Exercise Prescription

• Physical Inactivity


  • 4th leading cause of death worldwide
  • Women more inactive than men
  • Physical inactivity increases with age
  • Promotes poor health outcomes
• Reasons for Physical Inactivity

  • Time issue
  • Lack of confidence
  • Facilities not convenient
  • Exercise not interesting/painful
  • Too costly
  • Other reasons
• Exercise


  A subset of physical activity performed for the purpose of improving or maintaining physical fitness
• Physical Activity (PA)


  Any bodily movement produced by skeletal muscles that requires energy expenditure
• Physical Fitness


  Ability to carry out daily tasks with vigor, alertness, without undue fatigue and with ample energy to enjoy leisure time
• Benefits of Exercise/Physical Activity

  • Reduce atherosclerotic vascular disease
  • Reduce all-cause mortality
  • Reduce cancer
  • Reduce diabetes mellitus
  • Reduce hypertension
  • Reduce osteoporosis
  • Improve mental health/reduce obesity
  • Reduce systemic inflammation
  • Enhance lipid lipoprotein profile
  • Improve body composition
  • Decrease blood coagulation
  • Augment cardiac function
  • Improve coronary blood flow
• Absolute Contraindications to Exercise


  • Unstable angina
  • Moderate aortic stenosis
  • Ventricular tachycardia and other dangerous dysrhythmias
  • Uncontrolled metabolic disease (diabetes, thyroid disease, etc) or electrolyte abnormality
  • Acute congestive heart failure
  • Chronic or recurrent infectious disease (malaria, hepatitis, etc)
  • Recent systemic or pulmonary embolus
  • Neuromuscular, musculoskeletal or rheumatoid diseases that are exacerbated by exercise
  • Active or suspected myocarditis or pericarditis
  • Cardiomyopathy
  • Dissecting aortic aneurysm
  • Complicated pregnancy
• Relative Contraindications to Exercise

  • Recent acute myocardial infarction
  • Untreated or uncontrolled severe hypertension
• Exercise (PA) Prescription Steps

  1. Patient visits the clinic

  2. Assess the patient's physical activity stage of change

  3. Conduct history and physical examination, assess patient goals

  4. Patient completes exercise assessment form

  5. Conduct cardiovascular risk assessment

  6. If patient has diagnosed disease or symptoms of cardiovascular disease, conduct full cardiovascular risk assessment and consider more tests or cardiology referral

  7. If patient has more than 1 major risk factor, moderate exercise is safe but consider supervision and monitoring

  8. If patient is male >40 years or female >50 years, moderate or vigorous activity is safe

  9. If patient is male <40 years or female <50 years, moderate activity is safe, vigorous activity requires graded exercise test

  10. Complete individual exercise prescription

  
• Transtheoretical Model/Promoting Physical Activity

  • Precontemplation: Individual is not physically active and does not intend to become active in next 6 months
  • Contemplation: Individual is not physically active but intends to become active in next 6 months
  • Preparation: Individual is active but not to recommended level, less than 6 months
  • Action: Individual has been active to recommended level for less than 6 months
  • Maintenance: Individual has been active to recommended level for more than 6 months
• Five-A's Model to Facilitate Behavioral Changes of Patients in the Context of Promoting Physical Activity

  1. Assess: Ask about current PA level, risk factors, readiness, beliefs, skills, knowledge

  2. Advise: Provide information about personal health harms due to physical inactivity and benefits of PA

  3. Agree: Select appropriate goals and methods based on the individual's interest

  4. Assist: Help individual achieve goals by acquiring skills, confidence, social and environmental support

  5. Arrange: Schedule follow-up for ongoing assistance and to adjust the plan as needed
• Principle of Exercise Prescription (FITT-VP)


  • Type: The mode of exercise performed and its connection with fitness capacity
  • Frequency: How often the exercise is performed
  • Intensity: How hard a person works to do the activity (absolute, relative)
  • Time: Duration of the exercise session
  • Volume: Combination of frequency and duration
  • Pattern: Workload, rest periods, density
  • Progression: Gradual increase in workload over time

  
• Exercise Session Components


  • Warm-up
  • Aerobic exercise
  • Resistance exercise
  • Neuromotor exercise
  • Flexibility exercise
  • Cool-down

  
• Aerobic exercise recommendations: 150 minutes per week of moderate intensity, or 75 minutes per week of vigorous intensity, or 500-1000 MET-minutes per week

  
• Strength exercise recommendations: 2-3 times per week for major muscle groups
• Neuromotor exercise recommendations: 2-3 times per week, 60 minutes or more per week (balance, coordination, gait, agility, proprioceptive training)
• Flexibility exercise recommendations: 10-30 second holds for adults, 30-60 second holds for elderly