Please Stop Telling Patients to "Just Walk" For Their Health

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A friend of mine who is a full-time wheelchair user (and who asked me to write about this and gave full permission to share her story) sent me an email with the subject “Wouldn’t this be something?” Attached were the notes that she was given at the end of her recent doctor’s appointment. Under “Recommendations” she had highlighted  “walk for 30 minutes a day, three days a week.”

This is an extreme example of an issue I hear about a lot - practitioners whose discussion around movement as a way to support health is confined to telling their patients to “just walk.”

While research shows that movement can support health (for people of all sizes, and without weight loss) that doesn’t make movement an obligation, and nobody ever said that the movement had to be walking. But all too often information about the possible health benefits of “movement” gets translated to  “just walk” by healthcare providers. This is an issue for a number of reasons.

First, as my friend’s experience made very clear, it’s ableist. There are many people for whom walking is not an option. For others, a walking program is contraindicated due to disabilities, chronic injuries and pain (which may be visible and invisible) and which a healthcare practitioner may or may not be aware of (and, it seems, rarely ask about.)

Many others are not able to walk safely. This could be due to not having appropriate footwear and/or clothing. It could be because they don’t have a safe place to walk, including because of oppression. As a fat person I’ve experienced everything from people moo-ing at me from their cars to people throwing eggs at me.  When I interviewed multiple-time marathoner and creator of 300 Pounds and Running Martinus Evans, he told me about being stopped by the police for looking “suspicious” while running in running clothes. And the tragic murder of Ahmaud Arbery also reminds us that racism creates a world where “just walk” is far from a safe option for everyone.

For others, time constraints make a walking program terrible advice that would lead people to forgo other important elements of health like rest, sleep, and social connection.

Many people have trauma around fitness/movement/exercise that comes from horrible experiences either in physical education classes and/or as adults. They may or not want to share that with a healthcare provider.

Finally, people may not enjoy walking. While people aren’t required to enjoy participating in movement in order to choose it as an option to support their health, their healthcare providers should avoid misleading them into believing that there is only one option - like it or not.

The good news is that the solution here is really simple.

First, ask patients if they want to discuss movement as an option to support their health.  If they don’t, respect that.

If they do, ask them questions like what they are currently doing or have tried in the past and how that is going/went (don’t make assumptions or guess about whether or not patients are engaged in movement – just ask the doctor who told me I needed to start walking 10 minutes a day, the day after I had done an 18 miler training for my first marathon!) Explain that movement is an option for supporting their health, and how it might support them in their current situation (and be clear that it’s not about weight loss, it’s about the movement itself.) Then explain that all movement counts and that they can come to this completely on their own terms – whether that’s choosing something they enjoy, choosing something they hate the least and doing the bare minimum (for example, someone with Type 2 Diabetes may be able to impact their blood sugar with just a few minutes of movement after a meal,) or choosing not to engage in movement.

Finally, take responsibility for any print-outs or chart notes that they receive after the appointment to make sure that your message is mirrored there. Nobody is obligated to participate in movement, but everyone should be able to obtain honest information about movement from their healthcare provider free of judgment, ableism, weight stigma, and diet culture.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.