Fam Pract Manag. 2019 Mar-Apr;26(2):32.


Getting sedentary patients to exercise can be a challenge. I often encourage them to reinitiate an activity they enjoyed when they were younger because I believe they are more likely to stick with it. But it can be difficult if the patient only liked team sports, so instead I will advise him or her to start walking more. I’ve found that giving the patient detailed instructions in either paper or electronic form, including walk duration and number of days, can help. To make it easier and address common barriers to exercise, our practice developed a guide that details places patients can walk in our area, which we offer on our practice website. Our office staff has visited most of the sites, and our guide includes the ease of terrain, quality of trail surfaces, hours of operation, type and location of parking, and availability of restrooms.


As patients get older, they tend to accumulate health conditions, such as heart issues or diabetes, and undergo major life changes, including physical or memory limitations. Physicians are trained to focus on curing or treating as many health problems as possible, but in the process, they can lose focus on what outcomes matter most to the patient. To avoid this, address the “4Ms”:

  • What Matters (What outcomes are most important to the patient?)

  • Medication (What are the drug’s side effects?)

  • Mentation (Is the patient affected by depression, dementia, or delirium?)

  • Mobility (How well can the patient move around?)

Make sure you address these issues as a whole, not individually, which can be confusing and sometimes contradictory. For example, a patient with Parkinson’s disease typically has trouble with mobility. The medications used to treat Parkinson’s can improve mobility but degrade memory or the


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz


Jan-Feb 2020

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now