with chronic conditions?

[C]

Well, physical activity is a very good investment for people with one or more chronic conditions. Several systematic reviews have shown consistently that it improves health without increasing the risks of serious adverse events. But despite this common knowledge and widespread knowledge, the vast majority of patients with chronic conditions have very low levels levels of physical activity and what we argue is that an overlooked aspect on the complexity of physical activity is how clinicians talk and communicate about physical activity with patients.

[B]

Now, physical activity can be a touchy subject. What is the best way to initiate a conversation about physical activity with an individual with chronic conditions?

[C]

A quick and simple way to do that can include questions like is it okay if we talk about physical activity? Or has a healthcare professional talk with you about physical activity? And what I want to stress is that this is a very delicate phase in the conversation because these patients have heard many times that they should be more physically active, but still they have not managed to do so. So the entry question is particularly important to set up the scene for a nice conversation.

[B]

What do you say to the patient who responds negatively at the suggestion of increasing physical activity?

[C]

On one hand, I think we somewhat need to accept that not all patients will improve their physical activity regardless of what we do. But one question I would ask is, well, the patient to elaborate on the reasons why he or she does not Want to talk about physical activity. So something like, may you elaborate on. On why you don't want to talk about physical activity?

[B]

Now, assuming that someone does want to talk about physical activity, or maybe if they don't, you make a really great point. In the article that I liked about the difference between physical activity and exercise, or specifically structured exercise. Can you elaborate on that and how you would explain that to a patient?

[C]

So there is a lot of misconception about what is what in terms of physical activity and exercise. I think the most responsible is usually researchers that have used these terms interchangeably in the literature, but in the clinic in a very pragmatic way, what I would tell patients is that physical activity is basically any movements that is done during the day, including activities like gardening, walking or cycling to work, going on foot to the supermarket, or climbing stairs. Instead, exercise is something much more specific. It falls within the umbrella of physical activ. But it's a structured plan of physical activities. And in people with chronic conditions, the ultimate goal is usually to reduce the symptoms and reduce disability. And that's why we often call it exercise therapy.

[B]

And do you feel that when talking to a patient, they may feel more receptive to the idea of start with increasing your physical activity rather than having to think of a structured program and the exertion that goes with that?

[C]

That's a good question. Well, I think that it depends on the patient characteristics, needs and preferences. For some, it might be more appropriate or convenient to be, for example, referred to places where there are structured programs that can help increase physical activities, whereas others can do it without joining a specific class.

[B]

Now, there's some parallels in the stigma and blame that can arise in the discussion of physical activity and also of weight loss. How do you address the stigma and the negative feelings that patients may associate with increasing physical activity or exercise?

[C]

What we argue is that it's about shifting the conversation from being judgmental to presenting physical activity as an opportunity. And therefore, it is important to acknowledge that physical activity is a complex behavior and it's not so straightforward straightforward to increase it. There are many challenges in life that could go in the way or in the journey towards becoming more physically active. And making the patients aware that this is common can reassure them and make them feel more psychologically safe. Also, to talk about physical activity, can

[B]

you give an example of what you would say to a patient?

[C]

Yes, I would tell a patient, well, I know that physical activity is hard. There are many challenges and barriers towards physical activity. But I'm here to try to find opportunities where you could become more physically active.

[B]

What about discussing physical activity and weight loss in the same visit? I'm sure there's not a literature around this, but what would you advise based on your knowledge about physical activity and probably having looked at some of the weight loss literature as well?

[C]

Overall, I think that ideally, all key health related behavior should be considered in the consultation, which include weight loss, if necessary, smoking, cessation, alcohol, alcohol consumption, sleep, and physical activity. So ideally, all these health related behaviors should be at least considered. But of course, it always depends on the individual patient characteristics, their needs, their preferences, as well as the capability of the clinician to talk about these health behaviors. So overall, I think that it should be at least considered.

[B]

What kind of advice do you give about the dose and intensity of exercise when you recommend that? And how is that something that we can incorporate into our practice?

[C]

In practice, very pragmatically, I think that the optimal dose and intensity is the one that the patient wants to do and can do now and over time. And this is very much in line with the latest message from the WHO guidelines on physical activity and sedentary behavior, where it's clear that they do recommend that every move counts. However, the WHO guidelines on physical activity also highlights that adults should at least perform 150 minutes per week of aerobic, moderate intensity physical activity. And this could be the goal, maybe long term, from most patients and not the starting point.

[B]

And so what would you say to a patient when trying to counsel them on getting started and getting that movement going and dose and intensity?

[C]

I would on average recommend starting for the least active with very small bouts of physical activity, which could be up to 10 minutes. And recommend them that when being active, aim to breathe faster while still being able to talk, which is a pragmatic way of telling them, well, be physically active at a moderate intensity.

[B]

Okay, so my patient increases their physical activity. How can I help them continue to do so?

[C]

That's a very good question. And this is the second biggest challenge I think that there is in terms of physical activity. So first, I would tell the patient and the clinician, well done, that's not so common. But second, I would recommend using behavior change strategies to help the patient maintain physical activity. And these strategies include pairing up with a buddy or a friend, or overall, getting some sort of social support to maintain the physical activity. Additionally, other strategies, such as self monitoring of the behavior via a wearable, for example, a digital tool or an activity log, has been shown consistently to promote maintenance of physical activity as well as setting a goal. And in this case, what I would focus is not the outcome itself, which could be for example fitness, but the actual activity. So for example walking 10 minutes Monday, Wednesday and Friday at moderate intensity before dinner.

[B]

All right, that was incredibly helpful. Do you have any final thoughts as

[C]

we tell patients that every move counts? I would tell clinicians that every word counts when communicating about physical activity. And finally, I would really like to thank the co authors of the paper, Professor Julia Mitgord and Professor Sorensko which really helped to make this possible.

[B]

Thanks so much. Sounds like there are opportunities while wearing your wearables and listening to things to listen to podcasts. So let's encourage people to do that and do whatever it takes to keep moving. I am Dr. Anne Coppola and I have been speaking with Dr. Alessio Brica about communicating with patients about physical activity. You can find a link to the article in this episode's description. This episode was produced by Shelly Steffens at the JAMA Network. To follow this and other JAMA Network podcasts, please visit us online@jama networkaudio.com or search for JAMA Network. Wherever you get your podcasts. Thanks for listening. This content is protected by copyright by the American Medical association with all rights reserved, including those for text and data mining, AI training, and similar technologies.