BY ANURADHA SHUNMUGAM VELUSWAMY, MD, AND JANET LIMKE, MD, ON BEHALF OF THE MMS COMMITTEE ON NUTRITION AND PHYSICAL ACTIVITY
Fortunately, most patients no longer rely on daily physical labor for survival. Yet the same advances that have improved safety and comfort have also engineered movement out of everyday life, contributing to rising rates of obesity, diabetes, cardiovascular
disease, and functional decline—making physical activity an increasingly important public health priority.
While physical activity guidelines have changed little since 2008, the science of helping patients move more has advanced significantly. Emerging evidence supports practical, scalable
approaches that meet patients where they are, from increasing non-exercise activity thermogenesis (NEAT) among sedentary individuals to prescribing high-intensity interval training (HIIT) for those ready for greater intensity. Together, these strategies
give physicians new opportunities to make movement prescriptions more personalized, achievable, and effective.
Guidelines and Evidence
For adults ages 18–64, the American Heart Association 2008 Physical Activity Guidelines for Americans recommend engaging in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity
weekly in addition to strength training for all major muscle groups twice weekly. For children ages 6–17, guidelines recommend 60 minutes of moderate-to-vigorous-intensity physical activity daily, including three days of vigorous activity and weight-bearing activities such as dancing, running, or jump roping.
Since the inception of these guidelines, the evidence for exercise leading to improved health outcomes has continued to accumulate. Studies demonstrate improved bone health and weight status for children ages 3 through 5 years and improved cognitive function and reduced anxiety
and depression for youth ages 6 to 13 years. For pregnant women, adequate physical activity reduced the risk of excessive weight gain, gestational diabetes, and postpartum depression. For older adults, there is a reduced risk of fall-related injuries.
For people with chronic medical conditions, exercise reduces the risk of all-cause and disease-specific mortality, improves physical function, and enhances quality of life.
However, people have become more inactive in the last decade, especially since the COVID-19 pandemic. As of 2024, the World Health Organization (WHO) noted that 1.8 billion adults are at risk of disease due to physical inactivity. Commitment to physical activity is much preferred to the elevated risks of cardiovascular diseases, type 2 diabetes, dementia, and cancers that come with being sedentary. Just how do we help our patients engage in physical activity?
Physical Activity Recommendations
Physical activity includes any bodily movement that expends energy from the musculoskeletal system, and these will incur metabolic benefits (see the dedicated MMS webpage).
A formal exercise program is not always necessary. Thus, when exploring options for sedentary patients, non-exercise activity thermogenesis (NEAT) includes anything from fidgeting, standing at a workstation, walking to a printer at work, or playing
with a pet. Overcoming obstacles to physical activity may start with small steps, such as walking after dinner or during lunch breaks or taking stairs instead of an elevator. NEAT plays a significant role in calorie expenditure.
For our more active patients, a program that includes HIIT is often more appealing and efficient. HIIT is a form of exercise that involves alternate short bursts of intense exercises followed by rest. It can help with better cardiovascular health, boost metabolism, and improve mood. This form of exercise might be popular in young and healthy individuals; however, older people or those with comorbid conditions might need to check with their health care providers before beginning this form of exercise. Some examples include burpees, jumping jacks, lunges, sprinting, and push-ups.
Social Prescribing
Finally, health systems in the UK and Canada have begun “social prescribing,” which utilizes a team-based approach to discover a patient’s interests or skills and match them to multiple pillars of lifestyle medicine. For example, prescribing walking in nature with a group of friends or with the Walk with A Doc program incorporates the pillars of exercise, stress reduction, and connectedness or socialization.
Physical inactivity is no longer simply a lifestyle concern — it is a modifiable risk factor driving many of the chronic conditions we treat every day. As physicians, we are uniquely positioned to normalize movement as a core element of prevention and
disease management, not an optional add-on. Whether the starting point is NEAT for a sedentary patient, HIIT for a motivated exerciser, or a socially prescribed community program that builds connection and accountability, the message is the same:
progress matters more than perfection. Even small increases in daily movement can produce meaningful improvements in cardiometabolic health, mood, function, and quality of life. If we routinely assess physical activity the way we assess blood pressure
or smoking status — and offer practical, individualized next steps — we can help patients reclaim movement as medicine, one achievable change at a time.
